#february2020mccqe1
A 65-year-old woman is evaluated for a 1-day history of fever, headache, and altered mental status. Medical history includes type 2 diabetes mellitus and hypertension treated with glipizide and hydrochlorothiazide. She has no allergies. On physical examination, the patient is confused. Temperature is 38.9°C (102.0°F), blood pressure is 104/66 mm Hg, pulse rate is 100/min, and respiration rate is 20/min. Her neck is supple, and she has no rashes. The leukocyte count is 19,000/μL (19 × 109/L); platelet count, 90,000/μL (90 × 109/L); and plasma glucose level, 120 mg/dL (6.7 mmol/L). A non-contrast-enhanced CT scan of the head is normal. Cerebrospinal fluid (CSF) analysis shows a leukocyte count of 1300/μL (1300 × 106/L) with 98% neutrophils, a glucose level of 20 mg/dL (1.1 mmol/L), and a protein level of 200 mg/dL (2000 mg/L). CSF Gram stain results are negative for any organisms. Dexamethasone is begun. Which of the following antimicrobial regimens should now be initiated?
(A) Ceftriaxone
(B) Penicillin G
(C) Vancomycin, ampicillin, and ceftriaxone
(D) Vancomycin plus ceftriaxone
(E) Vancomycin plus trimethoprim-sulfamethoxazole
A 65-year-old woman is evaluated for a 1-day history of fever, headache, and altered mental status. Medical history includes type 2 diabetes mellitus and hypertension treated with glipizide and hydrochlorothiazide. She has no allergies. On physical examination, the patient is confused. Temperature is 38.9°C (102.0°F), blood pressure is 104/66 mm Hg, pulse rate is 100/min, and respiration rate is 20/min. Her neck is supple, and she has no rashes. The leukocyte count is 19,000/μL (19 × 109/L); platelet count, 90,000/μL (90 × 109/L); and plasma glucose level, 120 mg/dL (6.7 mmol/L). A non-contrast-enhanced CT scan of the head is normal. Cerebrospinal fluid (CSF) analysis shows a leukocyte count of 1300/μL (1300 × 106/L) with 98% neutrophils, a glucose level of 20 mg/dL (1.1 mmol/L), and a protein level of 200 mg/dL (2000 mg/L). CSF Gram stain results are negative for any organisms. Dexamethasone is begun. Which of the following antimicrobial regimens should now be initiated?
(A) Ceftriaxone
(B) Penicillin G
(C) Vancomycin, ampicillin, and ceftriaxone
(D) Vancomycin plus ceftriaxone
(E) Vancomycin plus trimethoprim-sulfamethoxazole
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