04-01-2008, 12:12 PM
whats the ans pacemaker ,thanks...i stick to bb.
|
a 16 - pacemaker
|
04-01-2008, 12:12 PM
ok....waiting to read the answer, i dont know it.
04-01-2008, 12:21 PM
The correct answer is E. This patient has cat-scratch disease,
a self-limited infection caused by Bartonella henselae. Symptoms can vary from mild to severe and may include malaise, anorexia, fever, and headache. Three quarters of cases occur between September and March. Most patients give a history of exposure to a cat, although other small animals also may be the reservoir. 18 USMLE Step 2 Assessment Exam 19 Within 3 to 10 days, a small papule, pustule, or vesicle appears at the site of injury. A week later, edema and tenderness develop in regional lymph nodes. Untreated, the disease resolves spontaneously in 2 to 5 months except in severely immunocompromised individuals such as those with AIDS. Diagnosis is established through clinical presentation, increasing titers of antibodies, or histopathologic evaluation of tissue stained with the Warthin-Starry technique. Treatment is supportive, except in immunosuppressed individuals who require antibiotics. A nasopharyngeal swab for culture (choice A) would not help to establish the diagnosis of cat-scratch disease because the microorganisms are not present in nasopharyngeal secretions. Infection is the result of direct inoculation into the skin. Needle biopsy of the lymph nodes (choice B) is not indicated, because the diagnosis can be established based on clinical presentation and increasing serum antibody titers to Borrelia henselae. Although the diagnosis of cat-scratch disease most commonly is made based on history of contact with an animal and clinical presentation, it should be confirmed either by increasing serum antibody titers or specially stained tissue sections from biopsy of a skin lesion. It is therefore incorrect that no further studies are indicated (choice C). Radiography of the head and neck (choice D) would be noncontributory in establishing the diagnosis, as it would show only soft tissue swelling at the site of the enlarged lymph nodes. |
| « Next Oldest | Next Newest » |