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Q) The fun NEVER ends. A 40-year-old woman with HIV, last CD4 count 350/mm3 and last viral load 150,000 copies/mL, presents with cough, fever and shortness of breath. The patient has been well and has been compliant with her triple drug HIV therapy. Four 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 104 degrees F over the past few days. On examination, her blood pressure is 140/70 mm Hg, pulse is 95/min, and oxygen saturation on room air is 70%. 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. What drug do you give? (What is the likely bug?) 1-Start P.O. isoniazid, rifampin, pyrazinamide and ethambutol 2-IV TMP SMX 3-IV azithromycin 4-IV clindamycin 5-PO amoxicillin 6-IV Amphotericin B 7-IV TMP SMX plus a steroid 8-PO ceftriaxone 9-Penicillin G 10-Nystatin sublingual 11-Start PO isoniazid only

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Subject: Tommy's Concepts

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Q) The fun NEVER ends. A 40-year-old woman with HIV, last CD4 count 350/mm3 and last viral load 150,000 copies/mL, presents with cough, fever and shortness of breath. The patient has been well and has been compliant with her triple drug HIV therapy. Four 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 104 degrees F over the past few days. On examination, her blood pressure is 140/70 mm Hg, pulse is 95/min, and oxygen saturation on room air is 70%. 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. What drug do you give? (What is the likely bug?)
1-Start P.O. isoniazid, rifampin, pyrazinamide and ethambutol
2-IV TMP SMX
3-IV azithromycin
4-IV clindamycin
5-PO amoxicillin
6-IV Amphotericin B
7-IV TMP SMX plus a steroid
8-PO ceftriaxone
9-Penicillin G
10-Nystatin sublingual
11-Start PO isoniazid only

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