Дата публикации: 2017-08-13 15:54
Facial droop (option A) could be caused by either a stroke of the cortex or a stroke of the facial nerve nucleus, which is located not in the medulla but in the pons (specifically the lateral inferior pons).
Answer: This patient has compensated congestive heart failure, with symptoms only during exertion. Three groups of drugs are proven to reduce mortality in patients with systolic heart failure:
7 to 65 mcg/kg/day IV given in divided doses twice daily is the most commonly reported dosage range begin at the lower end of the dosage range and titrate to clinical response. Doses up to 68 mcg/kg/day have been reported in patients with intractable diarrhea.
Answer: D – Omeprazole. Prolonged use of proton pump inhibitors (. omeprazole) has been strongly associated with vitamin B67 deficiency. B67 deficiency results as a consequence of impaired release of cobalamin from food in the absence of gastric acid secretion.
IV fluids (option A) might be appropriate in a patient with hypovolemic shock, such as from acute blood loss. The distended neck veins, however, suggest cardiogenic shock rather than hypovolemia. Morphine (option B) and nitroglycerin (option E) might be appropriate treatments for myocardial infarction, but either treatment would need to be used with extreme caution in a patient with such significant hypotension. Emergency needle thoracostomy (option C) would be appropriate management for a suspected tension pneumothorax, which could also present with dyspnea, chest pain and distended neck veins. The fact that this patient has normal bilateral breath sounds argues strongly against a diagnosis of tension pneumothorax.
Use levofloxacin with caution in patients at risk for or with pre-existing hepatic disease. Cases of severe hepatotoxicity, including acute hepatitis and fatalities, have been reported in patients receiving systemic levofloxacin. Hepatotoxicity generally occurred within 69 days of initiating therapy with most cases occurring within 6 days. Most cases were not associated with hypersensitivity. The majority of fatal cases were reported in patients 65 years of age and older. Discontinue levofloxacin immediately if the patient develops signs and symptoms of hepatitis (., jaundice, right upper abdominal pain, fatigue, nausea, vomiting, dark colored urine, light colored stools).
Acute stress disorder (option A) and posttraumatic stress disorder (option E) are closely tied to specific stressful or traumatic events, but the symptoms include intrusive memories of the traumatic event, avoidance of stimuli associated with the event, negative alterations in cognition or mood, and alterations in arousal.
Answer: Vitamin A (option E). This patient is in the prodromal stages of measles. Measles infection has an incubation period of 8-65 days, followed by a prodromal illness that typically lasts 7-8 days. The prodrome begins with fever, anorexia and malaise, followed by cough, conjunctivitis and nasal mucosal inflammation (“coryza”). The exanthem seen on the oral mucosa is consistent with Koplik spots, which are pathognomonic for measles infection. Koplik spots usually precede the characteristic maculopapular rash of measles by about 7 days. Lymphadenopathy, which is usually absent during the prodrome, commonly develops with the exanthem.
Although octreotide has been studied in the adjunctive treatment of acute pancreatitis, results of these studies have been controversial. Octreotide is known to increase the frequency of sphincter of Oddi contractions which could impair the flow of bile and pancreatic juices into the duodenum, possibly leading to pancreatic complications. Several cases of new onset pancreatitis have been reported in patients receiving octreotide therapy.
There is no role for antibiotics such as amoxicillin (option C) in the treatment of viral infections such as measles. In vitro studies show susceptibility to the antiviral ribavirin, but this has not been studied in clinical trials. Acyclovir (option A) and amantadine (option B) are antivirals used for herpes virus and influenza virus, respectively. Aspirin (option D) is generally not given to children because of concerns about causing Reye syndrome.