Environmental Exposures 465426.A 23-year-old construction worker is brought by ambulance to the
ED with bilateral knee pain. He reports mixing cement the day before and
kneeling in the process. The patient states that his jeans were soaked through
most of the day but did not attempt to wash the cement off. Upon physical
examination, you see marked tissue necrosis of both knees extending to the
bone in some places. Which chemical was this patient most likely exposed to?
a. Hydrocarbon
b. Phenol
c. Ammonia
d. Formic acid
e. Lime
427.A 40-year-old veterinary assistant presents to the ED with puncture
wounds over her right upper extremity and neck. She reports being bitten
multiple times by a cat in her care, also stating that the cat’s immunizations
were up to date. The injury was sustained 2 days ago with minimal initial
symptoms. However, today the patient noticed redness and pain in that area.
She denies any fever, chills, nausea, vomiting, or any other constitutional
symptoms. Her initial vitals include an oral temperature of 99.7°F, a heart
rate (HR) of 90 beats per minute, blood pressure (BP) of 125/75 mm Hg,
respiratory rate (RR) of 14 breaths per minute, and an oxygen saturation of
99% on room air. Multiple punctate wounds may be seen over her right lateral
neck extending down to her deltoid with surrounding erythema and edema.
Which antibiotic coverage for the specific organism involved in this type of
injury would be most appropriate?
a. A first-generation cephalosporin/Staphylococcus aureus
b. Amoxicillin/Clavulanate (Augmentin)/Pasteurella multocida
c. Clindamycin/Streptococcussp.
d. Vancomycin/Methicillin resistant S aureus
e. Bacitracin ointment/S aureus