HISTORY
The patient has a small-fiber sensory neuropathy that is managed with lamotrigine. She is a physical therapy student who has frequent patient contact. She drinks alcohol occasionally but denies smoking and illicit drug use; she says she is not sexually active.
PHYSICAL EXAMINATION
This uncomfortable-appearing woman has a heart rate of 116 beats per minute and an oral temperature of 39.6°C (103.2°F); all other vital signs are normal. Her face is flushed, but no cervical or axillary lymphadenopathy is noted. Heart rhythm is regular, with no murmurs, and lungs are clear. Abdomen is normal. No neurological deficits are noted, and she is oriented to time and place.
LABORATORY AND IMAGING STUDIES
White blood cell count is 1100/μL, with 40% neutrophils, 3% band forms, and 50% lymphocytes. Hemoglobin level is 12.2 g/dL, and platelet count is 116 x103/μL. Results of a basic metabolic panel, liver function tests, and urinalysis are unremarkable. A chest radiograph is normal.
| Which of the following is the most appropriate next step? A. Initiate treatment with intravenous amphotericin B. B. Initiate therapy with oral moxifloxacin. C. Initiate therapy with intravenous ceftazidime. D. Administer granulocyte colony-stimulating factor. |
(answer on next page)
