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I was thinking mastoiditis
Persistent pain from AOM with displaced ear and postauricular pain suggests mastoiditis, which is evaluated with a head CT.
Fat emboli usually occur from long bone fractures, not hip fractures. Altered mental status is also a common symptom of fat emboli, which is not seen here. Petechiae can also be present, but are not necessary to make the diagnosis.
Regardless of this, this patient has a Wells score of at least 4 (HR >100, ≥3 days of immobilization, hemoptysis). If you think PE is the most likely diagnosis (I personally did), then this patient has a Wells score of 7. For any patient with dyspnea and a Wells score of ≥4, PE is likely, so you would heparinize and conduct a CTA or V/Q scan.
Isn't possible for folic acid deficiency and suppression of bone marrow by alcohol to be potential causes of the patient's decreased leukocyte count?
Folic acid deficiency would not explain the disproportionate decrease in neutrophils. Yes, this is leukopenia, but more specifically, this is agranulocytosis, which is a side effect of carbamazepine.
I think she more likely has asthma. Cough is worse at night and worse with physical activity. Key findings on exam: end-expiratory wheezes bilaterally. Responsive to b2-agonists.
There was a UWORLD question very similar to this that said the diagnosis was acute bronchitis. The next best step according to UWORLD was also to start empiric therapy with bronchodilators. So either way, the answer would be a SABA.
Process of elimination question for me.
The only other decent choice was A, but you wouldn't recommend "punishing" the patient if she doesn't comply. Maybe you just wouldn't offer her reward.
Therefore, B makes the most sense. I think of it like trying to bargain with the girl -- "if you take the medication, then we'll do x for you". Something to incentivize good compliance.
I agree that it was mainly by process of elimination to get to the right answer. Negotiating a contract is also the only answer that has some leeway to talk to the patient about why she doesn't believe she needs the medication.
The event happened 4 weeks ago, but his symptoms have occurred for 2 weeks.
Same lol. A question I had was I thought lymphangitis was supposed to precede some sort of injury, obv not lol but was the lymph node the main giveaway?
I think the key distinguishing features are the red streaks leading to an area of local lymphadenopathy. Otherwise, cellulitis would be a viable option if given.
I think the key thing here is that the participants were told what treatment they would be receiving. This is in line with an open-labeled clinical trial. Open-labeled clinical trials can still be randomized and do not need a control (as in this case).
Yeah, bad question IMO. Open-labeled trial can also be randomized... Since they didn't tell us how participants were selected for each group perhaps that's why C is better than D?
divalent cations interfere with the absorption of tetracyclines, not fluoroquinolones.
anti-acids interfere with the absorption of fluoroquinolones. (like in this q, it's ca carbonate)
According to SketchyPharm, divalent cations also interfere with the absorption of fluoroquinolones
Calcium carbonate is an antacid but it has Calcium in it....which is a divalent cation