WBR1064
| Author | [[PageAuthor::Mohamed Moubarak, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 35 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started suddenly over the last 5 days. His past medical history is not significant. He smoke one pack of cigarette per day for the last 10 years, and drinks alcohol occasionally. He is sexually active, and use I.V drugs with the recent use one week ago. On examination, his temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. There is a painful, red, raised lesion on the finger pulps. His chest x-ray shows patchy infiltrations, and his echocardiography shows tricuspid valve vegetation. Blood culture results shows viridans group streptococci that is highly penicillin-resistant. What is the best antibiotic choice for this patient?]] |
| Answer A | AnswerA::Intravenous penicillin G sodium |
| Answer A Explanation | [[AnswerAExp::Incorrect
According to AHA recommendations, intravenous penicillin G sodium + gentamicin is the recommended regimen for resistant viridans group streptococci.]] |
| Answer B | AnswerB::Intravenous penicillin G sodium+ gentamicin sulfate |
| Answer B Explanation | [[AnswerBExp::Correct
According to AHA recommendations, intravenous penicillin G sodium + gentamicin is the recommended regimen for resistant viridans group streptococci.]] |
| Answer C | AnswerC::Intravenous penicillin G sodium + ceftriaxone sodium |
| Answer C Explanation | [[AnswerCExp::Incorrect
According to AHA recommendations, intravenous penicillin G sodium + gentamicin is the recommended regimen for resistant viridans group streptococci.]] |
| Answer D | AnswerD::Intravenous ceftriaxone sodium |
| Answer D Explanation | [[AnswerDExp::Incorrect
According to AHA recommendations, intravenous penicillin G sodium + gentamicin is the recommended regimen for resistant viridans group streptococci.]] |
| Answer E | AnswerE::Intravenous gentamicin sulfate |
| Answer E Explanation | [[AnswerEExp::Incorrect
According to AHA recommendations, intravenous penicillin G sodium + gentamicin is the recommended regimen for resistant viridans group streptococci.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::This is an acute case of Infective endocarditis; it is diagnosed according to the Duke clinical criteria. Treatment regimens according to the latest American Heart Association (AHA) guidelines for viridans group streptococci and streptococcus bovis highly penicillin-resistant include intravenous penicillin G sodium or ceftriaxone plus gentamicin Educational Objective: |
| Approved | Approved::No |
| Keyword | [[WBRKeyword::Infective endocarditis]] |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |