Test your medicine knowledge: 40-year-old man with headache and epistaxis

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is admitted to the emergency department with a 1-day history of headache and epistaxis. He has had type 1 diabetes mellitus requiring insulin for 30 years and two episodes of ketoacidosis in the past year. On physical examination, temperature is 36.0 °C (96.8 °F), blood pressure is 100/70 mm Hg, pulse rate is 120/min, and respiration rate is 22/min. There is mild proptosis of the right eye with periorbital edema and a black eschar on the inferior turbinate of the right nostril. Skin examination shows no other lesions. The remainder of the examination is normal. Laboratory studies are consistent with diabetic ketoacidosis. Blood cultures are negative. A chest radiograph is normal. CT of the head reveals mild proptosis of the right eye and right ethmoid and maxillary sinusitis with bony erosion. Intravenous amphotericin B is instituted. In addition to treatment of this patient’s diabetic ketoacidosis and institution of antifungal therapy, which of the following is the most important next step in treatment? A. Add piperacillin-tazobactam B. Add posaconazole C. Administer hyperbaric oxygen treatment D. Perform surgical debridement Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs