cirus
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48) A 37-year-old woman with HIV, last CD4 count 390/mm3 and last viral RNA copy number 120,000 copies/mL, presents to the medical walk-in clinic with cough, fever and shortness of breath. The patient has been well and has been compliant with her triple drug therapy. She reports that 3 weeks ago, she began to experience increasing shortness of breath and developed a non-productive cough. Over the past few weeks, both of these complaints have gradually worsened. She also reports fevers to 103 degrees F over the past few days. On examination, her blood pressure is 130/70 mm Hg, pulse is 90/min, and oxygen saturation on room air is 71%. Her lungs have diffuse crackles, no egophony and no dullness to percussion. The rest of her examination is unremarkable. A chest radiograph shows diffuse interstitial and alveolar infiltrates with hilar predominance bilaterally. Which of the following is the most appropriate course of therapy for this patient?
A. oral isoniazid, rifampin, pyrazinamide and ethambutol
B. intravenous trimethoprim-sulfamethoxazole
C. intravenous azithromycin
D. intravenous trimethoprim-sulfamethoxazole and prednisone
E. intravenous amphotericin B
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| kpmle2
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D. intravenous trimethoprim-sulfamethoxazole and prednisone
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| liliaeliz
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d- but I do not because I give prednisone when the patiente has PaO2 <70mmmhg
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| hallachi
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A...Isnt that Tb presentations...the Cd count is 390...more goes towards TB in HIV pt
for PCP CD count should below 200 and there is no sign of pneumonia no egophony ,nodullness on purcussion..and pt looks more ill if PCP..
tell the right ans
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| Drtweetie
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A. RIPE (Dx: TB pneumonia)
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| cirus
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The ans is D
TB treatment is not assumed only by X-ray, u need sputum analysis for that, & the O2 level drop is typical of PCP (KAPLAN EXPL)
as far as i know, CD4 >200 + Hilar lymphadenopathy is TB, but that was there explanation, & they mentioned that PCP can come with any XRay picture.
Can someone expl?
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| hallachi
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After reading the q again i find out that Cd count which mention in the q is not recent as mention in the q"last CD count 390/mm3 so this is not recent it mean he had TB before and get tripple regiem for that and he was complient for his TB regiem...Now he has got new opertunistic infection and the CD count did not mention ( no new CD count ) but the condition detoriate and now his PO2 decline ...should be PCP ..go for PCP regien ie TMP+SMX+prednisone
the ans should be D
I think chest findings is due to his previous Tb infection
hope it helps
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| hallachi
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After reading the q again i find out that Cd count which mention in the q is not recent as mention in the q"last CD count 390/mm3 so this is not recent it mean he had TB before and get tripple regiem for that and he was complient for his TB regiem...Now he has got new opertunistic infection and the CD count did not mention ( no new CD count ) but the condition detoriate and now his PO2 decline ...should be PCP ..go for PCP regien ie TMP+SMX+prednisone
the ans should be D
I think chest findings is due to his previous Tb infection
hope it helps
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| Step2300
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Just to clarify for liliaeliz, PaO2 does not equal %O2.
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| MAGY17
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I GO FOR ANS B
WHY? BECAUSE THE USED OF PREGNISONE IS IN SEVERE PNEUMONIA=Po2 of <70 AND QS HAS PO2=71
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| Justice
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B. intravenous trimethoprim-sulfamethoxazole
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| dr in trouble
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Hallachi says---he had TB before and get tripple regiem for that and he was complient for his TB regiem...Now he has got new opertunistic infection and the CD count did not mention ( no new CD count )
He was getting triple regimen for HIV (2 nucleosidase inhibitors + 1 protease inhibitor) and not for TB. Dry cough, bilateral lung infiltrates point towards PCP, his viral count is too high. Answer shoud be B.
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| elitoki
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His last CD count before got sick was 390, so at this point he should have less, his symptoms go with PCP, and I agree with giving him TMPZMX but his oxygen saturation on room air is 71%. and prednisone is indicated when O2 saturation go less than 70%.
So~ 
I agree that answer should be B 
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