USMLE Forum Archives - USMLE Step 2 CK - Haematology question #1
Haematology question #1
revision - 12-30-08 12:26
You are treating a 42-year-old man with epistaxis in the emergency department. He was hit with a softball at the company picnic and the bleeding started immediately. He reports that he has had approximately 6 ounces of blood loss. Vital signs are normal. You control the epistaxis with placement of pre-made, specially designed sponges in each nasal cavity. Your plan is to leave those in place for 5-7 days until the patient can return for removal. The patient also should receive which of the following?
A. Antibiotics effective against gram-positive flora as prophylaxis against toxic shock syndrome
B. Broad-spectrum antibiotics to treat underlying infection, which plays a major role in epistaxis
C. Coagulation studies to rule out bleeding diathesis
D. CT scan to ensure that there is no neoplasm as the source of the bleeding
E. X-rays to rule out nasal fracture
revision - 12-30-08 12:26
You are treating a 42-year-old man with epistaxis in the emergency department. He was hit with a softball at the company picnic and the bleeding started immediately. He reports that he has had approximately 6 ounces of blood loss. Vital signs are normal. You control the epistaxis with placement of pre-made, specially designed sponges in each nasal cavity. Your plan is to leave those in place for 5-7 days until the patient can return for removal. The patient also should receive which of the following?
A. Antibiotics effective against gram-positive flora as prophylaxis against toxic shock syndrome
B. Broad-spectrum antibiotics to treat underlying infection, which plays a major role in epistaxis
C. Coagulation studies to rule out bleeding diathesis
D. CT scan to ensure that there is no neoplasm as the source of the bleeding
E. X-rays to rule out nasal fracture
Page 1
#1
Re: Haematology question #1 bingousmle - 12-30-08 12:30 i think that A. Antibiotics effective against gram-positive flora as prophylaxis against toxic shock syndrome should be the most appropriate choice.
#2
Re: Haematology question #1
revision - 01-01-09 14:30 The correct answer is A.
Specially designed sponges and catheters with inflatable balloons are used frequently in the control of epistaxis refractory to topical decongestants and conservative measures.
Because they are foreign bodies that remain in place for several days, there is the potential for colonization with Staphylococcus capable of producing toxic shock syndrome toxin. In fact, toxic shock syndrome has been reported from nasal packing.
All patients with nasal packing (even sponges specially designed for control of epistaxis) therefore should receive coverage with antibiotics directed at Staphylococcus.
Page 1