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| {{WBRQuestion
| | Plagiarism detected. |
| |QuestionAuthor={{Sapan}}
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| |ExamType=USMLE Step 3
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| |MainCategory=Inpatient Facilities
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| |SubCategory=Infectious Disease, Surgery
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| |Prompt=A 60-year-old male on total parenteral nutrition (TPN) for 10 days following development of a postoperative enterocutaneous fistula has developed high, spiking temperatures up to 102.3°F over the last 7 hours. The only abnormal finding on physical examination is redness and induration around his central line. The most appropriate step is which of the following?
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| |Explanation=A high index of suspicion is warranted for catheter sepsis in any patient who has had a central line for several days and suddenly spikes a high fever. The catheter site may have redness, induration, tenderness, and purulent discharge extruding from the skin. Often, however, the skin appears normal. A thorough search for other possible sources of fever including pulmonary, intraabdominal, urinary, and wound infections is always prudent. Catheter sepsis can be life threatening and early intervention is essential. Peripheral and central blood cultures should be obtained and the catheter must be removed promptly.
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| Educational objective- A high index of suspicion is warranted for catheter sepsis in any patient who has had a central line for several days and suddenly spikes a high fever.
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| |AnswerA=Begin broad-spectrum antibiotics and observe for 48 hours
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| |AnswerAExp=Incorrect- It is not mandatory to treat with antibiotics unless the fever persists or signs of sepsis are present.
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| |AnswerB=Blood cultures through the central line, begin broadspectrum antibiotics and await culture results
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| |AnswerBExp=Incorrect- As the catheter must be removed promptly to control infection.
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| |AnswerC=Catheter removal, send tip for culture and replace with a new central line over the guide wire
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| |AnswerCExp=Incorrect- It is contraindicated to replace the catheter over a guide wire because the skin tract is infected.
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| |AnswerD=Catheter removal, send tip for culture and establish central line at another site
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| |AnswerDExp=Correct- See explanation
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| |AnswerE=Catheter removal, send tip for culture and establish peripheral intravenous line
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| |AnswerEExp=Incorrect- It is right to remove the catheter but for TPN, establishing central line at another site is more appropiate action than establishing peripheral intravenous line.
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| |RightAnswer=D
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| |Approved=Yes
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