Question of the Week # 465

Posted on March 23, 2015 by Archer USMLE Reviews

465) A 6-year-old boy is brought to the emergency department 2 hours after he was bitten by a peer in kindergarten in a fight. The child’s mother is frantic and wants to “sue the center for allowing such behavior!” The child is up-to-date on his vaccinations. The other child is very healthy and his vaccinations are current. On physical examination, there is puncture wound on the right hand. You gently clean the wound and consult with the hand surgeon who says that there does not appear to be any damage to the nerves, muscles, tendons, or joints of the hand. What is the most appropriate next step?

A. close the wound with a suture
B. obtain a wound culture
C. provide ampicillin-sulbactam
D. send him home with a follow-up appointment within 48 hours
E. vigorously irrigate and debride the wound

Filed under: USMLE STEP III QUESTION BANK, USMLE Test Prep | Tagged: Archer Infectious Diseases, internal medicine board review, USMLE STEP 3 INFECTIOUS DISEASES |

13 Responses

Rohini, on March 23, 2015 at 2:04 am said:

Provide ampicillin sulbactam to prevent infection by eikenella corrodens. Bite wound = dirty wound. Esp. This one is a puncture wound also and on the hand. All roads point to antibiotic prophylaxis.

Reply
- Archer USMLE Reviews, on March 23, 2015 at 2:31 am said:
  
  So, which one?
  
  Reply
  - Rohini, on March 23, 2015 at 2:33 am said:
    
    augmentin – amox-clav
Rohini, on March 23, 2015 at 2:30 am said:

On second thought, the wound does need to be thoroughly cleaned first – so probably irrigate it and debride the wound prior to starting antibiotic prophylaxis.

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- Rohini, on March 23, 2015 at 2:39 am said:
  
  wish we could choose more than one answer in this exam!!!
  
  Reply
Kumar, on March 23, 2015 at 2:50 am said:

C

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GZ (@Neurofrantic), on March 23, 2015 at 4:00 am said:

C

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laurentiu244, on March 23, 2015 at 11:47 am said:

C

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Adeel, on March 24, 2015 at 3:12 pm said:

i think its C… because its not a closed abcess or anything that the ABX wont penetrate…

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Arabe, on March 26, 2015 at 5:00 pm said:

E.
1st. irrigation very well,
2nd. do not close unless the open wound
is large and the subQ tissue is protruding,
3rd. if not up to date on his vaccines, give
tetanus vacc. ,
4th. D/C home on augmentin X 3-5 days + ibuprofen + an advice to take probiotic for one week go to the nearest ER if the child develops fever, swelling…

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chad p., on June 1, 2015 at 1:52 am said:

C.
its a bite, recent wound. it has been already irrigated by physician.

you do debridement of wound where there is non-viable tissue , grossly infected tissue and as such.
its a puncture wound, since they did not give the size and any more description of it I would avoid picking suture option.

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Farzana, on August 17, 2015 at 1:57 am said:

C

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Nabil shafik, on October 21, 2015 at 2:58 pm said:

C

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