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 Best of Five 2.54

 

   

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BOF: 2.54

A 63-year-old male is admitted with a history of low-grade fever and feeling generally unwell.

He had had an endoscopy two months ago and was found to be Helicobacter pylori positive and was given a course of eradication treatment.

As he was having fever his general practitioner also gave him a weeks course of ciprofloxacin but this did not settle his fever .The course of antibiotics was completed a week prior to admission.

On examination he has a temperature of 38.4 C. On examination of his hands there are erythematous macules on his palms and tender erythematous nodules in the pulp of his fingers. His pulse rate is 70 beats per minute, regular with a slow rising pulse. There is brachio-radial delay of the pulse.

The JVP is not elevated, the apex beat is in the 5th intercostal space in the mid-clavicular line and it is heaving in nature. The second heart sound is soft and single and there is an ejection systolic murmur in the aortic area conducted to the neck.

On examination of his abdomen the spleen tip is palpable.

Investigations reveal normocytic, normochromic anaemia, elevated CRP and he has microscopic haematuria.

In this patient your next line of management would be to take blood cultures and:

a)      Treat with penicillin 1.2 g 4-hourly with gentamicin 80 mgs 12-hourly

b)      Treat with vancomycin 1 g 12- hourly with gentamicin 80 mgs 12- hourly

c)      Treat with ampicillin 2 g 4-hourly with gentamicin 80 mgs 12-hourly

d)      Treat with flucloxacillin 2g 4-hourly with gentamicin 80 mgs 12-hourly

e)      Await results of blood cultures

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