10-19-2009, 12:17 PM
sorry for being late
The correct answer is
D. This is an HIV patient with signs of a pulmonary infection and a chest radiograph suggesting a pulmonary process. The concept underlying this question is two-fold. First, HIV patients suffer from atypical infections and second, one of the more common organisms, Pneumocystis carinii can present with ANY RADIOGRAPHIC finding. Once these concepts are understood, the course of action is immediately clear, begin the appropriate intravenous therapy. Given that this patient has a room air oxygen saturation of less than 75%, steroids are indicated. Steroids are only given if the question of adrenal insufficiency, a common complication of HIV, is suspected.
Oral INH, rifampin, pyrazinamide, ethambutol (choice A) would be appropriate for the treatment of tuberculosis. We have yet to see any data that this patient also has T
B. We would need to see sputum positive for AFB staining or a positive AFB PCR on sputum.
Intravenous trimethoprim-sulfamethoxazole (choice B) is not the indicated therapy for PCP pneumonia when oxygen saturation is less than 75% on room air.
Intravenous azithromycin (choice C) is the incorrect antibiotic. In an otherwise healthy 37-year-old, the likely diagnosis would be atypical community-acquired pneumonia, for which azithromycin might be useful. In an HIV patient however, this is incorrect.
Intravenous amphotericin B (choice E) is not appropriate since we have no suspicion of a fungal infection in this patient.
The correct answer is
D. This is an HIV patient with signs of a pulmonary infection and a chest radiograph suggesting a pulmonary process. The concept underlying this question is two-fold. First, HIV patients suffer from atypical infections and second, one of the more common organisms, Pneumocystis carinii can present with ANY RADIOGRAPHIC finding. Once these concepts are understood, the course of action is immediately clear, begin the appropriate intravenous therapy. Given that this patient has a room air oxygen saturation of less than 75%, steroids are indicated. Steroids are only given if the question of adrenal insufficiency, a common complication of HIV, is suspected.
Oral INH, rifampin, pyrazinamide, ethambutol (choice A) would be appropriate for the treatment of tuberculosis. We have yet to see any data that this patient also has T
B. We would need to see sputum positive for AFB staining or a positive AFB PCR on sputum.
Intravenous trimethoprim-sulfamethoxazole (choice B) is not the indicated therapy for PCP pneumonia when oxygen saturation is less than 75% on room air.
Intravenous azithromycin (choice C) is the incorrect antibiotic. In an otherwise healthy 37-year-old, the likely diagnosis would be atypical community-acquired pneumonia, for which azithromycin might be useful. In an HIV patient however, this is incorrect.
Intravenous amphotericin B (choice E) is not appropriate since we have no suspicion of a fungal infection in this patient.