Property:AnswerAExp
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<font color="red">'''Incorrect.'''</font>- Thyroid scan by I<sup>131</sup> is used to detect the activity of thyroid masses, like differentiating the hot nodules from cold nodules. It is used in diagnostic evaluation for the thyroid masses, especially when there is associated clinical hypothyroidism or hyperthyroidism. There is no role of thyroid scan in this case. +
<font color="green">'''Correct.'''</font>- The edrophonium (Tensilon) is the first bed side test to be performed is such a case. This test should be used only in those patients with obvious ptosis or ophthalmoparesis, in whom improvement after infusion of the drug can easily be observed. +
Incorrect
The rapid progression of acute cases necessitates the start of empirical treatment antibiotic therapy once the blood cultures have been collected +
Correct
Antibiotic therapy for subacute hemodynamically stable disease, and in those who have received antibiotics recently can be delayed waiting for the results of blood cultures, as this delay allows an additional blood cultures without the confounding effect of empiric treatment. +
Correct
Intravenous penicillin G sodium is the recommended 1st line of therapy according to the American Heart Association guidelines. +
Incorrect
According to AHA recommendations, a compination of gram positive and gram negative antibiotics (intravenous penicillin G sodium+ gentamicin sulfate), should be used in resistant viridans group streptococci. +
Repeating the echocardiography will not add any new information to the case. On the other hand, colonoscopy is important to exclude any source of infection in the colon, that usually accompany streptococcus bovis endocarditis. +
Incorrect
The patient blood pressure is borderline, instead hyponatremia lead to increased water shifting into the brain, resulting in cerebral edema. +
Incorrect
Hypotonic saline infusion will increase the hyponatremia degree and worsen the case. +
Lorazepam is not given in Tricyclic antidepressant poisoning. There are no indications to prescribe lorazepam in an acute setting except when the patient has uncontrollable and refractory seizures. +
HAART is not indicated in the treatment of CMV retinitis. It is indicated for treatment of HIV . The patient has HIV since 5 years and doesn't have any other complaints. Hence HAART is not indicated now . It may be started in combination to treatment of CMV . +
After treating the patient with ganciclovir or foscarnet the patient should be started on valganciclovir for maintenance therapy. +
The main symptom of vestibular neuronitis is vertigo, which appears suddenly, often with nausea and vomiting. This can be made worse by head movement. Vertigo usually lasts for several days or weeks. In rare cases it can take months to go away entirely. Vestibular neuronitis does not lead to loss of hearing. A common indication is horizontal nystagmus with the fast beat towards the healthy ear. The main differentiating factor is that vestibular neuronitis stays for weeks whereas BPPV lasts for few seconds. +