doc_clotaire
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A 21-year-old man comes to the clinic because he has become increasingly short of breath and has had a cough for the past week.
He appears dyspneic and has a temperature of 38.3EC (101.0EF). On physical examination he has bibasilar rales and generalized
lymphadenopathy (1 to 2 cm). Rectal examination shows multiple perianal contusions and a small amount of blood oozing from the
anal orifice. Chest x-ray film shows bilateral patchy alveolar infiltrates. The most appropriate course of action is to order blood tests
and to do which of the following?
A) Admit him to the hospital and begin administration of trimethoprim-sulfamethoxazole, intravenously
(B) Admit him to the hospital and begin administration of penicillin and gentamicin, intravenously
(C) Begin administration of erythromycin, orally, and see him again the next day
(D) Prescribe isoniazid and rifampin, orally
(E) Recommend aspirin, fluids and rest at home
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| doyoudig
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A) Admit him to the hospital and begin administration of trimethoprim-sulfamethoxazole, intravenously
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| dr.wad
Forum Senior
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A_ pneumocystis carinii ......
the patient has AIDS >>>>>lymphadenopathy ,perianal contusions indicate homosexuality.
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| new_n_lost
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dr.wad wrote:
A_ pneumocystis carinii ......
the patient has AIDS >>>>>lymphadenopathy ,perianal contusions indicate homosexuality.
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| Justice
Forum Fanatic
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Of course (A) Admit him to the hospital and begin administration of trimethoprim-sulfamethoxazole, intravenously
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| doc_clotaire
Forum Guru
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The correct answer is A.
The history and physical in this 21-year-old man raises the
possibility of HIV infection. There is a strong suggestion of homosexuality, given that the
rectal examination demonstrates multiple perianal contusions and blood oozing from the
anal orifice. Furthermore, this man has generalized lymphadenopathy; his chief complaint
is of pulmonary distress with an x-ray consistent with Pneumocystis carinii pneumonia.
Since the patient has become increasingly short of breath and is febrile, he should be
treated with intravenous therapy.
There is nothing here to suggest the possibility of a gram-negative pneumonia, so
gentamicin (choice B) is wrong.
The use of oral erythromycin (choice C) might be appropriate in a patient in whom
Mycoplasma pneumonia is suspected; however, as described above, the strong suspicion
of HIV infection makes this a less likely diagnosis than pneumocystis.
Isoniazid and rifampin (choice D) is not indicated in this case because the findings are
more consistent with Pneumocystis carinii pneumonia than with tuberculosis.
Aspirin, fluids, and rest (choice E) are inappropriate management for this patient with
Pneumocystis carinii pneumonia
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