A 25-Year-Old Man Is Brought to the Emergency Department Due

question 282

Multiple Choice

A 25-year-old man is brought to the emergency department due to high-grade fever, chills, myalgias, and skin rash, which started on the day of admission.  He also had nausea and 3 episodes of profuse watery diarrhea and is now feeling lightheaded.  Two days ago, he underwent corrective surgery for a deviated nasal septum but otherwise has no other past medical history.  The patient has not traveled recently and has not been around sick contacts.  He does not use illicit drugs.  His temperature is 39.4 C (103 F) , blood pressure is 85/50 mm Hg, and pulse is 116/min.  Oxygen saturation is 98% on room air.  He is lethargic but has no focal weakness or nuchal rigidity.  Examination shows clear lung fields and tachycardia with normal first and second heart sounds.  The abdomen is soft and nontender.  There is nasal packing in both nostrils.  Skin examination shows a diffuse, red, macular rash that also involves the palms and soles. Blood cultures are sent. Which of the following is the most important next step in the treatment of this patient?

• A)Dobutamine infusion
• B)Epinephrine injection and antihistamines
• C)Intravenous fluid infusion and antibiotic therapy
• D)Intravenous fluid infusion and high-dose corticosteroids
• E)Polyclonal human immunoglobulin

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Definitions:

Discount Factor

A multiplier used in discounted cash flow (DCF) analyses to determine the present value of future cash flows, reflecting the time value of money.

Proposed Project

An outlined plan or proposal for undertaking a specific activity or achieving a goal that requires approval or funding.

Discount Rate

The rate used in discounted cash flow analysis for valuing future cash flows in today's monetary terms.

Tractor-Trailer

A large vehicle consisting of a towing engine (tractor) and a trailer used for transporting goods.