USMLE Forum Archives - USMLE Step 2 CK - infectious
infectious
Sarahhh - 02-03-08 20:46
A 52-yr-old patient with a history of emphysema spends a two-week vacation on a cruise
ship. Shortly after returning home he becomes lethargic, disoriented and has fever. His
wife describes that he is short of breath and has been coughing since his return to
home, she also describes that he vomited several times in the last 48-hours and has had
diarrhea. On physical examination he appears lethargic but arousable, oriented to
current date, he has loud ronchi in both lung fields. His abdominal examination reveals
mild tenderness over the liver edge, there is no splenomegaly or ascites. His neurological
examination is non-focal. Lab results are notable for AST 112 U/L and ALT 157 U/L.
Which of the following is the most appropriate treatment for this patient.
A. IV ceftazidime.
B. IV erythromycin.
C. IV gentamycin.
D. IV nafcillin.
E. IV vancomycin.
Sarahhh - 02-03-08 20:46
A 52-yr-old patient with a history of emphysema spends a two-week vacation on a cruise
ship. Shortly after returning home he becomes lethargic, disoriented and has fever. His
wife describes that he is short of breath and has been coughing since his return to
home, she also describes that he vomited several times in the last 48-hours and has had
diarrhea. On physical examination he appears lethargic but arousable, oriented to
current date, he has loud ronchi in both lung fields. His abdominal examination reveals
mild tenderness over the liver edge, there is no splenomegaly or ascites. His neurological
examination is non-focal. Lab results are notable for AST 112 U/L and ALT 157 U/L.
Which of the following is the most appropriate treatment for this patient.
A. IV ceftazidime.
B. IV erythromycin.
C. IV gentamycin.
D. IV nafcillin.
E. IV vancomycin.
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#2
Re: infectious radhamesramos - 02-04-08 11:56 B. Always begin with a macrolide for atypical pneumonias. Since this patient is an emphysematous, try IV and going to hospitalisation
#3
Re: infectious
Sarahhh - 02-05-08 07:59 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 he 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 gramnegative
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.
#6
Re: infectious bingousmle - 06-30-10 16:58 the patient should be given erythomycin as it is the imp drug of choice in an atypical pneumonia where legionnaires disease is suspected ...
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