MKSAP: 74-year-old man with fever and chills

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a 5-week history of a nonhealing ulcer on the plantar surface of his left foot. He has diabetes mellitus, hypertension, and peripheral vascular disease for which he takes metformin, glyburide, lisinopril, chlorthalidone, and aspirin. He has no known medication allergies. On physical examination, temperature is 39.0 °C (102.2 °F), blood pressure is 92/60 mm Hg, pulse rate is 108/min, and respiration rate is 18/min. He appears ill and is slow to respond. Examination of the left foot discloses a 3.5 × 2.5-cm ulcer with surrounding erythema and warmth. A foul odor and edema and tenderness involving the entire foot are noted. Pedal pulses are absent. The underlying bone is detected with a metal probe. Laboratory studies indicate a leukocyte count of 21,500/µL (21.5 × 109/L) with 18% band forms. Serum electrolyte levels and kidney function tests are normal. A radiograph of the left foot indicates no subcutaneous gas or foreign bodies. Which of the following is the most appropriate empiric antimicrobial regimen? A. Aztreonam and metronidazole B. Cefazolin and metronidazole C. Clindamycin and gentamicin D. Vancomycin and meropenem Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A socia...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Infectious disease Source Type: blogs