每日一题_2023.07.17

A 54-year-old white man presents for a routine preoperative assessment. Physical examination reveals that the man is unable to close his left eye completely or to seal the corner of his mouth on the left side. ECG reveals new atrioventricular heart block. The patient denies any recent changes in his health, but notes that he recently traveled to upstate New York for a camping trip. The patient is given a common medication to treat the underlying cause of his symptoms. What is a major adverse effect of this treatment in adults?

一名54岁白人男性前来接受常规术前评估。体格检查显示，该男子不能完全闭上他的左眼或封闭他的左嘴角。心电图显示新的房室传导阻滞。病人否认他最近的健康状况有任何变化，但指出他最近去了纽约州北部的一次露营旅行。给病人一种普通的药物来治疗引起症状的潜在原因。这种疗法对成人的主要不良影响是什么?

(A) Acute cholestatic hepatitis 急性胆汁淤积性肝炎

(B) Discoloration of teeth 牙齿变色

(C) Nephrotoxicity 肾毒性

(D) Ototoxicity 耳毒性

(E) Photosensitivity 光敏性

答案解析：

该患者患2期莱姆病，其特征是贝尔麻痹和新发心脏传导阻滞。Bell麻痹是由面神经下运动神经元损伤引起的，表现为患侧面神经麻痹，患侧不能闭眼或封闭嘴角。患者很可能是在最近去纽约北部露营时被硬蜱叮咬而感染莱姆病的。治疗莱姆病最常用的抗生素是多西环素。儿童光敏、胃肠道不适和牙齿变色是多西环素常见的不良反应。

正确答案：E