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Old 12-15-2012
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Default Immunology

A 25-year-old man comes to the emergency department
because of a 1-month history of fever, chills, nonproductive
cough, and progressive shortness of breath; he now becomes
short of breath after walking 20 feet. He has had a 4.5-kg
(10-lb) weight loss during this period. He has not seen a
physician for 10 years, and he takes no medications. He has a
10-year history of intravenous heroin use and shares needles.
He is in mild respiratory distress while sitting. His
temperature is 38.6C (101.4F), pulse is 92/min, respirations
are 24/min, and blood pressure is 110/70 mm Hg. Pulse
oximetry on room air shows an oxygen saturation of 90%.
There is no jugular venous distention. Diffuse crackles are
heard bilaterally. There is no peripheral edema. An x-ray of
the chest shows diffuse interstitial infiltrates bilaterally. This
patient is most likely to have which of the following
immunologic abnormalities?
(A) Decreased B-lymphocyte count
(B) Decreased CD4+ T-lymphocyte count
(C) Decreased serum complement concentrations
(D) Decreased serum IgA concentration
(E) Decreased splenic opsonization
(F) IgG autoantibodies

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Old 12-15-2012
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decreased cd4 count..pcp pnemonia...
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(B) Decreased CD4+ T-lymphocyte count
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yes B.....
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Atypical Pneumonia (fever, chills, nonproductive cough, shortness of breath, 38.6C, Diffuse crackles are heard bilaterally, diffuse interstitial infiltrates bilaterally) + High risk of HIV (10-year history of intravenous heroin use and shares needles) = Most probably PCP in patient with CD4+ < 200 so ans B is correct
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B) Decreased CD4+ T-lymphocyte count
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