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  #1  
Old 09-15-2010
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Lungs Challenging Question #4

4) Match the most likely micro-organism with the clinical scenario:

A 35-year-old woman, recently returned from a hiking trip in Arizona, presents with low-grade fever, cough with minimum clear sputum production, and rash. She is otherwise healthy with no significant past medical history. She has been on treatment with albuterol for intermittent asthma and she does have seasonal allergies.

A) Coccidioides immitis
B) Measles virus (rubeola)
C) Mycobacterium tuberculosis
D) Mycoplasma pneumoniae
E) Histoplasmosis

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  #2  
Old 09-15-2010
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i'll go with A
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Old 09-15-2010
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Yeah Arizona is a buzzword for coccidiodes
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Old 09-15-2010
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A) Coccidioides immitis
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Old 09-16-2010
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Anyone care to give analysis or reasoning for choice A?
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Old 09-16-2010
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Default Reasoning

Quote:
Originally Posted by MedicalExams View Post
Anyone care to give analysis or reasoning for choice A?
The south west location, the pulmonary infection, the rash all pointing to Desert Fever (caused by coccidoides immitis)
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Old 09-16-2010
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I will go with A too
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Old 10-14-2010
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these are some keywords that existence of them in question stem will lead you to causative agent ;

1.travel to ohio or st .lawrence river valleys: histoplasma capsulatum
2.travel to southwestern united states: hantavirus,coccidioides
3.travel to southeast asia:burkholderia pseudomallei,avian influenza virus
4.stay in hotel or on cruise: legionella spp.
5.exposure to bats: histoplasma capsulatum
6.exposure to birds: chlamydophila psittaci
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Old 10-19-2010
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Hey guys I found the answer on their site.

The correct answer is Choice A.

The main clues in this question are a) the geographical location and b) the presence of a rash.

In Arizona, coccidioidal pneumonia (also called Valley Fever) accounts for around 18-29% of CAP cases. Getting a true estimate of the frequency is difficult because:

the case numbers in the studies to date have been small
paired sera are required and compliance can be poor
the sensitivity of serological testing is below 100%
many clinicians do not test for coccidioidal infection unless patients have failed to respond to conventional therapy
coccidioidal infection is often self-limiting, and so many antibiotic "successes" are really just the disease burning out
in many cases symptoms are extremely mild
The incidence appears to be rising (now 75-85 cases per 100,000 population per year), and is highest in Arizona (60% of USA symptomatic cases) and California. New tests such as urinary antigen detection are coming on-line. Symptoms vary from mild common cold symptoms to cough, fever and shortness of breath, typical of CAP. The presence of a rash is significantly more frequent than with most of the common bacterial causes of CAP.

Coccidioides immitis is a dimorphic fungus, and azoles (itraconazole > posaconazole > voriconazole) are the standard treatment, although lipid preparations of amphotericin B are also effective. There is some data to suggest that patients treated with antifungals are at higher risk of relapse after therapy stops, although these patients will generally have been more ill at the start.
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Old 01-23-2011
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But what if it was in an immunocomprimised patient?? would you still see the rash (since its an IC mediated rxn)????
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Infectious-Diseases, Internal-Medicine-, MedicalExams.com, Pulmonology-, Step-2-Questions

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