#august2020mccqe1
A 62-year-old woman is evaluated for a 3-day history of fever and left knee pain and swelling. She has a 30-year history of rheumatoid arthritis treated with methotrexate and nonsteroidal anti-inflammatory drugs. She has no other medical problems. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 140/78 mm Hg, pulse rate is 86/min, and respiration rate is 14/min. The left knee is swollen, red, warm, and tender to palpation. Range of motion is limited because of pain. Arthrocentesis is performed, and the following results are reported: synovial fluid leukocyte count 75,000/μL (75 × 109/L) with 69% neutrophils. Gram stain is positive for gram-positive cocci. Which would be the most appropriate initial antibiotic therapy pending culture results?
(A) Cefazolin
(B) Ceftriaxone
(C) Nafcillin
(D) Vancomycin
A 62-year-old woman is evaluated for a 3-day history of fever and left knee pain and swelling. She has a 30-year history of rheumatoid arthritis treated with methotrexate and nonsteroidal anti-inflammatory drugs. She has no other medical problems. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 140/78 mm Hg, pulse rate is 86/min, and respiration rate is 14/min. The left knee is swollen, red, warm, and tender to palpation. Range of motion is limited because of pain. Arthrocentesis is performed, and the following results are reported: synovial fluid leukocyte count 75,000/μL (75 × 109/L) with 69% neutrophils. Gram stain is positive for gram-positive cocci. Which would be the most appropriate initial antibiotic therapy pending culture results?
(A) Cefazolin
(B) Ceftriaxone
(C) Nafcillin
(D) Vancomycin
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