A patient presents with severe ear pain, itching, and discharge from the ear. Upon examination, the external auditory canal is swollen and red. Which of the following is the most appropriate initial intervention for a patient diagnosed with otitis externa?

Choice A Reason:

Febrile non-hemolytic transfusion reactions (FNHTRs) are common and typically present with fever, chills, and sometimes rigors. However, they do not usually cause severe symptoms such as back pain and difficulty breathing. FNHTRs are generally less severe and are caused by the recipient’s immune response to donor white blood cells or cytokines in the transfused blood.

Choice B Reason:

Allergic reactions to blood transfusions can range from mild to severe. Mild reactions may include itching, hives, and rash, while severe reactions (anaphylaxis) can cause difficulty breathing and hypotension. However, allergic reactions do not typically cause back pain, which is more indicative of a hemolytic process.

Choice C Reason:

Fluid overload, also known as transfusion-associated circulatory overload (TACO), can occur when too much blood is transfused too quickly. Symptoms include dyspnea, hypertension, and pulmonary edema. While difficulty breathing is a symptom of fluid overload, chills and back pain are not typical features.

Choice D Reason:

Acute hemolytic transfusion reaction (AHTR) is the most likely cause of the patient’s symptoms. AHTR occurs when the recipient’s immune system attacks the transfused red blood cells, leading to their destruction. This reaction can cause severe symptoms such as chills, fever, back pain, and difficulty breathing. It is a medical emergency that requires immediate intervention to prevent serious complications, including kidney failure and shock.

Choice A Reason:

Weight loss is not typically associated with acromegaly. Acromegaly is characterized by excessive growth hormone production, leading to the enlargement of bones and tissues. Patients often experience weight gain rather than loss due to increased bone and soft tissue mass.

Choice B Reason:

Exophthalmos, or bulging eyes, is not a common manifestation of acromegaly. This symptom is more commonly associated with Graves’ disease, a thyroid disorder. Acromegaly primarily affects the bones and soft tissues, leading to changes in facial features and extremities.

Choice C Reason:

Thin and fragile hair is not a typical symptom of acromegaly. While hormonal imbalances can affect hair quality, acromegaly is more commonly associated with changes in bone and soft tissue structure. Symptoms like coarse, oily skin and excessive sweating are more characteristic of this condition.

Choice D Reason:

Enlarged hands and feet are hallmark signs of acromegaly. The excessive production of growth hormone leads to the enlargement of bones in the hands, feet, and face. Patients may notice that their rings no longer fit and that their shoe size has increased. This symptom is a key indicator of acromegaly and is often used in the diagnosis of the condition.