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Postoperative pulmonary embolism — USMLE Step 2 CK MCQ

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HardSurgeryPostoperative pulmonary embolismUSMLE Step 2 CK

A 31-year-old man develops fever, severe calf and lumbar myalgias, conjunctival suffusion, jaundice, oliguria, thrombocytopenia, and bilateral pulmonary infiltrates 8 days after wading through floodwater in Puerto Rico. Creatinine is 4.1 mg/dL, and oxygen saturation is 88% on room air. Blood and urine are obtained for molecular testing. Which antimicrobial strategy is most appropriate now?

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Correct answer: B — Begin intravenous penicillin G or ceftriaxone without awaiting confirmation

The best answer is “Begin intravenous penicillin G or ceftriaxone without awaiting confirmation”. Floodwater exposure, conjunctival suffusion, intense calf myalgia, jaundice, acute kidney injury, thrombocytopenia, and pulmonary involvement indicate severe leptospirosis. CDC guidance supports immediate intravenous penicillin G or ceftriaxone without waiting for molecular or serologic confirmation. Oral doxycycline is used for mild disease, whereas this patient requires hospitalization, oxygenation, renal support as indicated, and monitoring for pulmonary hemorrhage and a Jarisch-Herxheimer reaction after therapy begins.

Reference: CDC Clinical Overview of Leptospirosis: https://www.cdc.gov/leptospirosis/hcp/clinical-overview/index.html