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that may prolong the QT interval
38%
31/82
that may cause tooth discoloration and inhibit bone growth in children
18%
15/82
that is known to cause nephrotoxicity and ototoxicity
30%
25/82
that may cause gray baby syndrome in premature infants
5%
4/82
that may cause a disulfiram like reaction when taken with alcohol
7%
6/82
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Suspect bordatella pertussis in an elderly patient or an infant with cough for greater than two weeks with no clear cause and a paroxysmal cough, inspiratory whoop, or post-tussive emesis. Treat with a macrolide, which may cause QT prolongation. Whooping cough is a severe form of bronchitis. It comes in three stages. In the catarrhal stage, there is severe congestion and rhinorrhea and the patient is most contagious. In the paroxysmal stage, coughing episodes begin and patients are most likely to present. Finally in the convalescent phase, the coughing decreases. The whole course of the illness may take 6-8 weeks. Diagnosis can be made from 1-4 weeks by cultures and/or PCR of nasopharyngeal secretions. Diagnosis after 4 weeks may be done with serology. Treat with a macrolide antibiotic if clinical suspicion high. Toxicities of macrolides include QT prolongation (especially erythromycin), GI discomfort, acute cholestatic hepatitis, and eosinophilia. Note that although the illness may be prevented with the DTaP immunization, immunity may wane. Kline et al. discuss the reemergence of Pertussis. Incidence has been increasing in recent years. Complications vary by age, with infants more likely to experience severe complications such as apnea, pneumonia, seizures, or death. In adolescents and adults, complications are the result of chronic cough. Although antibiotics have not shown clear effectiveness in the treatment of pertussis, they eradicate nasal bacterial carriage and may reduce transmission rates. Macrolide antibiotics such as azithromycin are first-line treatments to prevent transmission. Trimethoprim/sulfamethoxazole is an alternative in cases of allergy or intolerance to macrolides. Chiappini et al. note that a shift of cases from school-age children to adolescents, adults and children under 1 year of age has been described in the last decade, and mortality rates in infants are still sustained. Adolescent and/or adult vaccination seems to be cost-effective, however data from observational studies suggest that this vaccination strategy, used alone, leads to a reduced pertussis burden globally, but does not affect the disease incidence in infants. Illustration A depicts the classic butterfly pattern of pertussis on chest radiograph. The butterfly appearance is created by the perihilar infiltrate and edema caused by pertussis. Incorrect Answers: Answer 2: These toxicities are found in tetracyclines. Answer 3: These toxicities describe aminoglycosides. Answer 4: This toxicity is characteristic of chloramphenicol. Answer 5: This toxicity is characteristic of metronidazole.
4.8
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