USMLE Forum Archives - USMLE Step 3 - int med
int med
bingousmle - 07-26-10 03:32
A 68-year-old man is brought to the emergency room with altered mental status, fever, and leg pain. His wife reports that he first complained of pain in his leg yesterday, and there was some slight redness in this area. Over the night, he developed a fever to as high as 39.8°C and became obtunded this morning. At that point, his family brought him to the emergency room. Upon arrival, he is unresponsive to voice and withdraws to pain. The vital signs are: blood pressure 88/40 mmHg, heart rate 126 beats/min, respiratory
rate 28 breaths/min, temperature 39.3°C, and SaO2 95% on room air. Examination of the right leg shows diffuseswelling with brawny edema. The patient grimaces in pain when the area is touched. There are several bullae filled with dark blue to purple fluid. Laboratory studies show: pH 7.22, PaCO2 28 mmHg, PaO2 93 mmHg. The creatinine is 3.2 mg/dL.White blood cell count is elevated at 22,660/μL with a differential of 70% polymorphonuclear cells, 28% band forms, and 2% lymphocytes. A bulla is aspirated and the Gram stain shows gram-positive cocci in chains.What is the most appropriate therapy for this patient?
A. Ampicillin, clindamycin, and gentamicin
B. Clindamycin and penicillin
C. Clindamycin, penicillin, and surgical debridement
D. Penicillin and surgical debridement
E. Vancomycin, penicillin, and surgical debridement
bingousmle - 07-26-10 03:32
A 68-year-old man is brought to the emergency room with altered mental status, fever, and leg pain. His wife reports that he first complained of pain in his leg yesterday, and there was some slight redness in this area. Over the night, he developed a fever to as high as 39.8°C and became obtunded this morning. At that point, his family brought him to the emergency room. Upon arrival, he is unresponsive to voice and withdraws to pain. The vital signs are: blood pressure 88/40 mmHg, heart rate 126 beats/min, respiratory
rate 28 breaths/min, temperature 39.3°C, and SaO2 95% on room air. Examination of the right leg shows diffuseswelling with brawny edema. The patient grimaces in pain when the area is touched. There are several bullae filled with dark blue to purple fluid. Laboratory studies show: pH 7.22, PaCO2 28 mmHg, PaO2 93 mmHg. The creatinine is 3.2 mg/dL.White blood cell count is elevated at 22,660/μL with a differential of 70% polymorphonuclear cells, 28% band forms, and 2% lymphocytes. A bulla is aspirated and the Gram stain shows gram-positive cocci in chains.What is the most appropriate therapy for this patient?
A. Ampicillin, clindamycin, and gentamicin
B. Clindamycin and penicillin
C. Clindamycin, penicillin, and surgical debridement
D. Penicillin and surgical debridement
E. Vancomycin, penicillin, and surgical debridement
The correct answer and explanation will be available after you answer.
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#2
Re: int med
bingousmle - 07-27-10 01:26 My answer is: c.
the scenario describes necrotising fasciitis caused by group A streptococcus and the treatment is Clindamycin, penicillin, and surgical debridement
#3
Re: int med babbu5508 - 07-27-10 03:07 My answer is: c.
Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin, and clindamycin...and debridement for necrotising fasciitis
#6
Re: int med babbu5508 - 08-30-10 03:31 In necrotizing fasciitis, aggressive surgical debridement (removal of infected tissue) is always necessary to keep it from spreading and is the only treatment available. Diagnosis is confirmed by visual examination of the tissues and by tissue samples sent for microscopic evaluation. Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin, and clindamycin
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