| A |
peter90036, CocaCola, Markus2009 |
3 |
20% |
| B |
vibrio, nyimalay, khiladi, Jcala, lq2006, kpmle2, aspire |
7 |
47% |
| C |
Justice |
1 |
7% |
| D |
Drtweetie, cool doctor, inkspot, vijay1900 |
4 |
27% |
| Author | 10 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,881
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A 35-year-old man was admitted to the intensive care unit (ICU) because of injuries sustained as a result of a gunshot wound. He underwent repair of a perforated colon, required hemodialysis for acute renal failure, and was treated with imipenem for Enterobacter pneumonia.
On the 22nd day in the ICU, these problems are resolving, but he develops fever to 39.7 °C (103.4 °F) without localizing signs. All catheters are changed, blood cultures are obtained, and imipenem is restarted. On the 23rd day in the ICU, his temperature is normal, a chest radiograph shows no new pulmonary infiltrates, and the renal failure continues to resolve. On the 26th day, as he is about to be transferred from the ICU, the laboratory reports that a yeast is growing in one bottle of each of two sets of blood cultures that were obtained on the day that he became febrile.
Which of the following is the most appropriate next step in managing this patient?
A. Repeat the blood cultures; await culture results before beginning fluconazole
B. Repeat the blood cultures; begin fluconazole immediately after specimens are obtained
C. Do a funduscopic examination; begin fluconazole only if chorioretinitis is present
D. Removing the catheters is adequate; no additional diagnostic studies or treatment is indicated
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Don't live in a town where there are no doctors
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| peter90036
Forum Elite
Topics: 28
Posts: 315
|
no fever
clear cxr,
better renal fail
...improving
...
...how long do fungus cultures grow in the lab?
...how fast would PT deteriorate if he still had fungal?
...is there a reason NOT to give fluconazole ? (any bad sidefx?)
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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B
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| Jcala
Forum Junior
Topics: 10
Posts: 44
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B
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| drshvetasm
Forum Elite
Topics: 22
Posts: 274
|
i would say D...whats the answer justice?btw good questions...which book/qbank r they from...i'd definitely like to solve them...
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,881
|
Dear colleagues,
I will post answers to all poll Qns on Friday, and will also post new bunch of polls.
Thank you for understanding
___________________
Don't live in a town where there are no doctors
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| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
Patient is improving...is that culture reliable?----------->A
|
| Justice
Forum Fanatic
Topics: 100
Posts: 1,881
|
The correct answer is B
Candida infections are the fourth most common cause of nosocomial bloodstream infections. The source is usually from the patients gastrointestinal tract or from a central venous catheter. Patients in surgical intensive care units are at great risk for candidemia because of surgical procedures involving the gut, the frequent need for parenteral nutrition supplied through a central venous catheter, the frequent occurrence of acute renal failure requiring hemodialysis, and the use of broad-spectrum antibiotics.
This patient requires immediate treatment with fluconazole to prevent development of a focal infection. Candida should never be assumed to be a contaminant in a blood culture. Therefore, removing the catheter alone is not adequate therapy. Even transient candidemia can lead to endophthalmitis, vertebral osteomyelitis, or other serious focal Candida infections. Focal infections such as chorioretinitis may take weeks to develop, and treatment should not be withheld until such an infection is documented. The fact that only two of four culture bottles grew Candida reflects the obligate aerobic nature of the organism; the bottles incubated anaerobically will not support the growth of Candida.
Fluconazole, 400 mg daily, is appropriate for treating candidemia in patients with normal renal function and should be adequate for treating most Candida bloodstream infections. If the organism is identified as Candida krusei or Candida glabrata, therapy should be changed to amphotericin B or caspofungin.
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Don't live in a town where there are no doctors
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| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
Nice questions justice, thanks!
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| paheli
It'sAllAboutGoodKarma
Topics: 170
Posts: 2,215
|
Good qn. I went with B.
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