Justice
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A 25-year-old man comes to the emergency department in April with fever and a cough of 2 weeks duration. HIV infection was diagnosed when he was incarcerated 4 years ago. He was recently released on parole.
On physical examination, he appears thin. Temperature is 38.3 °C (100.9 °F), and respiration rate is 22/mm. Breath sounds are decreased in the right mid-lung field. Arterial oxygen saturation is 98% by pulse oximetry with the patient breathing room air. A chest radiograph shows a right middle lobe infiltrate, and he is hospitalized.
Which of the following should be included in this patient’s admitting orders?
A. Contact isolation
B. Airborne isolation (negative pressure)
C. Droplet isolation
D. Standard precautions only
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| nyimalay
Forum Elite
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B
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| dr.wad
Forum Senior
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C ??
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| peter90036
Forum Elite
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B
whats droplet isolation?
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| cool doctor
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C?
why to put him in a neg pressure?
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| arlete
Intern in 2009!!!!!
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B
I changed after Markus explanation.
Droplet isolation would be use of mask? 
Edited by arlete on 04/01/08 - 09:59 AM
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| Markus2009
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He just came out from prison with a H/O cough for 2 weeks. TB doesn't sound out of the blue so B--------->respiratory isolation
Edited by Markus2009 on 04/01/08 - 07:41 AM
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| Justice
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The correct answer is B
This patient is at high risk forMycobacterium tuberculosis infection because of his
immunocompromised state and recent incarceration. He should therefore requires empiric airborne isolation (negative pressure). Airborne isolation is needed becauseM. tuberculosis is spread by droplet nuclei, which are aerosolized when patients with pulmonary infection speak, cough, or sneeze. In immunocompromised patients, tuberculosis may not have the classic isolated upper lobe pattern on chest radiographs. Patients with suspected M. tuberculosis infection do not require contact or droplet isolation.
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