Answer 5

5. Choice D is the correct answer.  This patient has pyelonephritis.  Patients with pyelonephritis need 10-14 days worth of antibiotics.  This patients vitals are normal, labs are reassuring, and pain is under control and likely does not need to be admitted to the hospital.  The other antibiotic choices are acceptable but are not long enough to treat pyelonephritis.

Question 5

5.  Your patient is a 21 year old female that presents with right flank pain, fever 102, dysuria, polyuria, with nausea and vomiting.  Lab values are as follows WBC 11.4, and remainder of CBC is normal.  BMP is normal.  Urine reveals WBC 75-100, many bacteria, nitrite positive.  Vitals are Temp 101, HR 97, BP 124/76, RR 20, Sat 100.  The patient is comfortable and pain is under control.  You have just given the patient Cipro 400 mg IV Piggy Back.  Which of the following regimens is most appropriate for this patient.?

A.  Continue Cipro 400 mg IV Piggy Back BID in Hospital awaiting cultures
B.  Bactrim DS one PO BID for 7 days
C.  Cipro 500 mg BID for 7 days
D.  Cipro 500 mg BID for 14 days

Answer 4

4.  Choice D is the correct answer.  All men with epididymitis should be covered for gonorrhea and chlamydia.  Rocephin provides excellent coverage for gonorrhea.  Chlamydia is best covered in this situation with doxycycline 100 mg BID.  While chlamydia is sensitive to Zithromax, ideally it should be give 1000 mg times one dose.  There is a lot of resistance to cipro in terms of chlamydia.  Flagyl is for trichomonas, not chlamydia.

Question 4

4.  Your patient is a 30 year old male that has had left testicle pain for 2 weeks.  The pain is alleviated when sitting and worse with standing.  His urinalysis is essentially negative.  Ultrasound of scrotum reveals left sided epididymitis.  Which of the following is the most appropriate antibiotic regimen?

A.  Rocephin 250 mg x1, plus Zithromax 500 mg PO daily for 10 days
B.  Rocephin 250 mg x 1, plus cipro 500 mg BID for 10 days
C.  Rocephin 250 mg x 1, plus flagyl 500 mg BID for 7 days
D.  Rocephin 250 mg x 1, plus Doxycycline 100 mg BID for 10 days