→ castlen4:這題這樣申覆感覺滿有機會 08/05 16:58
※ 引述《bathape (Vesalius)》之銘言：
: 有關「急性淚囊炎(acute dacryocystitis)」的敘述，何者錯誤？
: 考選部給C，儘早施行淚囊灌洗術及淚囊探針術
: Rakel: Textbook of Family Medicine, 7th ed.
: Chapter 53 – Ophthalmology
: Earl R. Crouch Jr. Eric R. Crouch Thomas Grant
: Acute Dacryocystitis
: Neonates may present with acute dacryocystitis, an inflammation of the
: lacrimal sac ( Fig. 53-4 ). Pain, tearing, redness, and discharge usually
: occur. If the child is febrile, culture testing and Gram staining should
: carried out. S. pneumoniae and S. aureus are the most common pathogens.
: Systemic antibiotics are indicated for the acute stage. The ophthalmologist
: should be consulted immediately, because irrigation and probing may be
: necessary to establish drainage as quickly as possible. Severe cases may
: progress to a dacryocystocele, sepsis, meningitis, or even death, especially
: in young infants.
: 希望有人能補充眼科 textbook的資料
: 最後，本題推無正確解答，建議送分
不利的:
資料來源: http://emedicine.medscape.com/article/1210688-treatment
‧Purulent infection of the lacrimal sac and skin should be treated
similarly. Hospitalization is not mandatory unless the patient's condition
appears serious.
oTreatment with oral antibiotics (eg, Augmentin) is appropriate.
oCultures of the lacrimal fluid should be obtained. The presence of a
lacrimal sac mucocele in adults mandates treatment even if asymptomatic.
oThe treatment of choice is a dacryocystorhinostomy whether the patient is
symptomatic or not. [Probing should not be performed because mucoceles often
are not sterile and probing may incite a cellulitis.]
當然,這個不會放上去......
Acute Dacryocystitis
Neonates may present with acute dacryocystitis, an inflammation of the
lacrimal sac ( Fig. 53-4 ). Pain, tearing, redness, and discharge usually
occur. If the child is febrile, culture testing and Gram staining should
carried out. S. pneumoniae and S. aureus are the most common pathogens.
Systemic antibiotics are indicated for the acute stage. [The ophthalmologist
should be consulted immediately, because irrigation and probing may be
necessary to establish drainage as quickly as possible.] Severe cases may
progress to a dacryocystocele, sepsis, meningitis, or even death, especially
in young infants.
資料來源:www.uptodate.com Nasolacrimal duct obstruction (dacryostenosis)
Acute dacryocystitis — Acute dacryocystitis is indicated by erythema,
swelling, warmth, and/or tenderness of the lacrimal sac. Acute dacryocystitis
can be complicated by preseptal or orbital cellulitis, sepsis, or meningitis
and should be treated promptly with systemic antibiotics. (See appropriate
topic reviews).
Infants and children with acute dacryocystitis should be managed in
consultation with an ophthalmologist. [If NLD probing is to be performed,
preoperative antibiotics should be considered.] The most common organisms
isolated from children with acute dacryocystitis include alpha-hemolytic
streptococci, Staphylococcus epidermidis, and Staphylococcus aureus [21].
申覆理由:選項C-應儘早施行淚囊灌洗術及淚囊探針術(並沒有提到without antibiotics)
建議全部送分
(我猜probe本身不是一個問題,沒有給perop antibiotics才是!!)
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