#august2020mccqe1
A 53-year-old obese man with poorly controlled non-insulin-dependent diabetes mellitus presents with fever to 39.6° C (103.2° F), jaundice, hypotension, and acute onset of right upper quadrant pain. Right upper quadrant imaging shows multiple gallstones and cholecystitis. Urgent cholecystectomy is performed, and subsequent gall bladder fluid and blood cultures grow aerobic, non-lactose-fermenting, oxidase- positive, gram-negative rods. Blood tests show:
Hematocrit: 29%
WBC count: 14,700/mm3
Platelet count: 76,000/mm3
International Normalized Ratio: 3.2
D-dimer: 8500 ng/mL
Fibrinogen levels: low
Microscopic inspection of peripheral blood smear shows schistocytes and multiple helmet cells. Clinically, there is no evidence of active bleeding. What is the most appropriate treatment for this patient’s coagulopathy?
(A) Amoxicillin
(B) Aztreonam
(C) Fresh frozen plasma
(D) Vancomycin
(E) Vitamin K
A 53-year-old obese man with poorly controlled non-insulin-dependent diabetes mellitus presents with fever to 39.6° C (103.2° F), jaundice, hypotension, and acute onset of right upper quadrant pain. Right upper quadrant imaging shows multiple gallstones and cholecystitis. Urgent cholecystectomy is performed, and subsequent gall bladder fluid and blood cultures grow aerobic, non-lactose-fermenting, oxidase- positive, gram-negative rods. Blood tests show:
Hematocrit: 29%
WBC count: 14,700/mm3
Platelet count: 76,000/mm3
International Normalized Ratio: 3.2
D-dimer: 8500 ng/mL
Fibrinogen levels: low
Microscopic inspection of peripheral blood smear shows schistocytes and multiple helmet cells. Clinically, there is no evidence of active bleeding. What is the most appropriate treatment for this patient’s coagulopathy?
(A) Amoxicillin
(B) Aztreonam
(C) Fresh frozen plasma
(D) Vancomycin
(E) Vitamin K
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