tommyk
04-10-2006, 02:15 AM
Hy 2123 Thanks family, but I “donta wanta your money” as Dr. Goljan said to me. This HY will help you answer many many questions. Take it slow....;)
I truly, firmly believe that all education should be FREE. OPEN the mind please. Think of all your past deeds good and bad. They say that “We may think we are through with the past, but the past is not through with us.” Thus, I proclaim that all of us should live as if a tape recorder is going on, as in the movie “Gladiator”, Maximus says “All our actions echo through eternity.” If I can do even a “little” more “good” for God through my posts, that is thanks enough. If I accepted money, all my efforts would be harshly diminished in my point of view. I seek and want nothing material, maybe a nice prayer or two would be appreciated, but I am here to help as much as I can…J :) ;)
Q) So, here we go…A 45-year-old gent named Brussel Sprouts comes to you with a history of emphysema. He spends a 2-week vacation on a cruise ship in summer with a good air conditioning system.
Shortly after returning home, he develops high fevers and becomes lethargic and disoriented. His wife describes that he has been coughing and short of breath since returning home. She also describes that he has vomited several times over the past 48 hours and has had diarrhea.
On physical examination, he appears lethargic but arousable. He is disoriented to the current date. He has loud, coarse, rhonchi in both lung fields. His abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. His neurologic examination is nonfocal. Laboratory results are notable for an aspartate aminotransferase (AST) of 112 U/L and an alanine aminotransferase (ALT) of 157 U/L. What drug are you going to give? Think hard and have a 1st and 2nd choice!
Plus, with this history, think of at least one “bug” that he could have? Is this bug gram positive or gram-negative (VERY IMPORTANT). But first, give the drug from the list you will use to treat:
IV heroin
PO LSD
IV ceftazidime
IV penicillin
IV erythromycin
IV gentamicin
IV nafcillin
IV vancomycin
IV albuterol
IV steroids
Intubation, emergent.
a) Pick IV erythromycin for Legionella. (Note: This gram neg. blocks OUT penicillins). 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 and gentamicin are antibiotics effective against gram-negative organisms but are not used in treatment of Legionella. They grow well on buffered charcoal yeast extract agar, but it takes about five days to get sufficient growth. When grown on this medium, Legionella colonies appear off-white in color and circular in shape. Laboratory identification can also include microscopic examination in conjunction with a direct flourescent antibody (DFA) test. Legionella are Beta-lactamase +. Vancomycin is used in patients with staphylococcal infections that are resistant to the nafcillin. These drugs have no role in the management of Legionnaires disease. Think HARD about which bugs are gram positive and gram negative so you can answer the antibiotic choices with ease….:rolleyes: :cool:
I truly, firmly believe that all education should be FREE. OPEN the mind please. Think of all your past deeds good and bad. They say that “We may think we are through with the past, but the past is not through with us.” Thus, I proclaim that all of us should live as if a tape recorder is going on, as in the movie “Gladiator”, Maximus says “All our actions echo through eternity.” If I can do even a “little” more “good” for God through my posts, that is thanks enough. If I accepted money, all my efforts would be harshly diminished in my point of view. I seek and want nothing material, maybe a nice prayer or two would be appreciated, but I am here to help as much as I can…J :) ;)
Q) So, here we go…A 45-year-old gent named Brussel Sprouts comes to you with a history of emphysema. He spends a 2-week vacation on a cruise ship in summer with a good air conditioning system.
Shortly after returning home, he develops high fevers and becomes lethargic and disoriented. His wife describes that he has been coughing and short of breath since returning home. She also describes that he has vomited several times over the past 48 hours and has had diarrhea.
On physical examination, he appears lethargic but arousable. He is disoriented to the current date. He has loud, coarse, rhonchi in both lung fields. His abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. His neurologic examination is nonfocal. Laboratory results are notable for an aspartate aminotransferase (AST) of 112 U/L and an alanine aminotransferase (ALT) of 157 U/L. What drug are you going to give? Think hard and have a 1st and 2nd choice!
Plus, with this history, think of at least one “bug” that he could have? Is this bug gram positive or gram-negative (VERY IMPORTANT). But first, give the drug from the list you will use to treat:
IV heroin
PO LSD
IV ceftazidime
IV penicillin
IV erythromycin
IV gentamicin
IV nafcillin
IV vancomycin
IV albuterol
IV steroids
Intubation, emergent.
a) Pick IV erythromycin for Legionella. (Note: This gram neg. blocks OUT penicillins). 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 and gentamicin are antibiotics effective against gram-negative organisms but are not used in treatment of Legionella. They grow well on buffered charcoal yeast extract agar, but it takes about five days to get sufficient growth. When grown on this medium, Legionella colonies appear off-white in color and circular in shape. Laboratory identification can also include microscopic examination in conjunction with a direct flourescent antibody (DFA) test. Legionella are Beta-lactamase +. Vancomycin is used in patients with staphylococcal infections that are resistant to the nafcillin. These drugs have no role in the management of Legionnaires disease. Think HARD about which bugs are gram positive and gram negative so you can answer the antibiotic choices with ease….:rolleyes: :cool: