The admitting physician notes that the degree of pain appears to be disproportionate to the amount of overlying cellulitis. She is treated empirically with oxacillin intravenously for a cellulitis. A 32-year-old woman is admitted to the hospital complaining of right thigh pain. Ceftriaxone, vancomycin, and amphotericin Bĭ. Ceftriaxone, ampicillin, and vancomycinĬ. What are the most appropriate empiric antibiotics for the treatment of this patient?ī. Blood, sputum, and urine cultures are obtained. His only other history is an automobile accident at age 20 years, requiring exploratory laparotomy and splenectomy. He takes amlodipine 10 mg daily and atorvastatin 20 mg daily. The patient has a history of hypertension and hyperlipidemia. Ongoing volume resuscitation is ordered, and the patient is initiated on norepinephrine to maintain adequate blood pressure. The patient received 1 L of normal saline before arrival in the emergency department but continues to have hypotension (blood pressure, 75/40 mmHg). He was intubated and placed on mechanical ventilation. He was tachypneic with a respiratory rate of 32 breaths/min with an oxygen saturation of 75% on room air, and his initial temperature was 104.9☏ (40.5☌). Upon arrival of emergency medical services, his initial blood pressure was 60/40 mmHg with a heart rate of 142 beats/min. He was brought to the hospital by ambulance this morning when he was lethargic and unresponsive at home. He had no other specific complaints but reportedly had decreased oral intake and generalized malaise. His family reports that he developed myalgias and fevers at that time. He was well until 1 day before admission. A 48-year-old man is admitted to the intensive care unit for treatment of septic shock for an uncertain cause. Deficits in the complement membrane attack complex (C5-8) are associated with infections of what variety? SECTION IV. Infectious DiseasesĭIRECTIONS: Choose the one best response to each question. Collectively, these changes have led to dramatic refinement of dose parameters for avoidance organs, as briefly summarized below.Harrisons Principles of Internal Medicine Self-Assessment and Board Review 18th Ed. Adoption of technologies such as surface-guided radiation therapy have enhanced the accuracy of set-up and treatment delivery. One practical advantage of VMAT over IMRT for RNI is its relatively rapid delivery time, which enables its combination with deep-inspiratory breath hold (DIBH) techniques that may subsequently minimize exposure of high doses to the heart and lung in left-sided breast cancers (Dumaine et al., Radiat Oncol 13:187, 2018). RTOG Foundation: Radiation Therapy Oncology Group, 2016 DeSelm et al., Int J Radiat Oncol Biol Phys 103:583–591, 2019). Guidelines for target delineation have been modified based on mature datasets of patterns of regional nodal failure in breast cancer patients (Macdonald et al., RADCOMP Breast Atlas. Over recent years, inverse planned IMRT (intensity modulated radiation therapy) or VMAT (volumetric arc therapy) techniques have been increasingly incorporated into the management of breast cancer patients requiring regional nodal irradiation (RNI).

Shotty lymph nodes 60mmhg in intensity