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


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/L. 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



This is a printer-friendly version of this page

Print this page  |  Close the preview




Internist Archives Quick Links

Not an ACP Member?

Join today and discover the benefits waiting for you.

Not an ACP Member? Join today and discover the benefits waiting for you

ACP offers different categories of membership depending on your career stage and professional status. View options, pricing and benefits.

A New Way to Ace the Boards!

A New Way to Ace the Boards!

Ensure you're board-exam ready with ACP's Board Prep Ace - a multifaceted, self-study program that prepares you to pass the ABIM Certification Exam in internal medicine. Learn more.