WBR1063

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 drink 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 are negative. What is the best antibiotic choice for this patient?]]
Answer A	AnswerA::Intravenous ampicillin-sulbactam+ gentamicin sulfate
Answer A Explanation	[[AnswerAExp::Correct Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin]]
Answer B	AnswerB::Intravenous penicillin G sodium+ ceftriaxone sodium+ gentamicin sulfate
Answer B Explanation	[[AnswerBExp::Incorrect Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin]]
Answer C	AnswerC::Intravenous penicillin G sodium + ceftriaxone sodium
Answer C Explanation	[[AnswerCExp::Incorrect Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin]]
Answer D	AnswerD::Intravenous ceftriaxone sodium+ gentamicin sulfate
Answer D Explanation	[[AnswerDExp::Incorrect Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin]]
Answer E	AnswerE::Intravenous vancomycin hydrochloride
Answer E Explanation	[[AnswerEExp::Incorrect Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::This is an acute case of infective endocarditis, it is diagnosed according to the Duke clinical criteria, which include: Two major criteria, or One major and three minor criteria, or Five minor criteria Major Criteria 1.Positive blood culture for infective endocarditis 2.Evidence of endocardial involvement: which include positive echocardiogram for infective endocarditis Minor criteria: Predisposition: predisposing heart condition or intravenous drug use Fever: temperature > 38.0° c (100.4° f) Vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and janeway lesions Immunologic phenomena: glomerulonephritis, osler's nodes, roth spots, and rheumatoid factor Microbiological evidence: positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with infectious endocarditis Echocardiographic findings: consistent with infectious endocarditis but do not meet a major criterion as noted above Treatment regimens according to the latest American Heart Association guidelines for culture negative cases include intravenous ampicillin-sulbactam + gentamicin sulfate, or intravenous vancomycin + gentamicin + ciprofloxacin For other treatment regimens, refer to infective endocarditis. Educational Objective: References: ]]
Approved	Approved::No
Keyword	[[WBRKeyword::Infective endocarditis]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::