A 25-yr-old lawyer from Edinburgh was brought into hospital with a 3-day Hx of increasing
shortness of breath and fevers. She recently received a Dx of Cushing’s disease and is awaiting
treatment.
Initial examination revealed a respiratory rate of 20 breaths/min and bilateral sparse crackles, with a characteristic buffalo hump and centripetal obesity.
CXR revealed sparse perihilar shadowing only. She has been on the admission’s ward for 2 days and is being treated with IV cefotaxime and oral clarithromycin. Overnight, she has deteriorated and ABG reveal a p(O2) of 6.5 on 24% oxygen.
What management is most appropriate?
A. Increase the oxygen to 100% and arrange admission to medical HDU for closer monitoring, and change the antibiotics to IV Tazocin
B. Increase the oxygen to 100% and arrange admission to medical HDU, with the addition of IV co-trimoxazole
C. Increase the oxygen to 100% and arrange admission to medical HDU, with the addition of amphotericin iv
D. Increase the oxygen to 100% and arrange admission to medical HDU, with no change in therapy
E. Increase the oxygen to 100% and arrange admission to medical HDU, adding cotrimoxazole, amphotericin and switching to iv Tazocin
Answer:
B. Increase the oxygen to 100% and arrange admission to medical HDU, with the addition
of IV co-trimoxazole
Discussion: This Pt is at an increased risk of contracting pneumocystis pneumonia. Although classically associated with HIV infection (and a CD4 count < 200 cells/mm3), PCP also occurs in Pts who are immunosuppressed for other reasons, eg post bone-marrow transplant and those on highdose steroids, effectively this woman has endogenous high dose steriods as a result of Cushing’s disease. Amphotericin should also be considered, as she is also likely to be at risk of a fungal infection; however, this is less likely than PCP
He heals and solve most of the problems & sickness which are failed to be healed by other doctors/healers. He solve bad luck, pregnancy problems, lost lover, sexual weakness, early ejaculation, witch-crafts, broken marriage, poverty, debts trouble, divorce, court cases, domestic problems, gambling losses, Lost jobs, promotions at work, Do you need penis enlargement? Do you want to be Rich? Do you need many children? Are you tired of jealousy people, Evil dreams, all long illnesses, blood pressure, HIV & aids, skin infections? etc. He use strong herbs & magic spells as well as powerful ancestors. Get healed today by this greatest miracle doctor who has healed many people through his experienced ancestors. Join the rest of the world to cerebrate his miracle healings. he can even read and tell you your problems before you say anything to him. He can connect you to talk to the spirit of a deceased of your family member or friend. he can also tell you your future through reading palm, play card, a mirror/water. He uses many ways of healing just to make sure that he certify his clients all over the world. he is the only traditional healer who does fully corresponds with all religious beliefs. contact him on his email address at babaka.wolf@gmail.com or Facebook at priest.babaka
ReplyDeleteHe heals and solve most of the problems & sickness which are failed to be healed by other doctors/healers. He solve bad luck, pregnancy problems, lost lover, sexual weakness, early ejaculation, witch-crafts, broken marriage, poverty, debts trouble, divorce, court cases, domestic problems, gambling losses, Lost jobs, promotions at work, Do you need penis enlargement? Do you want to be Rich? Do you need many children? Are you tired of jealousy people, Evil dreams, all long illnesses, blood pressure, HIV & aids, skin infections? etc. He use strong herbs & magic spells as well as powerful ancestors. Get healed today by this greatest miracle doctor who has healed many people through his experienced ancestors. Join the rest of the world to cerebrate his miracle healings. he can even read and tell you your problems before you say anything to him. He can connect you to talk to the spirit of a deceased of your family member or friend. he can also tell you your future through reading palm, play card, a mirror/water. He uses many ways of healing just to make sure that he certify his clients all over the world. he is the only traditional healer who does fully corresponds with all religious beliefs. contact him on his email address at babaka.wolf@gmail.com or Facebook at priest.babaka
ReplyDelete