A 38-Year-Old Hospitalized Man Is Evaluated for Persistent Fever

question 214

Multiple Choice

A 38-year-old hospitalized man is evaluated for persistent fever.  He has a history of paraplegia after spinal injury and was admitted 2 weeks ago due to septic shock from an infected sacral pressure ulcer.  His condition improved with broad-spectrum antibiotics, intravenous fluids, vasopressors, and wound debridement, but he has been having recurrent fevers for the past 4 days.  The patient also has a history of asthma and takes an inhaled glucocorticoid and bronchodilator.  Temperature is 38.3 C (101 F) , blood pressure is 120/80 mm Hg, and pulse is 96/min.  Several white patches are present on the oral mucosa.  There is a peripherally inserted central venous catheter in the right arm with mild tenderness but no surrounding erythema.  The sacral pressure ulcer has pink granulation tissue with a mild amount of serosanguinous fluid.  A chronic indwelling urinary catheter is draining yellow-colored urine.  Repeat blood cultures grow budding yeasts.  Which of the following is the most likely source of the organism in this patient's blood culture?

• A)Central venous catheter
• B)Contaminated sample
• C)Indwelling urinary catheter
• D)Oropharyngeal infection
• E)Pressure ulcer

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Definitions:

Psychoactive Drugs

Substances that affect the mind, mood, or behavior by altering the brain's chemical function.

Narcotics

Drugs that relieve pain and often induce sleep, typically used for pain relief but have a high potential for abuse or addiction.

Rapid Development

The process of quickly bringing a new product or technology to the market or achieving progress in a short amount of time.

Tolerance

Tolerance is the capacity to endure pain or hardship, or in pharmacology, it refers to the body's adaptation to a drug which reduces its effects over time.