An 18-month-old boy presents to the emergency department for malaise. The boy’s parents report worsening fatigue for 3 days with associated irritability and anorexia. The patient’s newborn screening revealed a point mutation in the beta-globin gene but the patient has otherwise been healthy since birth. On physical exam, his temperature is 102.4°F (39.1°C), blood pressure is 78/42 mmHg, pulse is 124/min, and respirations are 32/min. The child is tired-appearing and difficult to soothe. Laboratory testing is performed and reveals the following: Serum: Na+: 137 mEq/L Cl-: 100 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 16 mg/dL Creatinine: 0.9 mg/dL Glucose: 96 mg/dL Leukocyte count: 19,300/mm^3 with normal differential Hemoglobin: 7.8 g/dL Hematocrit: 21% Mean corpuscular volume: 82 um^3 Platelet count: 324,000/mm^3 Reticulocyte index: 3.6% Which of the following is the most likely causative organism for this patient's presentation?
AStreptococcus pneumoniae
BListeria monocytogenes
CHaemophilus influenzae
DNeisseria meningitidis
ESalmonella
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 previously healthy 10-day-old infant is brought to the emergency department by his mother because of episodes of weakness and spasms for the past 12 hours. His mother states that he has also had difficulty feeding and a weak suck. He has not had fever, cough, diarrhea, or vomiting. He was born at 39 weeks' gestation via uncomplicated vaginal delivery at home. Pregnancy was uncomplicated. The mother refused antenatal vaccines out of concern they would cause side effects. She is worried his symptoms may be from some raw honey his older sister maybe inadvertently fed him 5 days ago. He appears irritable. His temperature is 37.1°C (98.8°F). Examination shows generalized muscle stiffness and twitches. His fontanelles are soft and flat. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?
AListeria monocytogenes
BNeisseria meningitidis
CEscherichia coli
DClostridium botulinum
EClostridium tetani
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