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  #1  
Old 10-18-2011
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Question Pneumonia Q3?

A 40-year-old man was admitted with fever, nonproductive cough, bilateral pulmonary infiltrates, and worsening hypoxemia. Five weeks earlier, he returned from a trip to Arizona and 2 weeks thereafter developed initial symptoms of fever, nonproductive cough, and night sweats. A pruritic and painful rash on his trunk developed 10 days before admission, prompting his local physician to prescribe a brief course of oral prednisolone. The rash improved but his respiratory symptoms worsened and prompted admission to the hospital. Initial examination included an oral temperature of 99.5 F, a resting room air pulse oximetry saturation of 84%, and bibasilar rales. The earlier rash had resolved. Initial laboratory showed white blood cell count 12,400 with 81% neutrophils. The chest radiograph and CT scan showed bilateral infiltrates with signs of consolidation. His early hospital course was characterized by worsening hypoxemia, such that by day 4, he required an FIO 2 of 0.50 by face mask to achieve a pulse oximetry saturation of 92%. Bronchoscopy on hospital day 5 showed 1,950 white blood cells/μl with bronchoalveolar lavage showing 30% eosinophils and 65% lymphocytes. Transbronchial biopsy pathology stained with Methenamine silver is shown below:

What is the most appropriate treatment for this patient?
A- Ampicillin
B- Flucanazole
C- Tetracycline
D- TMP-SMX
E- Cephalosporin
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  #2  
Old 10-18-2011
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I would say Fluconazole.
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  #3  
Old 10-18-2011
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Quote:
Originally Posted by m82_ghasemi View Post
A 40-year-old man was admitted with fever, nonproductive cough, bilateral pulmonary infiltrates, and worsening hypoxemia. Five weeks earlier, he returned from a trip to Arizona and 2 weeks thereafter developed initial symptoms of fever, nonproductive cough, and night sweats. A pruritic and painful rash on his trunk developed 10 days before admission, prompting his local physician to prescribe a brief course of oral prednisolone. The rash improved but his respiratory symptoms worsened and prompted admission to the hospital. Initial examination included an oral temperature of 99.5 F, a resting room air pulse oximetry saturation of 84%, and bibasilar rales. The earlier rash had resolved. Initial laboratory showed white blood cell count 12,400 with 81% neutrophils. The chest radiograph and CT scan showed bilateral infiltrates with signs of consolidation. His early hospital course was characterized by worsening hypoxemia, such that by day 4, he required an FIO 2 of 0.50 by face mask to achieve a pulse oximetry saturation of 92%. Bronchoscopy on hospital day 5 showed 1,950 white blood cells/μl with bronchoalveolar lavage showing 30% eosinophils and 65% lymphocytes. Transbronchial biopsy pathology stained with Methenamine silver is shown below:

What is the most appropriate treatment for this patient?
A- Ampicillin
B- Flucanazole
C- Tetracycline
D- TMP-SMX
E- Cephalosporin

Looks like we have Pneumocystis again.The rx would be TMP-SMX.
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  #4  
Old 10-18-2011
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Quote:
Originally Posted by doc Mm View Post
Looks like we have Pneumocystis again.The rx would be TMP-SMX.
Pneumonia + Arizona + rash + spherules in biopsy --> Coccidiomycosis --> Rx: Fluconazole
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  #5  
Old 10-19-2011
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Quote:
Originally Posted by Evergreen View Post
Pneumonia + Arizona + rash + spherules in biopsy --> Coccidiomycosis --> Rx: Fluconazole

Oops! I believe you are right..If only I could be more careful and stop rushing through when reading questions...
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  #6  
Old 10-21-2011
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B- Flucanazole
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