12-17-2007, 08:29 AM
A 17-year-old boy is admitted to the intensive care unit with fever, jaundice, renal failure, and respiratory
failure. Ten days ago he was part of a community service group from his school that cleaned up a
rat-infested alley. Two of his colleagues developed a flulike illness with headache, fever, myalgias, and
nausea that has begun to resolve. He developed similar symptoms with the addition of jaundice. On the
day of admission he developed shortness of breath. The physical examination is notable for a
temperature of 38.4°C (101.1°F), blood pressure of 95/65 mmHg, heart rate of 110/min, respiratory rate
of 25/min, and oxygen saturation of 92% on 100% face mask. He has notable jaundice and icterus as
well as bilateral conjunctival suffusion. A chest radiogram shows bilateral diffuse infiltrates. Laboratory
studies are notable for creatinine 2.5 mg/dL, total bilirubin 12.3 mg/dL, and normal aspartate
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aminotransferase (AST), alanine aminotransferase (ALT), and prothrombin time. Which of the following
antibiotics should be included in his therapy?
A. Cefipime
B. Ciprofloxacin
C. Clindamycin
D. Penicillin
E. Vancomycin
failure. Ten days ago he was part of a community service group from his school that cleaned up a
rat-infested alley. Two of his colleagues developed a flulike illness with headache, fever, myalgias, and
nausea that has begun to resolve. He developed similar symptoms with the addition of jaundice. On the
day of admission he developed shortness of breath. The physical examination is notable for a
temperature of 38.4°C (101.1°F), blood pressure of 95/65 mmHg, heart rate of 110/min, respiratory rate
of 25/min, and oxygen saturation of 92% on 100% face mask. He has notable jaundice and icterus as
well as bilateral conjunctival suffusion. A chest radiogram shows bilateral diffuse infiltrates. Laboratory
studies are notable for creatinine 2.5 mg/dL, total bilirubin 12.3 mg/dL, and normal aspartate
23/1/2007 13:18:45
Page 538 of 634
aminotransferase (AST), alanine aminotransferase (ALT), and prothrombin time. Which of the following
antibiotics should be included in his therapy?
A. Cefipime
B. Ciprofloxacin
C. Clindamycin
D. Penicillin
E. Vancomycin