A 40‐year‐old man is brought to the emergency room following an altercation in a nearby bar

A 40‐year‐old man is brought to the emergency room following an altercation in a nearby bar. According to paramedics, the man was found down on the street after being forcefully removed from the bar. Apparently, the man had fallen off a barstool and then started a fight with the bartender. The man has a distinct aroma of alcohol and urine, has multiple contusions and lacerations, and is wearing a rigid cervical collar placed by paramedics. After the cervical spine is determined to be stable by clinical and radiographic examination, the cervical collar is removed. The man’s clothing is removed, and his wounds are examined and cleaned. He has a 3‐cm laceration on his occiput, a 2.5‐cm laceration below his right eye, a 4‐cm laceration on his anterior neck, a jagged, 1‐cm laceration above his left nipple, and a 2.5‐cm laceration across his right metacarpophalangeal joint, though the joint appears to be unaffected. Of this patient’s multiple lacerations, which site presents the greatest risk for infection?

  • A. Face
  • B. Hand
  • C. Neck
  • D. Scalp
  • E. Trunk

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An 18‐year‐old man is taken to the emergency room by his family when he develops very severe headache accompanied by high fever. On physical examination, the patient is incoherent and demonstrates nuchal rigidity. CSF shows gram‐negative diplococci. When talking to the family, the physician learns that the patient has had 5 episodes of meningococcal meningitis in the past, the earliest being at age 6. Immunodeficiency related to impaired function of which of the following should be suspected?

  • A. B cells
  • B. Complement factors
  • C. Eosinophils
  • D. Neutrophils
  • E. T cells

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