USMLE Forum Archives - USMLE Step 3 - most appropriate at this time?
most appropriate at this time?
meduploader - 05-05-09 15:05
A 46-year-old man with known rheumatic mitral valve disease is hospitalized because of a 3-week history of fever, malaise, and night sweats. On physical examination, temperature is 38.5 °C (101.3 °F). Findings include a conjunctival hemorrhage, bibasilar crackles, and a grade 2/6 holosystolic murmur that is loudest at the apex and radiates to the left axilla. The murmur is unchanged from that heard on previous examinations. A transesophageal echocardiogram shows mitral regurgitation with a thickened mitral valve and an oscillating vegetation.
The patient is treated empirically with intravenous vancomycin plus low-dose gentamicin. However, he remains febrile 5 days after beginning therapy. Six blood culture specimens obtained before starting antibiotics show no growth after several days.
In addition to asking the laboratory to continue monitoring the blood culture specimens for a longer period, which of the following is most appropriate at this time?
meduploader - 05-05-09 15:05
A 46-year-old man with known rheumatic mitral valve disease is hospitalized because of a 3-week history of fever, malaise, and night sweats. On physical examination, temperature is 38.5 °C (101.3 °F). Findings include a conjunctival hemorrhage, bibasilar crackles, and a grade 2/6 holosystolic murmur that is loudest at the apex and radiates to the left axilla. The murmur is unchanged from that heard on previous examinations. A transesophageal echocardiogram shows mitral regurgitation with a thickened mitral valve and an oscillating vegetation.
The patient is treated empirically with intravenous vancomycin plus low-dose gentamicin. However, he remains febrile 5 days after beginning therapy. Six blood culture specimens obtained before starting antibiotics show no growth after several days.
In addition to asking the laboratory to continue monitoring the blood culture specimens for a longer period, which of the following is most appropriate at this time?
The correct answer and explanation will be available after you answer.
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#16
Re: most appropriate at this time? babbu5508 - 07-07-10 13:27 My answer is: e.
fever,conjunctival hemorrhage, bibasilar crackles, and a grade 2/6 holosystolic murmur that is loudest at the apex and radiates to the left axilla....may be infective endocarditis
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