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Sample text
About 80% of patients will give a history of tick exposure. Doxycycline is considered the drug of choice, but chloramphenicol is preferred in pregnancy because of the effects of tetracycline on fetal bones and teeth. Overall mortality from the infection is now about 5%. 24. The answer is c. ) Erysipelas, the cellulitis described, is typical of infection caused by S pyogenes (group A β-hemolytic streptococci). There is often a preceding event such as a cut in the skin, dermatitis, or superficial fungal infection that precedes this rapidly spreading cellulitis.
Discontinuing the patient’s beta-blocker will not improve the patient’s blood sugar control. 59. The answer is e. ) Syncope is usually caused by decreased blood flow to the brain. Although occasionally seizures and hypoglycemia can cause transient loss of consciousness, this patient’s rapid onset of symptoms and rapid recovery once recumbent suggest decreased cerebral perfusion. She has no evidence of aortic stenosis or other structural heart disease on echocardiogram. It would be reasonable to monitor the patient’s heart rhythm initially in the hospital.
The Infectious Disease Society of America’s guidelines on the treatment of community-acquired pneumonia still recommend the use of sputum Gram stain and culture. This is particularly important in the era of multiantibiotic-resistant S pneumoniae. Sputum culture and sensitivity can direct specific antibiotic therapy for the patient as well as provide epidemiologic information for the community as a whole. A good sputum sample showing many polymorphonuclear leukocytes and few squamous epithelial cells can give important clues to etiology.
