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  #1  
Old 10-17-2011
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Lungs Diagnose this chest x ray and the lavage sample

A 43-year-old nonsmoking male was referred to the hospital for persistent fever, progressive dyspnoea. The patient complained of intermittent mild to moderate fever, progressive dyspnoea, increasing exportation and paroxysmal wheezing for 6 weeks. His past history was unremarkable, except for being HIV positive for 8 years. He was initially diagnosed as community acquired pneumonia in his local hospital, treated with intravenous levofloxacin, which was escalated to cephatriaxone when her symptoms worsened. Intravenous dexamethasone with aminophylline was administered irregularly to relieve his dyspnoea and wheezing. He developed orthopnoea with high fever and copious gel-like phlegm four weeks after the onset of symptoms, so he was transferred to the hospital. On admission, he displayed orthopnoea, cyanosis, finger clubbing and nonpitting edoema in the lower extremities. Vital signs: body temperature 38.8°C, HR 124 beats/min, respiratory rate 32 breath/min, and Bp 124/76 mmHg. Fine crackles were audible at both bases. CXR is shown below:

Diagnose this chest x ray and the lavage sample-chestxray.jpg
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Arterial blood gas analysis (nasal oxygen, 3 L/min): pH 7.42, PaO26.54 kPa, PaCO2 3.86 kPa. Bronchoalveolar lavage stained with toluidine blue is shown below:

Diagnose this chest x ray and the lavage sample-lavage-sample.jpg
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What is the most likely cause of this condition?

A) Klebsiella
B) Tuberculosis
C) Maycobacterium avium
D) Pneumocystis jiroveci
E) Cytomegalovirus
F) Staphylococcus aureus
G) Legionella
H) Histoplasmosis
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Old 10-17-2011
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MAC mycobacterium avium.
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Old 10-18-2011
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MAC
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  #4  
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Your answers are wrong... notice the clues in the question!
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Old 10-18-2011
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Quote:
Originally Posted by m82_ghasemi View Post
Your answers are wrong... notice the clues in the question!

Maybe 'D'...or I give up
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Pneumocystis <------- lavage stained with toluidine blue
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d) PCP - by x-ray and microscopy
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Pneumocystis jiroveci
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Its D.u have not answered ur previous post yet lung related.
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my answer is 'D'
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Correct Answer Answer

The correct answer is D. P. Jiroveci.

Pneumocystis jirovecii pneumonia: In CXR, there is increased opacification (whiteness) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia.


Staining with toluidine blue, silver stain or periodic-acid schiff or immunofluorescence assay, which will show characteristic cysts. The cysts resemble crushed ping-pong balls and are present in aggregates of 2 to 8.

The disease attacks the interstitial, fibrous tissue of the lungs, with marked thickening of the alveolar septa and alveoli and leading to significant hypoxia which can be fatal if not treated aggressively; therefore, LDH levels increase and gas exchange is compromised. Oxygen is less able to diffuse into the blood, leading to hypoxia. Hypoxia, along with high arterial carbon dioxide (CO2) levels, stimulates ventilation, thereby causing dyspnea.
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answer is d ....
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Microbiology-, Micrographs-, Pathology-, Radiographs-, Respiratory-, Step-1-Questions

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