#april2020mccqe1
A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.
On physical examination, he does not appear ill. Temperature is 37.9°C (100.2°F); other vital signs are normal. The left foot is slightly warm and erythematous. A plantar ulcer that is draining purulent material is present over the fourth metatarsal joint. A metal probe makes contact with bone. The remainder of the examination is normal.
The leukocyte count is normal, and an erythrocyte sedimentation rate is 70 mm/h. A plain radiograph of the foot is normal.
Gram stain of the purulent drainage at the ulcer base shows numerous leukocytes, gram-positive cocci in clusters, and gram-negative rods. Which of the following is the most appropriate management now?
(A) Begin imipenem
(B) Begin vancomycin and ceftazidime
(C) Begin vancomycin and metronidazole
(D) Perform bone biopsy
A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.
On physical examination, he does not appear ill. Temperature is 37.9°C (100.2°F); other vital signs are normal. The left foot is slightly warm and erythematous. A plantar ulcer that is draining purulent material is present over the fourth metatarsal joint. A metal probe makes contact with bone. The remainder of the examination is normal.
The leukocyte count is normal, and an erythrocyte sedimentation rate is 70 mm/h. A plain radiograph of the foot is normal.
Gram stain of the purulent drainage at the ulcer base shows numerous leukocytes, gram-positive cocci in clusters, and gram-negative rods. Which of the following is the most appropriate management now?
(A) Begin imipenem
(B) Begin vancomycin and ceftazidime
(C) Begin vancomycin and metronidazole
(D) Perform bone biopsy
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