Treament: Tonsillitis & Diabetes - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-27-2012
alfjof's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 251
Threads: 56
Thanked 105 Times in 63 Posts
Reputation: 115
Send a message via Yahoo to alfjof
Idea! Treament: Tonsillitis & Diabetes

A 17 year old girl is brought to ED by her parents because of difficulty swallowing, abdominal pain nausea and vomiting. Physical examination shows dry mucous membranes, left tonsillar abcess, and generalized tenderness of abdomen. Lab studies reveal blood glucose of 355 mg/dL, calcium 9.4 mg/dL, and K+ 4.1mg/dL. Therapy with with insulin is begun. Which of the following drugs or combination of drugs should also be given?

A- Ca++ supplement + IV fluid + Levofloxacin
B- Ca++ supplement + IV fluid + metronidazole
C- Metronidazole + IV fluid
D- K+ supplement + IV fluid + clindamycin
E- K+ supplement + IV fluid + levofloxacin

Please, read with attention before answering and don't forget to post your explanation; thank you!!!!!
__________________
Happy to Learn New Concept and Mechanism each Day
Reply With Quote Quick reply to this message



  #2  
Old 02-27-2012
bunny's Avatar
Banned
 
Steps History: Not yet
Posts: 176
Threads: 34
Thanked 117 Times in 69 Posts
Reputation: 127
Default

A 17 year old girl is brought to ED by her parents because of difficulty swallowing, abdominal pain nausea and vomiting. Physical examination shows dry mucous membranes, left tonsillar abcess, and generalized tenderness of abdomen. Lab studies reveal blood glucose of 355 mg/dL, calcium 9.4 mg/dL, and K+ 4.1mg/dL. Therapy with with insulin is begun. Which of the following drugs or combination of drugs should also be given?

A- Ca++ supplement + IV fluid + Levofloxacin
B- Ca++ supplement + IV fluid + metronidazole
C- Metronidazole + IV fluid
D- K+ supplement + IV fluid + clindamycin
E- K+ supplement + IV fluid + levofloxacin
Reply With Quote Quick reply to this message
  #3  
Old 02-27-2012
alfjof's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 251
Threads: 56
Thanked 105 Times in 63 Posts
Reputation: 115
Send a message via Yahoo to alfjof
Angry

Explanation please; and I believe your answer is wrong.
__________________
Happy to Learn New Concept and Mechanism each Day
Reply With Quote Quick reply to this message
 
  #4  
Old 02-27-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 257
Threads: 49
Thanked 75 Times in 50 Posts
Default

D- K+ supplement + IV fluid + Clindamycin
Insulin drives K+ into the cells.
a tonsillar abscess is a complication most commonly caused be Strep pyogenes-Clindamycin is added to treat it.
Reply With Quote Quick reply to this message
  #5  
Old 02-27-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default



Feel C is the ans as the patient has peritonitis becoz of generalised abdominal tenderness so need metronidazole and Iv fluids .. but just confused whether she would need calcium ??? still dont know if she would need it .. so will go with C ...
Reply With Quote Quick reply to this message
  #6  
Old 02-28-2012
avash.nrs's Avatar
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 441
Threads: 53
Thanked 258 Times in 153 Posts
Reputation: 268
Default

I feel E is the choice...flouroquinolone for the tonsillar infect and also being broad spectrum antiobiotic and its an emergency setting...so levoflox...and the k+ will drive the insulin release and reducing blood glucose
Reply With Quote Quick reply to this message
  #7  
Old 02-28-2012
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 109
Threads: 2
Thanked 41 Times in 34 Posts
Reputation: 51
Default

D - sounds correct
Reply With Quote Quick reply to this message
  #8  
Old 02-28-2012
patho2012's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 213
Threads: 13
Thanked 119 Times in 81 Posts
Reputation: 129
Default

C because it looks like she has C.diff.
Reply With Quote Quick reply to this message
  #9  
Old 02-28-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

D.
as by exclusion.
Insulin will drive potassium into the cell, so she needs to get some extra K.

She is dehydrated - so IV fluids

Clindamycin? - well, I dunno, but i doubt that she would be given fluoroquinolones at this point, question stem doesnt give any extra clues
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
  #10  
Old 02-28-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

Quote:
Originally Posted by alfjof View Post
A 17 year old girl is brought to ED by her parents because of difficulty swallowing, abdominal pain nausea and vomiting. Physical examination shows dry mucous membranes, left tonsillar abcess, and generalized tenderness of abdomen. Lab studies reveal blood glucose of 355 mg/dL, calcium 9.4 mg/dL, and K+ 4.1mg/dL. Therapy with with insulin is begun. Which of the following drugs or combination of drugs should also be given?

A- Ca++ supplement + IV fluid + Levofloxacin
B- Ca++ supplement + IV fluid + metronidazole
C- Metronidazole + IV fluid
D- K+ supplement + IV fluid + clindamycin
E- K+ supplement + IV fluid + levofloxacin

Please, read with attention before answering and don't forget to post your explanation; thank you!!!!!
First of all, A B C are incorrect forms of treatment for this complication, D and E are correct except for the Antibiotic of choice here.

Clindamycin i think its incorrect because its for the treatment of Anaerobic infections, including bacteroides fragilis, clostridium, mostly in aspiration pneumonia or lung abscesses.

Fluoroquinolones, wouldn't be my first choice of drug in this patient considerring , the damage to cartilage.Mostly used for G- and UTIs and GI infections, but has some covarage for G+.

That's why i Choose E... Correct me if i'm wrong please.

This questions i think covers, DKA knowledge of pathology, and treatment. And antibiotics.
Reply With Quote Quick reply to this message
  #11  
Old 02-28-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by LatinGeorge View Post
First of all, A B C are incorrect forms of treatment for this complication, D and E are correct except for the Antibiotic of choice here.

Clindamycin i think its incorrect because its for the treatment of Anaerobic infections, including bacteroides fragilis, clostridium, mostly in aspiration pneumonia or lung abscesses.

Fluoroquinolones, wouldn't be my first choice of drug in this patient considerring , the damage to cartilage.Mostly used for G- and UTIs and GI infections, but has some covarage for G+.

That's why i Choose E... Correct me if i'm wrong please.

This questions i think covers, DKA knowledge of pathology, and treatment. And antibiotics.
Interesting fact I noticed yesterday is that FA'12 says that there is a tendon rupture in adults... I used to remember it was i children
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
  #12  
Old 02-28-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

Quote:
Originally Posted by DocSikorski View Post
Interesting fact I noticed yesterday is that FA'12 says that there is a tendon rupture in adults... I used to remember it was i children
yes, it affects cartilage in general. That's why its contraindicated in pregnant woman, and in children, damages cartilage, and in adults causes tendonitis and tendon ruptures
Reply With Quote Quick reply to this message
The above post was thanked by:
DocSikorski (02-28-2012)
  #13  
Old 02-28-2012
avash.nrs's Avatar
USMLE Forums Guru
 
Steps History: Step 1 Only
Posts: 441
Threads: 53
Thanked 258 Times in 153 Posts
Reputation: 268
Default

Quote:
Originally Posted by LatinGeorge View Post
First of all, A B C are incorrect forms of treatment for this complication, D and E are correct except for the Antibiotic of choice here.

Clindamycin i think its incorrect because its for the treatment of Anaerobic infections, including bacteroides fragilis, clostridium, mostly in aspiration pneumonia or lung abscesses.

Fluoroquinolones, wouldn't be my first choice of drug in this patient considerring , the damage to cartilage.Mostly used for G- and UTIs and GI infections, but has some covarage for G+.

That's why i Choose E... Correct me if i'm wrong please.

This questions i think covers, DKA knowledge of pathology, and treatment. And antibiotics.
yeah thats why i also said E..my doc will also be levoflox..for the wide spectrum antibiotic activity...and its safety is well valued of course only for depositon in tendons..
Reply With Quote Quick reply to this message
  #14  
Old 02-28-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

Quote:
Originally Posted by avash.nrs View Post
yeah thats why i also said E..my doc will also be levoflox..for the wide spectrum antibiotic activity...and its safety is well valued of course only for depositon in tendons..
I think its a tricky Q, because, to me sounds like strep pyogenes formed an abcess, but, it might be an anaerobic bacteria abcess for whatever reason making clindamycin the DOC. Still i think the answer is E... waiting for the confirmation
Reply With Quote Quick reply to this message
  #15  
Old 02-28-2012
alfjof's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 251
Threads: 56
Thanked 105 Times in 63 Posts
Reputation: 115
Send a message via Yahoo to alfjof
Default

D- K+ supplement + IV fluid + *clindamycin: *is only use in treatment of Bacteroides, clostridium p, and anaerobic infection; side effects: P colitis fever diarrhea: INCORRECT

E- K+ supplement + IV fluid + ***levofloxacin: ***CLX use Gram-, GI tracts, neisseria, some Gram+; some of you have been posted the side effects: CORRECT





Every good question for your real examen!!!!!!!!!!
__________________
Happy to Learn New Concept and Mechanism each Day
Reply With Quote Quick reply to this message
The above post was thanked by:
avash.nrs (02-28-2012), curiousmind (06-26-2012), Hitman (02-28-2012), LatinGeorge (02-28-2012)






Reply

Tags
Endocrine-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Diabetes treatment like diet and exercise! alfjof USMLE Step 1 Forum 16 08-30-2015 08:44 AM
ACE-I to prevent Diabetes? HaipengWang USMLE Step 1 Forum 1 10-06-2011 06:27 AM
type 2 diabetes usmleman2020 USMLE Step 1 Forum 8 08-12-2011 12:10 AM
Genetics of diabetes Tsveta USMLE Step 1 Forum 3 02-15-2010 03:15 PM
Cause of gestational diabetes cougars USMLE Step 2 CK Forum 1 08-28-2009 04:28 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)