American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the November ACP Observer, copyright © 2005 by the American College of Physicians.

Clinical scenario

A 36-year-old woman is admitted to the intensive care unit with Guillain-Barre syndrome. She requires intubation and is placed on mechanical ventilation. On hospital day 11, she develops fever and purulent tracheobronchial secretions. A chest radiograph reveals a new infiltrate in the left lower lobe. On physical examination, temperature is 39 °C (102.2 °F). Coarse crackles are heard in the left posterior lung field. The leukocyte count is 15,000/µL. An endotracheal aspirate is taken for culture and Gram stain.

Which of the following is the optimal management at this time?

A. Await Gram stain and culture results
B. Begin ceftriaxone
C. Begin vancomycin
D. Begin vancomycin, piperacillin and amikacin
E. Begin ceftriaxone and vancomycin

Answer

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