que---2 - targt250

[ArchivalUser]

A 26-year-old man with HIV and a history of
intravenous drug use presents to the emergency
department with 5 days of low-grade fever,
nonproductive cough, and dyspnea on exertion
that progressed to dyspnea at rest. His
oxygen saturation is 88% on room air. Arterial
blood gas analysis shows an arterial-alveolar
gradient of 45 and arterial oxygen pressure of
65 mm Hg. X-ray of the chest reveals diffuse
bilateral infi ltrates. Which of the following is
the most appropriate treatment?
(A) Ampicillin + gentamicin
(B) Intravenous clindamycin
© Isoniazid + pyrazinamide + rifampin +
ethambutol
(D) Third-generation cephalosporin +
doxycycline
(E) Trimethoprim-sulfamethoxazole +
oral prednisone
(F) Dapsone+doxycycline
(G) IV Atrovaquone

[ArchivalUser]

E. TMP-SMZ and steroids for PCP

[ArchivalUser]

EE. Pneumocystis jirovecii

[ArchivalUser]

Cant it be A for Infective endocarditis in IV drug abuser as he had dyspnea on exertion..!

[ArchivalUser]

I agree E...bc they want us to think that IV drug user means that he probably has HIV...and @hz28...yes he bc he's a IV drug user he can get infective endocarditis...but the question doesn't talk about IE...if it were IE it would mention a new murmur reflecting that this is IE...

Rather here the finding of the CXR and the A-a gradient n all point more towards a pulmonary pathology... and if u put a IV drug user and pulmo together then the only thing that comes to mind in PCP...

[ArchivalUser]

EEE

[ArchivalUser]

E) Trimethoprim-sulfamethoxazole +
oral prednisone

[ArchivalUser]

ans is e

[ArchivalUser]

E- TMP/SMX best initial therapy
Steroids to decrease mortality if the PCP is SEVERE(pO2 below 70 or A-a gradient >35)

[ArchivalUser]

Thank you