tommyk
10-05-2006, 08:02 AM
Hy 2414 On the last set of Step 1 tests… Micro…
A 50-year-old man named Clive Owen comes in diagnosed with a history of emphysema after a trip to Sin City, after a meeting at the The Convention of Cool Cats who are Super Sexy to da’ Ladies. Shortly after returning home, he develops high fevers and becomes lethargic and disoriented. His girlfriend describes that he has been coughing and short of breath since returning home (Start picturing the DIFFERENTIAL). 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 (What could this dx. Likely BE?). His abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. His neurologic examination is OK as well as his other organ systems. Laboratory results are notable for an aspartate aminotransferase (AST) of 130 U/L and an alanine aminotransferase (ALT) of 160 U/L. What disease does he have and what drug will you give???
1-IV ceftriaxone
2-IV erythromycin
3-IV gentamycin
4-IV nafcillin
5-IV vancomycin
a) pick #2, this is LEGIONNAIRES PNEUMONIA. This rather “cool dude” patient, who has just returned from ultra “cool” Sin City (or a very salacious site), 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 from the hotel Sin City Paradise. 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. I cannot wait personally for “Sin City II”…
A 50-year-old man named Clive Owen comes in diagnosed with a history of emphysema after a trip to Sin City, after a meeting at the The Convention of Cool Cats who are Super Sexy to da’ Ladies. Shortly after returning home, he develops high fevers and becomes lethargic and disoriented. His girlfriend describes that he has been coughing and short of breath since returning home (Start picturing the DIFFERENTIAL). 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 (What could this dx. Likely BE?). His abdominal examination reveals mild tenderness over the liver edge. There is no splenomegaly or ascites present. His neurologic examination is OK as well as his other organ systems. Laboratory results are notable for an aspartate aminotransferase (AST) of 130 U/L and an alanine aminotransferase (ALT) of 160 U/L. What disease does he have and what drug will you give???
1-IV ceftriaxone
2-IV erythromycin
3-IV gentamycin
4-IV nafcillin
5-IV vancomycin
a) pick #2, this is LEGIONNAIRES PNEUMONIA. This rather “cool dude” patient, who has just returned from ultra “cool” Sin City (or a very salacious site), 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 from the hotel Sin City Paradise. 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. I cannot wait personally for “Sin City II”…