I am not sure about the answer

[Unregistered101]

A homeless 38 yr-old man has a 3-month history of decreased appetite, generalized wasting, a low-grade fever, and worsening cough productive of blood, mucopurulent sputum. He has a 3-yr history of alcohol abuse. X-ray films of the chest show consolidation and cavitary lesions in the apices of the lungs. Which of the following is the most likely inflammatory and/or immune response in the lung?

A. Endothelial cell proliferation, vascular budding, fibroblasts
B. Epithelioid cells, multinucleated giant cells, caseation necrosis
C. Fibroblasts, Collagen deposition, replacement of intrinsic tissue
D. Macrophages, lymphocytes, hypergammaglobulinenia
E. Neutrophils, vascular congestion, exudate

[superoxide]

A homeless 38 yr-old man has a 3-month history of decreased appetite, generalized wasting, a low-grade fever, and worsening cough productive of blood, mucopurulent sputum. He has a 3-yr history of alcohol abuse. X-ray films of the chest show consolidation and cavitary lesions in the apices of the lungs. Which of the following is the most likely inflammatory and/or immune response in the lung?

A. Endothelial cell proliferation, vascular budding, fibroblasts
B. Epithelioid cells, multinucleated giant cells, caseation necrosis
C. Fibroblasts, Collagen deposition, replacement of intrinsic tissue
D. Macrophages, lymphocytes, hypergammaglobulinenia
E. Neutrophils, vascular congestion, exudate


this dude has TB I think the answer is (B)

[Unregistered101]

I think that this is a case of absess formation. Hence E will make sense. I am not sure...

[wcb22]

answer is b, he has TB

[IMG SURVIVOR]

Quick review remember that:
aspergillous
TB
Klebsiella
Histoplasmosis

can give you a cavitary lesion

[superoxide]

Quick review remember that:
aspergillous
TB
Klebsiella
Histoplasmosis

can give you a cavitary lesion

true. i was thinking that this guy has klebsiella, but a person with klebsiella would not have generalized wasting/decreased appetite. am i right?

[jameslynton]

Think Goljan - what would he say? The person is young for and Et-oh abuser

Wasting - chances are HIV or HIV with TB - what are the bodies response in the lungs to these stressor??? Alcohol in the mix also - Rule out - Histoplasmosis - no exposure to bird or bat poop. Klebsiella - ie same as E. Coli in the lungs - fat chance the person aperated poop. Sounds like
"E. Neutrophils(mucus) , vascular congestion, exudate (blood)" These would give "cough productive of blood, mucopurulent sputum". Yea - I maybe way off base here. Let keep this one going....

[caldje]

most definately klebsiela.

Think about this... in this questions

(a) was there anything specific to indicate TB in the history?
(b) was the anything specific to indicate klebsiella? (yes, ETOH)

clinically this patient could have either. I'd go with kelbsiella since history points us in that direction. Not to mention most questions with TB mention night sweats. ;-)

[superoxide]

most definately klebsiela.

Think about this... in this questions

(a) was there anything specific to indicate TB in the history?
(b) was the anything specific to indicate klebsiella? (yes, ETOH)

clinically this patient could have either. I'd go with kelbsiella since history points us in that direction. Not to mention most questions with TB mention night sweats. ;-)

yes, there is. it mentions that this person is homeless (TB is common among homeless/low socioeconomic status)...maybe i'm reading too much into the question??:rolleyes:

[st_55]

i agree with superoxide...it says that the lesion is located in apices of the lung which is the primary place that tb likes to hang out. klebsiella usually affects the fissures of the lung

[st_55]

i agree with superoxide. the question says that the lesion or consolidation is at the apices of the lung...tb usually hangs out it the apices of the lung. klebsiella usually affects the fissures of the lung.

[dr41]

Oh , he has TB for sure so the answer is B :)

[caldje]

according to emedicine, klebsiella hangs out in the apices as well.

eMedicine Clinical Knowledge Base (http://www.emedicine.com) do a search.

[confusedstudent7]

i thought kleibisella effected the upper lobe of the lungs as well?

[jameslynton]

yes, there is. it mentions that this person is homeless (TB is common among homeless/low socioeconomic status)...maybe i'm reading too much into the question??:rolleyes:I think you got it right - at age 35 and ET-OH abuse - most likely a manic depressive - most homeless use ET-OH to moderate/self medicate bipolar disorder - think studies of young homeless show between 25-40% are bipolar and abuse ET-OH. They also tend to have unprotected sex - so there is underlying HIV - opens up body to TB as a secondary infection. The wasting clue is seen in both TB and HIV.

[Captainwada]

you guys!!! its obvious!! its TB
1. generalized weight loss, low grade fever, homeless, productive cough, APEX CAVITY!!!!! TB is aerobic!! it loves oxygen!!! this is secondary TB, look it up anywhere!!
Besides, if it were klebsiella (my 2nd choice) it would say...blood tinged "currant jelly" sputum....
Answers anything w/ caseous necrosis & epithelioid cells