4.7 of 20 Ratings
A 43-year-old man with a history of hepatitis C and current intravenous drug use presents with 5 days of fever, chills, headache, and severe back pain. On physical exam, temperature is 100.6 deg F (38.1 deg C), blood pressure is 109/56 mmHg, pulse is 94/min, and respirations are 18/min. He is thin and diaphoretic with pinpoint pupils, poor dentition, and track marks on his arms and legs. A high-pitched systolic murmur is heard, loudest in the left sternal border and with inspiration. He is admitted to the hospital and started on broad-spectrum antibiotics. One of the blood cultures drawn 12 hours ago returns positive for Staphylococcus aureus. Which of the following is the most appropriate next step to confirm the diagnosis?
Repeat blood cultures now
Repeat blood cultures 24 hours after initial cultures were drawn
Repeat blood cultures 36 hours after initial cultures were drawn
Repeat blood cultures 48 hours after initial cultures were drawn
Do not repeat blood cultures
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A 63-year-old gentleman with a history of mitral valve prolapse presents to his internist with a 2-week history of fever, night sweats, and general malaise. Three weeks ago, he underwent periodontal surgery for gingival hyperplasia, for which he did not receive antibiotic prophylaxis. He denies a history of drug abuse. His physical exam is notable for a temperature of 39 deg C and a faint pansystolic murmur loudest at the cardiac apex. His nails are shown in Figure A, and painful lesions on his fingers are shown in Figure B. What is the most likely causative organism in this case?
A 37-year-old man with a history of IV drug use presents to the ED with complaints of fevers, chills, and malaise for one week. He admits to recently using IV and intramuscular heroin. Vital signs are as follows: T 40.0 C, HR 120 bpm, BP 110/68 mmHg, RR 14, O2Sat 98%. Examination reveals a new systolic murmur that is loudest at the lower left sternal border. Initial management includes administration of which of the following regimens?
IV Vancomycin, IV levofloxacin
IV Vancomycin, IV ceftriaxone
IV Vancomycin, IV gentamycin, PO rifampin
IV Vancomycin, IV ceftriaxone, IV fluconazole