new_n_lost
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A 41-year-old man with a 10 kg weight loss over the past 3 months now has had worsening fever, non-productive cough, and dyspnea for the past 3 days. His temperature is 38.2 C and there are diffuse rales in both lungs on auscultation. A chest radiograph shows patchy infiltrates in both lungs. Laboratory studies show a WBC count of 3250/microliter with differential of 78 segs, 3 bands, 5 lymphs, 11 monos, 2 eosinophils, and 1 basophil, Hgb 13.8 g/dL, Hct 41.4%, MCV 91 fL, and platelet count 317,000/microliter. His CD4 lymphocyte count is 79/microliter. Cryptosporidium organisms are found in a stool specimen. A bronchoalveolar lavage is performed, yielding fluid that microscopically demonstrates pink, foamy exudate with little inflammation. Which of the following additional findings on microscopic examination is he most likely to have in the BAL specimen?
A Acid fast bacilli
B Branching septate hyphae
C Multiple cysts with GMS stain
D Hemosiderin-laden macrophages
E Short gram positive rods
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| pasteur000
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Isn't it A. AFB and this pt. is a HIV + pt?
Edited by pasteur000 on 02/22/07 - 01:59 PM
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| bangledoc
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C
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| unique1
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C . The patient has Pneumocystis Pneumonia.
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| pasteur000
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Well, That is what my initial answer was. I changed it to A. Atypical TB. Patchy infiltrates - why not TB?
unique1 wrote:
C . The patient has Pneumocystis Pneumonia.
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| unique1
InGodITrust
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What is the right answer NNL ?
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| new_n_lost
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Yup Unique its C u r right
He is most likely to have Pneumocystis carinii pneumonia in association with the acquired immunodeficiency syndrome. PCP has an exudate composed of the Pneumocystis cysts and trophozoites with little accompanying inflammation. The clinical findings in this case are typical as well.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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