Question

Case Study 5 ( PLEASE EXPLAIN all options for Q1-4)

A 28-year old woman presents with fever for the past 8 weeks. She admits to low back pain and a 10- pound weight loss but has no other complaints. She is otherwise healthy. On physical examination, she a prominent holosystolic murmur heard at best at the apex with radiation to the axilla. No diastolic murmur is heard. There is no rash, and the results of the remainder of the examination are normal. Laboratory results are as follows:

Hct 32%

WBC count 5200 μL; 72 PMNs, 8 bands, 17 lymphocytes, 3 monocytes

Erythrocyte

sedimentation rate : 81 mm/hour

Electrolytes : Within normal limits

Urinalysis 2+ RBCs, + protein, 0 WBCs, Gram stain negative

1. What is the most appropriate diagnostic test at this time?

a. Blood cultures

b. Transthoracic echocardiogram

c. Transesophageal echocardiogram

d. Serology for Lyme disease

e. Abdominal CT scan

2. A diagnosis of endocarditis is established based on clinical findings and positive blood cultures. Which of these organisms is most likely in this patient?

a.Staphylococcus aureus

b.Escherichia coli

c.Group B Streptococcus

d. Coagulase-negative staphylococcus

e.Streptococcus sanguis

3.There is no history of cardiac disease. What is the most likely underlying valvular disorder?

a. Atrial septal defect

b. Mitral valve prolapse with regurgitation

c.Bicuspid aortic valve

d. Mitral stenosis

e. No underlying valvular disorder

4.Which of the following would be the most appropriate initial therapy in this patient assuming a fully susceptible organism?

a. Imipenem and gentamicin

b. Nafcillin

c. Vancomycin

d. Penicillin G

e. Ceftriaxone and gentamicin

Answer 1

Ans 1: Blood culture

It is used for the paient who present with a fever of unknown cause .In this case all test like CBC, urine analysis , ESR, and electrolyte is done but cause  is not ruled out. To ruled out the cause blood culture is the most appropriate test which can identif the bacteria and fungal pathogen in the blood.

Ans 2: Staphylococcus aureus , coagulase negative staphylococcus

These are the most common bacterias for hospital acquired infective endocarditis.

Ans 3: mitral valve stenosis

In infective endocarditis mitral valve or tricuspid valve stenosis is commonly seen.The bacteria causes the stenosis by obstructing the blood flow leading to hemodynamc decompensation.

Ans 4: Penicillin G

It is an antimicrobial agent.