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Question

Difficulty: MediumInfectious Diseases

Match each clinical exposure scenario with the most appropriate pharmacological prophylaxis or empiric antimicrobial regimen.

  • A patient steps on a nail that punctures deeply through the rubber sole of an athletic shoe.Oral ciprofloxacin
  • A patient presents with a closed-fist injury over the metacarpophalangeal joint after striking another person's mouth.Oral amoxicillin-clavulanate
  • An asymptomatic university student reports sharing a dorm room with a peer just diagnosed with Neisseria meningitidis meningitis.Oral rifampin twice daily for 2 days
  • A hiker in New England presents after removing an engorged Ixodes scapularis tick that was attached to their thigh for 48 hours.Single-dose oral doxycycline

Answer

Rubber shoe puncture matches with oral ciprofloxacin; human bite matches with oral amoxicillin-clavulanate; meningococcal contact matches with oral rifampin; tick bite ≥36\geq 36 hours matches with single-dose oral doxycycline.
Each exposure corresponds to a highly specific, guideline-directed antimicrobial regimen to prevent or treat the most likely inoculated organisms.

Step-by-Step Solution

1
Analyze the puncture wound scenario.
Recognize the risk of Pseudomonas aeruginosa from rubber-soled shoes.
Pseudomonas thrives in the moist environment of athletic shoes and requires targeted fluoroquinolone coverage like ciprofloxacin.
2
Evaluate the human bite (clenched-fist) injury.
Identify the need to cover Eikenella corrodens and oral anaerobes.
Amoxicillin-clavulanate provides excellent coverage for the typical oral flora inoculated during fight bites.
3
Assess the meningococcal exposure.
Determine that close household/dormitory contacts need immediate prophylaxis.
Rifampin (twice daily for 2 days) eradicates nasopharyngeal carriage to prevent secondary symptomatic cases.
4
Review the tick exposure parameters.
Confirm criteria for Lyme prophylaxis: Ixodes tick, endemic area, attached ≥36\geq 36 hours.
A single dose of doxycycline effectively prevents Lyme disease if given within 72 hours of tick removal.

Key Concept

Appropriate targeted antimicrobial prophylaxis and empiric therapy for specific high-risk pathogen exposures.
Estimated Time:1m 30s
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Topics

Infectious Diseases

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