NBME Step 2 CK Form 8 Ceftriaxone, parenterally (NBME Answers)

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submitted by ∗step_prep2(66)

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Infant with sickle cell disease presenting with sepsis (fever, clear rhinorrhea, lymphocytosis), which is most likely caused by Strep pneumo and can be effectively treated with ceftriaxone
Key idea: Sickle cell disease leads to functional asplenia, which leads to increased risk of encapsulated infections (SHiN: Strep pneumo, Haemophilus influenzae, Neisseria meningitidus)
Key idea: Although daily penicillin prophylaxis decreases the risk of Strep Pneumo infection, it does not completely eliminate the risk

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seagull I would make a different argument. Because the infant is covered by Penicillin the pneumonia is likely gram negative. We don't have imaging to see the lung parenchyma but I would like to cover pseudomonas (ceftriaxone has partial coverage). Lastly, Ciprofloxacin given orally isn't likely to be done for inaptient (it would need to be an IV medication here). Also Cipro isn't a respiratory floroquinolone unlike moxifloxacin, gemifloxacin and levofloxacin. +3

spiroskeet Also, fluoroquinolones are contraindicated in children (tendinopathy) +5

clu I would not call that sepsis... +1

cloroxveins Vaccination + prophylactic PCN can prevent almost all cases of pneumococcal sepsis in patients with sickle cell disease. This patient is taking penicillin, therefore it is unlikely be s. pneumo. SCD susceptible to SHiN organisms, ceftriaxone covers H.flu & neisseria meningitidis +7