A 54-Year-Old Woman Comes to the Office Due to a Slow-Growing

question 720

Multiple Choice

A 54-year-old woman comes to the office due to a slow-growing, painless mass in the right submandibular region.  The patient had a right molar extraction for severe tooth decay 2 months ago and soon thereafter developed swelling of the right jaw.  There was no pain or fever so she did not seek medical attention.  The swelling slowly worsened and 3 days ago began draining a thick yellow discharge.  The patient has a history of poorly controlled type 2 diabetes mellitus.  Temperature is 37.2 C (99 F) , blood pressure is 134/78 mm Hg, pulse is 88/min, and respirations are 18/min.  Physical examination shows a 4x4 cm, firm, nontender, indurated mass below the angle of the right mandible with erythematous overlying skin.  Palpation expresses serosanguineous fluid with small yellow granules through a small defect in the center of the lesion.  There is no crepitus.  Anaerobic culture of the needle aspirate grows filamentous gram-positive rods with rudimentary branching.  Which of the following is the best initial treatment for this patient?

• A)Amphotericin B
• B)Azithromycin
• C)Fluconazole
• D)Isoniazid, rifampicin, pyrazinamide, and ethambutol
• E)Metronidazole
• F)Penicillin
• G)Trimethoprim-sulfamethoxazole

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Definitions:

Mandated Membership

Refers to the requirement for an individual to join a specific group or organization, often as a part of a legal or organizational mandate.

Stable Membership

A characteristic of groups or organizations where the participation or affiliation of its members remains fairly constant over time, contributing to continuity and stability.

Orienting Members

The act of introducing and acclimatizing new participants to the objectives, procedures, and norms of a group.

Group Procedures

Encompasses the methods, rules, and protocols followed by a group to achieve its objectives and manage its operations.