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A 45-Year-Old Woman Is Brought to the Emergency Department by Her

question 122

Multiple Choice

A 45-year-old woman is brought to the emergency department by her husband due to fever and confusion. He notes that the patient began having fever, headache, nausea, and vomiting yesterday. She was also disoriented and made many odd statements to her children. The patient has a history of type 1 diabetes mellitus and chronic kidney disease and underwent simultaneous pancreas-kidney transplantation 2 years ago. She takes maintenance immunosuppressive therapy.
Temperature is 38.9 C (102 F) , blood pressure is 108/60 mm Hg, pulse is 105/min, and respirations are 21/min. The patient is lethargic and ill-appearing. No skin rash is present. The lungs are clear to auscultation, and there are no heart murmurs. The abdomen is soft and nontender. The patient is oriented only to self and moves all extremities to pain. No nuchal rigidity or signs of meningismus are elicited.
Leukocyte count is 15,500/mm³, serum creatinine is 0.9 mg/dL, and plasma glucose is 90 mg/dL. Blood cultures are obtained, and empiric antibiotics are administered. CT scan of the head shows no hemorrhage or mass, and lumbar puncture is subsequently performed. Cerebrospinal fluid (CSF) results are as follows:
CSF Gram stain reveals numerous gram-positive bacilli. Which of the following is the best treatment?

Definitions:

Developmental Network

A group of people or resources an individual uses for personal or professional growth, guidance, and support.

Protégé

A person who is guided and supported by an older and more experienced or influential person.

Newcomers' Proactive Behaviours

Activities initiated by new members of an organization aimed at understanding, assimilating, and contributing to the workplace.

Locus of Control

A psychological concept that describes the degree to which individuals believe that they have control over the outcome of events in their lives.