173.A 30-year-old woman presents to the ED with fever, headache, a
“sunburn-like” rash, and confusion. A friend states that the patient has
complained of nausea, vomiting, diarrhea, and a sore throat over the past
few days. Her last menstrual period began 4 days ago. Vital signs are HR
110 beats per minute, BP 80/45 mm Hg, RR of 18 breaths per minute, and
temperature of 103°F. On physical examination, you note an ill-appearing
female with a diffuse blanching erythroderma. Her neck is supple without
signs of meningeal irritation. You note a fine desquamation of her skin,
especially over the hands and feet, and hyperemia of her oropharyngeal, con-
junctival, and vaginal mucus membranes. Laboratory results reveal a creatine
phosphokinase (CPK) of 5000, WBC 15,000/μL, platelets of 90,000/μL, BUN
40 mg/dL, creatinine 2 mg/dL, and elevated liver enzymes. Which of the fol-
lowing is the most likely causative organism?
a. Staphylococcus aureus
b. Rickettsia rickettsii
c. Streptococcus pyogenes
d. Neisseria meningitidis
e. Neisseria gonorrhoeae
174.A 32-year-old diabetic man steps on a nail through his running shoe.
Two weeks later, he presents to the ED with fever and right foot pain. On
physical examination, his heel is mildly erythematous and diffusely tender
to palpation, with overlying warmth and edema. There is a small amount
of purulent drainage through the puncture hole in his heel. A plain radi-
ograph of his foot demonstrates a slight lucency of the calcaneus. He has
decreased range of motion, but you are able to passively dorsiflex and plan-
tarflex his ankle without difficulty. His vital signs include a temperature
of 101.4°F, HR of 98 beats per minute, BP of 130/75 mm Hg, and RR of
16 breaths per minute. Which of the following is the most common causative
organism of this condition?
a. Salmonellasp.
b. Pseudomonas aeruginosa
c. Staphylococcus aureus
d. Group B streptococci
e. Pasteurella multocida
Fever 181