USMLE Forum Archives - USMLE Step 2 CK - IM 31
IM 31
TheOne - 02-07-07 21:20
A 55-year-old woman with a history of emphysema spends a 10-days vacation on a cruise ship. Shortly after returning home, she develops high fever and becomes lethargic and disoriented. Her husband describes that she has been coughing and short of breath since returning home. he also describes that she has vomited several times over the past 24 hours and has had diarrhea. On physical examination, she appears lethargic but arousable. Disoriented to the current date. She has loud, coarse, rhonchi in both lung fields. Her abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. Her neurologic examination is nonfocal. Laboratory results are notable for an AST of 123 U/L and an ALT of 166 U/L. Which of the following is the most appropriate treatment for this patient?
A. IV ceftazidime
B. IV erythromycin
C. IV gentamicin
D. IV nafcillin
E. IV vancomycin
TheOne - 02-07-07 21:20
A 55-year-old woman with a history of emphysema spends a 10-days vacation on a cruise ship. Shortly after returning home, she develops high fever and becomes lethargic and disoriented. Her husband describes that she has been coughing and short of breath since returning home. he also describes that she has vomited several times over the past 24 hours and has had diarrhea. On physical examination, she appears lethargic but arousable. Disoriented to the current date. She has loud, coarse, rhonchi in both lung fields. Her abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. Her neurologic examination is nonfocal. Laboratory results are notable for an AST of 123 U/L and an ALT of 166 U/L. Which of the following is the most appropriate treatment for this patient?
A. IV ceftazidime
B. IV erythromycin
C. IV gentamicin
D. IV nafcillin
E. IV vancomycin
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#3
Re: IM 31
TheOne - 02-22-07 15:23 Explanation: The correct answer is B. This patient, who has just returned from a cruise, has developed symptoms of toxicity in association with confusion, pulmonary findings, gastrointestinal complaints, and liver function test abnormalities. This should suggest the diagnosis of Legionnaires pneumonia, which she acquired through the ventilation system on the ship. These patients may appear quite toxic, and immediate initiation of therapy is essential since diagnosis using direct fluorescent antibody assays may take several days. Sputum Gram's stain in these patients is usually unrevealing of the Legionella pneumophila organism.
Ceftazidime (choice A) and gentamicin (choice C) are antibiotics effective against gram-negative organisms but are not used in treatment of Legionella.
Vancomycin (choice E) is used in patients with staphylococcal infections that are resistant to the nafcillin (choice D) family of antibiotics. These drugs have no role in the management of Legionnaires disease.
#4
Re: IM 31 ammulufy - 07-06-10 21:45 The features are consistent wid Legionnaire's Pneumonia.....derfore I wud like to go wid IV erythromycin.
#5
Re: IM 31 babbu5508 - 07-06-10 22:56 B. IV erythromycin is the drug of choice for legionnaire's pneumonia suspected because the patient has respiratory symptoms with other atypical symptoms.
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