Еще одна пилюлька Hескучина

[papadoctor]

For 559 C. Kids are getting deaf after aspirin overdose

[riltsov]

Cyclosporine подавляет иммунитет и провоцирует развитие бородавок.
A. discontinue cyclosporine

[yananshs]

Нее, нельзя... Если бы циклоспорин не был нужен, его бы не назначили. Пaциенту нужна иммуносупрессия.
Он пришел не по поводу бородавок, а по поводу "ringing in the ears".

[riltsov]

Шум в ушах может рассматриваться как побочное действие лансопразола. Связать шум в ушах с салициловой кислотой не могу. He currently takes many medications, попробую побороться с полипрагмазией, отменив лансопразол.
B. discontinue lansoprazole

[yananshs]

Язвы не боитесь?

[dr.Ira]

E. tell him to continue current therapy until he sees an otolaryngologist about this problem

Может у него отит банальный? Вон и температура есть....
Меня смущает только, зачем его к ЛОР посылать, я бы и сама ему уши посмотрела...

[yananshs]

Уши в порядке.

[dr.Ira]

Тогда, остается только С - The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.

[exomen]

Без иммуносупрессии почка отвалится.
Без антисекреторного - язва прибавится.
Так что поверю ПАПЕ на слово.
Раз детки глохнут от негогово.
Ответ С.

[yananshs]

Сказочные стихи. )) Я бы так сказала:
"поверю папе на словО,
раз детки глохнyт от невО"

The correct answer is C. Discontinuing topical wart therapy is the correct answer because this patient is described to have widespread involvement of warts and covered each lesion with 40% salicylic plasters. Long-term systemic prednisone causes atrophy of skin, which results in increased absorption of topical salicylic acid. Salicylism commonly present with tinnitus, vomiting, tachycardia, and fever. Severe poisoning can result in seizures, coma, respiratory and cardiovascular failure, cerebral edema, and renal failure.

Cyclosporine (choice A) and lansoprazole (choice B) are both incorrect because neither medication typically result in tinnitus. In addition, there was no indication in the history that this patient has overdosed on his medication.

Referral to audiology (choice D) or otolaryngology (choice E) are both incorrect at this time. As mentioned above, salicylism can result in severe multiorgan failure if not caught early on. The first and most important step to take in this patient is to stop salicylic acid application. If tinnitus does not resolve, then a referral to a specialist is necessary.

[yananshs]

A 68-year-old diabetic man comes to the office because of double vision and a fever. He says that this all started about 3 weeks ago with dull pain over his cheeks, a low-grade fever, and thin, bloody nasal discharge. He says that he has not been feeling "great" since his wife passed away 4 months ago and he has not been very good at checking his "sugars" because that used to be his wife's job. He seems very sad and a bit confused. His temperature is 39.0 C (102.2 F), blood pressure is 120/80 mm Hg, pulse is 70/min, and respirations are 20/min. Physical examination shows proptosis and a reduction of movement of his left eye, an inflamed left cheek, and dusky red nasal turbinates on the left side. His blood glucose level is 269 mg/dL. The most correct statement about his condition is:
A. A biopsy of his nasal turbinates will show invasive squamous cell carcinoma
B. Insulin, intravenous fluids, and potassium replacement will improve his symptoms
C. Infectious invasion of the ophthalmic artery and globe is responsible for his visual signs and symptoms
D. The symptoms on the left side of his face are unrelated to his diabetes mellitus
E. Tight control of his diabetes will reverse the symptoms on the left side of his face

[riltsov]

По-видимому, опухоль врастает в глазницу.
A. A biopsy of his nasal turbinates will show invasive squamous cell carcinoma

[vosk]

не могу связать это с диабетом, хотя им, судя по цифрам, заняться следовало бы. судя по описанию, похоже на воспаление. тогда мне непонятно, откуда эти bloody nasal discharge? Да и для острого воспаления больно долго симптомы развиваются. может и вправду "А"?
хотя сказать трудно, поэтому буду считать, что most correct statement about his condition is D. The symptoms on the left side of his face are unrelated to his diabetes mellitus
Dmitry Voskovets

[yananshs]

Какие еше мнения?

[vosk]

если позволите вторую попытку, то все же скажу, что C. Infectious invasion of the ophthalmic artery and globe is responsible for his visual signs and symptoms
ну никак не могу поверить, что это можно купировать инсулином и контролем диабета. наверно, мало еще про диабет знаю
Dmitry Voskovets