A newborn infant is born at 40 weeks gestation to a G1P1 mother. The pregnancy was uncomplicated and was followed by the patient's primary care physician. The mother has no past medical history and is currently taking a multi-vitamin, folate, B12, and iron. The infant is moving its limbs spontaneously and is crying. His temperature is 98.7°F (37.1°C), blood pressure is 60/38 mmHg, pulse is 150/min, respirations are 33/min, and oxygen saturation is 99% on room air. Which of the following is the best next step in management?
ANo further management needed
BIntramuscular (IM) vitamin K and topical erythromycin
CFluid resuscitation
DVitamin D and IM vitamin K
ESilver nitrate eye drops and basic lab work
A neonate born at 33 weeks is transferred to the NICU after a complicated pregnancy and C-section. A week after being admitted, he developed a fever and became lethargic and minimally responsive to stimuli. A lumbar puncture is performed that reveals the following: Appearance Cloudy Protein 64 mg/dL Glucose 22 mg/dL Pressure 330 mm H20 Cells 295 cells/mm³ (> 90% PMN) A specimen is sent to microbiology and reveals gram-negative rods. Which of the following is the next appropriate step in management?
AMRI scan of the head
BStart the patient on IV ceftriaxone
CProvide supportive measures only
DStart the patient on IV cefotaxime
EStart the patient on oral rifampin
A 6-year-old boy and his parents present to the emergency department with high-grade fever, headache, and projectile vomiting. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He has had no sick contacts at school or at home. The family has not traveled out of the area recently. He likes school and playing videogames with his younger brother. Today, his blood pressure is 115/76 mm Hg, heart rate is 110/min, respiratory rate is 22/min, and temperature is 38.4°C (101.2°F). On physical exam, the child is disoriented. Kernig’s sign is positive. A head CT was performed followed by a lumbar puncture. Several aliquots of CSF were distributed throughout the lab. Cytology showed high counts of polymorphs, biochemistry showed low glucose and elevated protein levels, and a gram smear shows gram-positive lanceolate-shaped cocci alone and in pairs. A smear is prepared on blood agar in an aerobic environment and grows mucoid colonies with clearly defined edges and alpha hemolysis. On later evaluation they develop a ‘draughtsman’ appearance. Which one of the following is the most likely pathogen?
AStreptococcus pneumoniae
BStaphylococcus aureus
CNeisseria meningitidis
DStaphylococcus epidermidis
EStreptococcus agalactiae
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