Ouns a <1 > | procul hasty 2-yatol ile bought othe pytan by har moter becae of ly, ats ough for? aye ‘at worn at ah Se has alo bad hore and eer, Her older rote sath and Nad col ls ek Immunizations ae up-o-date Ste appeals oben md stress. Mer temgeraue 28° (1005), pls 40 min, ‘espranons are 35min ad lod pressure 9/56 mm Hg. Pulse oximetry on room ak shows an oxygen sattton of = S68: examination shows cer mnonfies anda dy hoarse cough. Theres mls nso stor upon agen at (elves wth es. The remainder ofthe examination Shows no abnormalities Which ofthe folowing the most, be ¥ @ acemicesmephnne S (© Emerge imbaton chester Noninvasive postive pressure vention 4Ouns ul 2 prowl hea gil rough the physician by har motor beste of BR HSRR BUG for 2 day rox Snel aD tcroce mentee aurea, Immunizations ae up-o-date Ste appeals oben mid ses, Mer temgeraue 281° (1005), pulses 140 min, respirations ae 25/mon ard blood pressure 1 99/36 mm Hy, Pulse ximety an rom a shows an oxygen saturation oF S68 examination shows ear rhorhes and ady,hoase cough Tee 5 “he veranda of te examination shows no sbnormales, Which ofthe folowtg fhe moet a 2a “ acemic epinephrine would be ince n madera seu cowp inspiratory ido st, subcostal reactions) in hic re are concerns atte arways nay be complonsed. However, the is lf and has an nyoenSauan of SEK Ceftnnone wou be approprate fr erpincal Weatment felt were suspected, Although eps presents with eer pence tee pave pera eeets eat ete eel voice, icaling andrei Swallowing. A baring cough would fo: be expected Sprptoms ase usualy progres Over Span erhouts rar tan 2a, making els uaa. Adaldonaly, ts ts nmunztons are asbup-to-dae, MCh eons an infection ith fsenae ne moe corn cause of eign) wou be las ih ‘regen itbton woe ny fr savers rept tes ane not stand nee he leer erie wi et, fds alert an hs an oxygen stration of 968 on room a Homer, thi g's ces conditon wave wo deteriorate ce away Became Comromased emeigert ituaton woul be fe saing ater,{nds alt ad hasan onygeneturacon of 968 on room a Homer, thas cea cordon ware wo deerrate tnd ine ary became comprorased emergent mubaton woul be a f-seang sto, ‘ronchscopy would be performed if foreign body arpration ws aunpecte, whch can prenet with mar ical etree (tes coughing sr, repratony dates Howmve present mora atl and eno secomparied by ehiorea and fever ae enn ti ch ‘Acros sort-Atng fe ayn se in the rece ashe or Ones DAK NX COUP. NOUN et has far natory and sign conuten ith ata ue yeh #2 fever, nprtry snore noha would ot Be ‘chest sray of ch wth rou i ey to ston subg narrowing steeple ign However th gil Re mild apt arses an eauees promot eaten prevent om worsening fore ay agnosis can be cared et 9 ‘The history ofa uperrespatory rat nfecbon olowes by ey, hoarse cough nd nspratry tnd incest of croup, The get sae ana ase oxygen stration of 9 on YM a Udo that acoWes Wt est andro SUBEOST FevaCeS, Inceating has ld croup. Snce the ely coup il inmate, sypomate eles neated. Col mt Relos ‘luce natal paseage ination ae dearctarone racers ay sling | Noninvasive postive pesur venation eerste he provision of velar supper hough the patents poe away Singoua 1+ 140 > Sec wou bu patra nay bey espns wae pin Wc an ean an dar neal Yates {ies coughing ster, fespraory sess However presen more acitdy ands nt ecompare by einen and ‘Abts sa shot-actng gona red nthe tetment of aha or onehospam bt nt coup. AMCuph is so fariy mister ana sans consistent wrth asta oy cout 32-0 fever, Sty Sido, and noha Would 0" BE expec. ‘chest ay of cid wth croup seh stom sual narrowing steeple ign However Ras ml eSptOry cases an equees promt veatment a pevet i om wotsring before ay agasics canbe cate ot. ‘The nisory ofan upper espa at neue otowes by dy, hats cough nd spat sudo ace of coup ‘ha gel wart and ean oxygen stration of on rom a, tte that archer ith et and ne subst reson, nceating she has mld cou, snc he elegy of coups il n Fate sypomat ees nated Cel mist elas "eucenasl passage nation a dexametasoneeauces away Sling, 9 3 crown Neneh postue pressure vention refers tothe proton af velatry rapper hough he pen: upper aney ung esi or srr desc Use in herp span alte cused by one away asease ans commonly ‘tempt btoeiuoaing a pan. Ts Chace, asa saturation of 6% aod haswspatry Sudo, suggesting ak Se ea alike Wh peels neal arenawots <2 > eal boys brought othe pyicanbacaie of 7-year ofa rogreeselywortoning cough The cough ‘ccs in sels and consist of round 3-10 cough in succeston afer enh pal he akes a ep, ny best He has ‘emited occasional lowing abou of coughing He ha aur nse ft aweek before he cough stared. ‘mother was gven a Téap vacemtion 11 yars ago, The father vaccination records ae unavalable Mis temperature Frise Gone, txamination shows na abacrmalties, Hs eukocy cour 42,000 rn? -Thos sua cure ard PCR ® Aamser orl arora othe baby and ether nd Tan accion othe ater “Adminstesora nytromyain ta the baby a father nd Tap vacation 1 he aor (©) Adminis ral azaycin oa aly mambers and Tap vaccination othe father and moar (aka eel Soci terete eal ete seca falar ‘Administer oa uimetoprin-suifaretanazoe ol Taray membels ae Taupvacnaien 1 th father an other [Admins era enomycint alfa members and aap acetone ater ane other “minster oa nomen t alfa member and Tap vacinion othe ater (Administer rl wimsthoprio-soarchaxazole to he father nd aby ard dp vaccination othe ahamos <2im> earl boys broaght othe pyican because of 7-day hoy of a protertely wortning cough The BUH ‘ad consist of round 3-10 coughs nsxccestion. After each pel he Kes a ea ny EAH has ‘emted occasional folowing 2 bout of coughing He ha aunty nse ft awesk before he cough stared. HS ‘mother was gven a Téap vacemtion 11 yars ago, The father vaccination records ae unavalable Mis temperature Frise Gone, txamination shows na abacrmalties, Hs eukocy cour 42,000 rn? -Thos sua cure ard PCR © Rerun copra sos towed by rt hci ra wear walt fecon th dela perasis conan pecasons should be alan o preven: fre eecton, especially he newb To Hom TS 2a {= (@) Administ: oral aithrrycin othe aby and father and Tap vaccination tothe father ‘Azklvomycinisnacaed a post-exposire propyl for alse coats of pent nected with pans dona, "aap vacation fe nacated na adults «65 yeas wh hve comtt with infant, provang they have no contend 0 “= () Acminser oa envoy to the bby nd tthe and Taap vacation tthe her attough marl ar nated for both testmet and poxt-eaporure props or ose comact of patent infected sath poise, ryiromptn sat wacom! for ifats Beauv sf an sscrnton nth fara hgperthte yore "eri, addon, Tap vaccination nad inal adults < 65 years of age wh have comace wth infants, prow0g <6) same ayant lay mem nd Tee acon te erg omer Mecrolide (op. atone, ethyl) ae the treatment of choice fr pats. Tey ate abo gen a» ‘eneal ae noc wed infants aged <1 month cause of te adverse getomestinal effec; ethvomycn in para i Ssocued witha creased Hk of ifn hyperwephe pier steno Howe, the pot bneit o audng AEougt a oye ‘ne ifr Tap aamsrton hus mgetr both he the (unm aU ané other st oor 2 Toys ao). The moter inh case actaly shoul ave Den vaccinate ng he pert posta peta of het acter nae a pos-eposreproptynsflx lst coma OF pat ced wih ers. TMF-SAK ah ‘Stennve propa agent bf cortendestedin nes <2 mane of age the pin babys) cae of the ‘et oftametro- aoa, Tap acenaton rinsed nal aus 3 oars oho Rave cont wt nants, omen ther have no contrncavons to eecaton. acres re nee a gos-exoste props fx cose comacs OF BEV Ice wi ers. TMP-SAK san ‘Stennive propa agent bt cortendestedin nuts «2 rane of age eth patents baby se) cae of the ‘etoflarnctrec: Aitonlly Tap vecchaton enced in al dus <5 Years ho hve contact oath fies, prow they have no contains eccinaton. ‘tough macros are maiested for bath eaten and post-expesure props or dose coms of pte inetd ‘th pemess,eyromyn sot reconmended orate = 1 month becuse tan a:scon with an hypertonic Pt dene flee even tp eel ets eee eed eee "hey have no canadian f scenaton ‘tough macrlis are aes for both este andpost-expesure props or dose coms of pte inetd ‘th peruse, eryomyan snot recommended or fate <1 tonthbecsse on acsocon with mand hyperophic Tae hee rc cel i oh sare Mic te ae teh eee ‘hoy nave no eaneandean a acenationonal a <2 ia > eros are nccata ap post-exposure ppm Yor clos contacts a patents infects wth persis. 1MY-SAI8 an ateratvepropyactc agent buf conamcletesm nfs < 2 moths of age te stent’ Baby te bans of the "isk of kericters.addoonally Tap vacations inated in al dus < 65 Yeats who have contact with fan, owing "hey have no eantandeaton section ‘atwough martes are waa fr noth ueatet and gost-eagcsurepropyals or dose coma of pales tected Ei pee cue redecorate i eect a Frode rani ddtonll, dap vaccaton ie tceated al ets < 68 yar hs bae contac th far proving they have no comands eccnaon. ‘tough macrolides ar nica fr both este andpost-exposure prophase ose comacs of ples inetd Sa te eee etree hts nc tee ere oa lbp ‘vor stenosis Adsmonaly, Teapvacanaten fs indeate i al ats <6 Yrs who have contact wth fant roving they have no contandcatns fo eccnaton. Nacrlds are nated a5 post-exposure propman for al cise contacts of patents nected wth peruss: TMP-SH san ‘erate propnactc agent bute comrarcated in intns< 2 wane of ge (gn te patent’ baby ster Uecauce othe eae ele eons a S63 Yl nected ‘hoy nave no eantandetons ascension ‘Aztvomycin i nacated as post-xposure propyl fr cose coma of sates infected with persis, Adora Tap vacemation acted nal adults «85 yeas of age wh have COMA wth nants, proaing they have rowots <2 > |£0.yareld man cmas athe physician beaut of €-wodk toy nesting shrines fast Fagus, and Fever He has had 2 cova productive of fusing Sputum fr 4 weeks. He as osptalized for la roxio ‘ice ae the pat £ mrths He has hypersion and Gepesion. He mas smoked one pack of ceaets dal ot tlngurhed Hee 195 er nal anaeions 57 ky 14 oN 1.1 kam. He emperaur 38.9C (100.87), piss 118i min respons ae 24min, ang bloed pressures 147/96 mm Hg. Pulse oxime on Foor 3 ‘ung. Which of he flowing the most porograt men step m management? be (© onchoscopy and dranage ofthe sion (©) tenia tmp, pyasnamide, and etambuol tay (© crea othe ches © cindanycn eepyOuns a < sim > o Ls {3 40-year-od man comes tothe physician because of 6-eek history of inceating shores of breath, fatigue, and Es ‘eve has had cough productive of lesen Bu for Wels He mas hosed for alcohol onkaton ‘ice ae the past Emrths He has hyperion and Gepesion. He mas smoked one pack of ceares dal oF Imalourshed He's 185 er (1 tal ana Wels 65.7 (145 oN 1.1 Kam Ms temperature 38.5 = (100.87), piss 118i min respons ae 24min, ang bloed pressures 147/96 mm Hg. Pulse oxime on Foor 3 daca) site ced soe » I eIRERIRT wr! around eae oi bn upper of a lung Which ofthe followings the mas approrate next sep n menenemen’? - ae ee eel levelon ehest-ray are suggesine of lang oscess. Ts man's stow of leona s ask actor foraspration. z 1) peers Za ‘ ® ‘he combination of varcomyan and levofloxacin may be conederedn some care of preumen, Vancomycin cours shee ‘ram-postebacera ncluing methan-resstar sures HRSA, whe lvelxac Is esprtoyFuoroguinelene mony wd to west paumonas cased by gram-postve tac aveprcocc and aya organs (opts age eae ad Pee ederim gee Te a hat slang abcos that sos aly secondary ta prion pneumonia, which arly bas 3 pohmerbil elegy that & usually involves anaerobic baceria. These agents ave therefore not indicated in this patent. ‘ronchoscoy ana orange ofthe eso re sed inthe Westen of lung abscess fhe general conven oraiographic Fings of he pate donot inpcove within 72-9 hours feet rete Orin ofthe abscen ot egies {ong the sess dane trough the bronchus spontaneous which is inated by an aud lvl on radiography and theonae a <2 +10 > finnas of he overt co rot orove wth 72-9 hours fanatic eaten. Drange ofthe 2bces snot equed 35 Jong sth aoscess dans tough the bronchus spontaneous hich is inca yan au lvl on acography anche presence of fou-smeling sputum, a een nhs ptt Sputum ukures can adn deteeng the organi reponse for he lng abot abn pate, However lung beet ‘onda 0 apratonpreurri,bronehesvol ages Usvslobaed fo mime contamination of he sample by ha ora Th coecion ofa cate speamen om te espatry Macs import oe te casache organism aS Can ead ean aunt investigation hey shoul ot daly management ae tee er elie te peepee one va sputum smear, cure, er mec sls empire Th an presen wh evr, fangue, mereasingshreess of ‘eth and cavacn onatlography, th pain doesnot have rst acre sch 8 irranodsiceny, abe or egos ional, Te mote canenan present wth aroptss not wth ou-smeling sputum ane afd level a een ‘Act oft chest ma be ndated ian ray ofthe chest uncer or matnancy suspected. whl ing nals can present Fever shortness o treaty an canaton on ty they ate wally avonic empl asng onge han he [Sicek a seenin ths ron. Adar, ou-smaling spat aay sen inlung cancer ules secandary anaeftie Ff techs ot aquired ame bu may be nad Ihe doesn espond orem " lung ebscesses usually have 2 pemerobil evelogy and though mettonazoes efecnve aganst anaerobes 1s ss sffecveaganst microeophic acer sich a 5m Monotherapy th metorigazle therfore oc maa this Patiene rmay bused tet ang aces in cnjuntion th a bet-acamase pencil at rose davlaatemos al “> ‘combmation of onze fampin,pyesramde, an ehambutos used to reat pulmonary tubercular dlegresing a sputum sea, cute, oF nude si ampiieaben) Whe Th a presen wh evr, fatigue, ncreasingshreess of [eg eet ence ie ee ee SE tak erent agli ee Dsorly Te more common potent th aropryse not wt fou tmeling spit a a-ald ai a a0 PE pater ‘Nr afte chest may be nda an ray ofthe chest uncer or magancy is suepeced. while ung neoplasms can presertwth fever shortness of treath and eataton on ty they af nally onic arpa lanng Inge tha he weeks as seen ths man. Adlonaly foul-smeling spit rr seen nung cecer unless Secondary angerobe ‘acta infection cers Because the patent's cic festurs and xray ae more Suggest fen nec Wing absce,& (Ch ofthe chest not required at this time hut may be inated ihe doesnot espond to treaiment. ‘ung anscsses usualy nave a poymiccba eteogy and, ahough metonsazole i electve agaist anaerobes, 5 es ‘Hfecineagast meroerophie acter sich a ler Monotherapy th metonarle therfore ot eaten this tens emay bused ess ung sbese in conjanction tn set iacamaepanciin th 2 fionctovlanace Carin suse to wea aod gran-posive cove pavuary metale-resstank Sure and wecuons wh Snarecgrar-negete organo sacha pertonts,cbeomyelit nd dra ifectionslndanyen In eect agans ‘he most common causative pathogens Incudng anaerobes especaly Reber and micozerophie baer This man reeds o be empl vested with ntavenous Camino 72-38 hows and assessed for cca adeyaphic Improvement (eduction of afd ee) elore dein upon futher manager Other combinations ha canbe ued 6 Sees aanwots oi | 2yar- od ile boagh to he pyian because of cough for 2 doy. The cough cca a patonyaralzplt th 3p ‘emg sometinesoccrtingaferwards he hes a deep breth afer hese spel tht makes a wheoping Sound. She has ben une sleep wal because of te cough. She Nad a uty nose and low-oace fs I Weck ago She as a ‘cinerea compton. she tans a deycare center bt there have been no cher clare who have sar "mptoms. Se aopsas wal Caapulmoray examination shows n anoralties, Her herogobin concemation is 122 gi, leuko coum 1,000 pete count 2 230,000 mm® and eryircys se dmertaton rate 2 mami. Anaya the chet is utemarkable, The patent es incresadrik for wie ofthe following eomplitons? (@ Memoir anemia © Hemopays (© recurswos wl |.2.yaur- old gilt boagh to he pytan Because of cough for 2 des. The a ‘emi ome cecaring rads re whes a deep breth afer these Spel that makes 2 sound She Deen unable o seep wel because oft cough, he fad aun ose sd ow-grade oer wesk ago She wae Taek der Al et tr ltr ‘cinerea compton. she tans a deycare center bt there have been no cher clare who have sar "Smotoms. She appears wl Caapulmonay examination shows 0 abnormal, Her hemoglobin concetaion is Ti gia leuko count 41,000/rm plate count fs 230,000/mm? and eytey sedemetaton rate 2 mami. Anaya the chet is utemarkable, The patent es incresadrik for wie ofthe following eomplitons? ark leukosis an ptonymal coughing spss lowed bya aspratry whoop and occasional vertigo pial 2a ‘asta san cbsvucive arg cease wth a complex eulogy Pat presets wth aacks of yspne, coughing, at ces pa. espratory tat ners, arene and oxen anll ger acute asthma tacks geneealprdlpoced nda. Céad nk actors for persian astima nce atop derma, aller hn, fod alerges, ard broncos Fequringhospeazavons. Whe the patent's Ws of hspiazaton fr DOnMHTS PU Re at an eae SK OF Seek ee acter eects ed emotaaremia a ovation characte byte nceased destucton ore bled cals an presents wih aa and Ee ie tee ee a ee ln ig ace eel ceed AT ssogavon wth infections Kroun neces causes ofhemobt anemia nclose Mycoplasma specs ana Coser Deringans. Borda passin he pahoge at cases whoop cough, Hons, rot sso ith hemo aeHemoptsss coughing up Bleed rom the over respratory ack. can be caused by a vary of condons icing Iarectousaseases ey tuberculosis autoimmune diseases eg, Condpastute syhdrone) cae ceases CONSE eee ee ae teen ecards ste numeration ofthe ptcarun tat resents wlth chest pala and dyspnea 5 mas commony lepaic ee ae re etre eee eer ede eee Systeme lupus ertematosi) certain drugs ovorvbion) alae, trauma, or fling acute myocardial ian omever, Sabo peas, the pathogen tha causes pers 1 tot Kno Wo case perc. ‘Peamatirae ste acca ofa within the peal Space tat presents ith dae Chest pa an dyspnea euSS ‘whooping ough i usualy astcistod mith severe buts af coughing, leading we increased nrahorce and ta-abdomnal pressure anda subsequent isk f completions such 2s scleral hemorreges, est, borin hernias, ana ‘bneumemeras her, ore commen conplicstons of puss incide apes aa Secondary Infecions cts mesa 9 ‘culated syatome ea mn: oditd neurloglal order hat posers wth progressive ascending pray. ‘most commonly cers 2 Sequel of Camoyabacter fen gasuoeeis but cn present assoc wth thet nections Such as pcos peumonie,cylomegaius of Eps S4 Vid econ. PSs Rowese, not associated wth|3.42.yareld woman comer tothe phyian because of fever, nautes and 2 nonproductive cough or 7 dye. Dating ths ped she has had headaches generale fatigue, and muscle anda pa She has aso ha ceasing shoriness ot bea for 2 ces she tas ype 2 abetes melts and osteoarcs o reete. Cfent meiaions clude Inslin and fupofen. he ad smoked tw packs of garetts daly for 20 years bt stopped 1 year ago Her ‘empertire 38. 19067), ple i 98 mi, reepratons ar Jin, ne lod press 1328 mm Ha- The lings ate clea co auscultation. There area sn lessons uth au ui ema, ple terete Zone, abd Sark {utes count 11,100 mm? Ne var neye cr Domea Urea nitrogen 17 ng Ghee a mga. sn cry of he ees's shown rch oF te folowing 5 Me mosey causal Exgansm? (@) sueprocaccs paeumoniae © Heemep his inerzae (D) Stepyloaces areuson at an Ww & Ome a es hes ‘re penphera im on the upper an lower extremes, Labretory tudes Show: Hemoalotm 14.5764 Leckey cunt 11,1002 me var magi Pa ss meat Someqie Glucose 123 mat Creatine 0.8 gia an xray ofthe chest shown Whi fe foloning the most ely cau organ? “a (Gren psu (@) sreprocoei preonie © | sensi (©) Senos anes (©) scolaire peurone (©) sina europaEo one perpeecernerr reared ere ermneteenyouns a {3.42 year-old woman comer tothe phyian because of fever, uses, and 2 HOBRIAUERIGESIRH for 7 days Dermg ‘his pri she as had headaches, geeralized fatigue ad muscle and nt ein She as als haa Ineasingshoiess ot bear fr 2 ces sheas ype 2 abet malts and esteoaras of re ft e. Cfent mesicatinsfcude inslin and upon. he had smoked tw packs of garetts dy for 20 years bt stopped 1 year ago Her temperatures 381°C 100.67), pulse 98 mn respratons are 18min, and bled pressures 132/85 mr Ha =~ ue warms & Doma ~ Urea niger 17g = Chee aa mga. an xray ofthe cst tan, Wn of 6 foaming she most alco orga? ba SST STS a ano Sa ee eee eee eee ere ee eS eet a eee aoun a 2a Aleut poeumonze aus horpl-acqed preumena,ssptatonpoeureria oss comment, commun segue ‘ypc posumnia, lsrort oer fect ler male, arpeially hore nth betes rich hi pte Soe ve) ehonie Wg disease, andor akoel use isorer. Atnough fection with Keble peamane may aso present wi fever ard cova, {he fevers usvaly Moh th shaking cil athe cough spredutve wth sputum thats eneray thick ard woody Ura {li).1ay pey would show a consoiiaton man oper lobe et i branchograms ana bulging ofan acer mterlobar “repeococurpreumonze tha most common aut af cmerunty-aqued yal prsamoni Type pneuments e characer2eé by hgh eer, shlong hls, prosuctve cough, decreased breath sounds and cracls on examination, and 0D Eonsationon xray wt ae ings hs pain dos hot have aemoehiusnbuensae cases tal poeamonia, hich cna 1 the ple aymgtons shared by high fever, ‘hling chil, prune coush eerste breath sound rset on examinstion, and ona coneslstion of = Furthermore, Haemophusnfuer2semre corimony aes chen.od ons Fe eoepe reeinreny rhea aneereg priory ee eet bed paririnainioint erent er sere T iy crsod onsC) eel Same) erneel @mos wl <5 tia > ‘eemochlis inven causes ya preamona whic, Wy con as 0 the patent syptons, is characterized by high fever, ‘shking chil prosutve cough deeessed breath sous nl crasles on examination and ona constation O97 Furthermore, Aaemopblur nfuonssomare common fects chee. “Stphyococosaureuri common cause of Noxptaacqued peamons and ten deeops ass sperifetion in patets “renonunss prearanis although horeta-sequrespreuvaia cane aeractaa uh interstate eee 28 Chest xray, hs agnosis sui because sual ecu in ei or patiems wth an inmunodecency and Ws patient foes nachave a str of areceathespalaamissioe see pa te cee cece (urease of ape! aurania stu secur in crowds eniranment a eho, mv barack, hog ana fen ‘Sead within houshols.Sace he ung infitates in pacts wt amyl pena fet the nesta space, the ngs ‘ypcall sound cer on auscultation, Ether mulorme sen anenate wth Wheaplim preumone infectionoy Comet) Seen peer eas pseeeeiirinyoy Comet) Seen peer eas pseeeeiirinyDaan <5 tia > wo ae parece ok et Fp ea of pel acim oe ely rs Cuibraste of apie! peumonia ually secur im cron onitanrments feel, mtrySatrack, hospi) ana fen ‘Sead within housols.Snce the ng infitvate in paces wth anypl pena fet the nesta space, he ngs ‘ypealy sound cer on auscultation, Eytema mulfonme ls fen asocated with Meoeise preunonize eon “agora prevmophiz can case respratry symeroms Smart thes een nhs patent Leplonrares eas) This pathogen commen i smckrs, su a5 vs patie a5 wel ab pens wih unetvng Cn ung ease oF Fecer. ‘xponte to contaranatd mater la-condoned het cute shi, Rept): Hower, ncaa father types of ayia Praumon pains charactarealvhave hgh feet oral » 29 ot 10227) an chil fen scarpaned by dates fd confusion ew hporatemi), fone of whichis presen this pater. Xray Fndngs af varie but usualy show uy uniter an obs vives hat progiss 1 consoldauon ater that a aTuse mest Neate Fur MN, {egonefe pemania nck assed wt cyte muliformeos Soret erent Pee aera paairerepnnten ere) paterson phere Cee ners caDaan <5 tia > wo ae parece ok et Fp ea of pel acim oe ely rs Cuibraste of apie! peumonia ually secur im cron onitanrments feel, mtrySatrack, hospi) ana fen ‘Sead within housols.Snce the ng infitvate in paces wth anypl pena fet the nesta space, he ngs ‘ypealy sound cer on auscultation, Eytema mulfonme ls fen asocated with Meoeise preunonize eon “agora prevmophiz can case respratry symeroms Smart thes een nhs patent Leplonrares eas) This pathogen commen i smckrs, su a5 vs patie a5 wel ab pens wih unetvng Cn ung ease oF Fecer. ‘xponte to contaranatd mater la-condoned het cute shi, Rept): Hower, ncaa father types of ayia Praumon pains charactarealvhave hgh feet oral » 29 ot 10227) an chil fen scarpaned by dates fd confusion ew hporatemi), fone of whichis presen this pater. Xray Fndngs af varie but usualy show uy uniter an obs vives hat progiss 1 consoldauon ater that a aTuse mest Neate Fur MN, {egonefe pemania nck assed wt cyte muliformea ee SS. a (© svopnrene abscessw & Ouns ul “This questions part of 2 sequence of uestion,Arswern hs questo wl unlock the folon-up questions However, you Wort be able to change his answer 25 soon a5 You hee ened the folon=up question. “ire days ser wdergoing an open colestcony, an obese 57-year-old woman hs FI, cis and a heatache ste UT ee es insterectomy 16 yeas ago formule lids ofthe uterus he tas smoked ne pack of gaetes dally fo 17 eas ‘he appears uncomfortable Hr temperatures 29°C (102.77), uses 98, espratons ae 18m, an Dood presses 126/62 mmHg Iaprtary “he abdomen sf ana antes ‘Theresa healing sural sion below the nar nage. The remaincer of me examination Shows abnormal hich of te following iste mosey agnosis? ‘sever, prodctin cough, eure chet pa, and rales ae all camman fetes of he portoperate completion, eich cally ecuts 3-5 days afer surgery 2a < Lefer asset wth CHF pel lade pulmonary symptoms eg, Syepte, hopes cough heh may "resemble those sents pati However, ths patent resenting with fee! 3 des flowing Suge more conceting for teraternatve dag ‘ne of te mostimpora sk factors of pulmonary ebolar mmobiy, sani is pati allowing sage. Cia presentations vatble, th symptoms including chest pain, coughing. dyspnea tachyarcha, pa ever cardogene shock. [though spate presents wah ches an shorty afer her sugary, she be eer, podve cu, ane rector he "ht lana base heals has no oreius story of dep venous tvombost or acycrda Al of hse features make te ldagross fF es key.Ouse <6 > ° ‘Altiough this paint presents wih chest pain story after hr surgery, she hs fever, productive cough, and crackles atthe ign ung nas he also nas no preius sory of deg venous tombs or WOWcRa, Al of ese ates make the ‘tagrors fF ee ay. Subphrni beets may zur then pus acurlatos beeen the spleen, saphragm and ne Subphni beets ype Desens with pal, nase, venting eve, ad dona pa teal 10 dys ae surgery. though the Daven hes ee, Ieetared > doe ater her operation and te has a ote yl fates of hs conduc “This patent’ cna presenti ' mos consistant with postoperative pneumonia common pstsuial complcaton tet ‘ypc prevent 2 to's dys ollwing surgery as inthis patent Aactoaly tha pater has undergane wpe” abdominal Cnc festues of tala depen onthe every and extent of telecon, and range om a amps fo respon) sess. Pysicalexainatin reels dls to percussion ard cnshed breathing sourds ov he affected sea Tis an resents wha productive cough and pew chest pa, ich make he dag of atlas ay. ‘trough his par presers wih pleut chest pa, she doesnot have acyctiiadnshed breath sounds, decreased est excursion ot hypresorant pecusion, whch vou be expecta wih pneumothorax, Sh ao presets Wit Ferrandi <7 im > ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. an x-ray ofthe cnet shows an eteniveconslotion tn the sat ower lobe constant wn bar aneurin “pura and blood cues ae sant othe laboratory for nai and empiric arbiovic ese wh ravenous ‘totais begun, Which ofthe flown is meat Heh Sone prevented as pains prewnese? (©) roenget bedrest (© Fevoneratve amon prophyneouns a <7 tim > ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. sy xy se tes sows SE OER FORGE cone: wn ER UREN > Sputum and blood cultures are sent to the laboratory for analysis, and empiric antibiotic treatment with intravenous. & ee eae a ee es ee ce {fee erates pear a mc Za 5 sk lect and pneumonia Postoperative petens ae a ar creased Mk of preumon for mu eons, cdg "ested thrac and abdominal movement ef ain a intubation-eated changes in venation (2 chai et rte citar eae ea] eet’ nese ieeteeae eat eiaferal gery the upper sbdoronatjacat ote apt apd sequence inition (SO i nde in paves a gh rk fr pulmonary aspraton Whe aspiration can cause Of the gstomeesnalwact en ats Mera or oss of reece ray refines ‘aq. rating for his pace may be ined by postoperative pain following an open abonina suger. Analgesics,home OM St all «> apd sequence ication 10 inde in pares a igh kor pulonayaspaion wie aspiraion cn cause ofthe gatamterinal aco ata Meri) ot oe of protect aay efter ” ‘Adequate breathing for his patent may be med by postopera an folowing an open abdominal suger. Analgesics Including wit opel reed, play an mporar lem ensuring sumcent beating flowing sue procedures eprevert Postoperative atelectasis andr preumona A reduction ops Consumption wouldnt be nccted. Mnmiing op onsumpton would nlp preven: potopestve iar, bt tearm ines problem fr he patent ‘Prolonged bed reat contibutes shallow breathing an decreed aeaton of he ng, whch inceaes the rk of postoperative pneumonia ay mebizaon eer urery eps prever ig claps lea) ad a0 Shortens the Postoperative recovery ue For pauents undergoing an open procedure, a sgl njecion of anions i usualy admis ety before me Procedure. However, ths singe dote wou not hae prevented the development of postoparave preva hi at Smoking cessation pie to surgery reduces the rik of postoperive compton, nclaing pulmonary complstion and ae ee pe eee ee Incrverion ede the sk of post-operative preumonia, However generally a ered of > 8 weeks is considered ontnal, choc nae faible wher parang sug mervencon,Sudes were unable to cont te benef of preperaiveOunss | s8-yar-ld woman brought othe amergency depanmn becauts of 22-day history of nereasing ches pan and shores of breath, te hes ha a productive cough wth foul-smeting spur for? week, Seven maths ape the paint adam scheme svoke Se has ast aa uneueahypertarsor. She cer) hues an assted-Ivng comer. ‘She has smoked one pack of gnetts day or 40 years, She has 2 20-year Hnoy of aha abu, but has Not “ontured ay alan nthe pst yess Her only medeston’s mebraaie She Soper een rexpratory sare ane Speaks incoherently, Har temperature 38° 002-7P, pulses 123 mi, espratons te 23min, and ood presses ‘roopng ae present on the night rel Blood gas aralss on rom a shows: Foo: amma ‘ees aay shows atiuaes ne ht stn upper abe. Which fhe olowng i the Uengestpreasposing ato, ‘ng in an asst- ng commany Uneated Wyperension (© Abwory of mehemie sake> & ouns a 158. yarold woman brought othe mergency depatiment cate of 22-day hit of Eig AGES x ‘She has ha eproducve cou wth fort week Seven months ago, the paient adam sce svoke She has ass aa uneueshypertarsor. She cer) hues i an asted-Ivng comer. ‘Shehas smoked ane pack of gnetts day or 40 year, She has 2 20-year Hsoy of eoha abu, but has Not “ontured ay alone pst yess Her only medeston’s omebranie She Soper een rexpatory eres ane Speaks incoherent Her ena s3818 (102 77, pulses 123m, espravons ate 33min, snd blood pressures ‘roopng ae present on the night rel Blood gas aralss on rom a shows: Foo: al mm ig ‘ees xrays aE WMH BONG UBDEPIOB. wich one olowng i the uongestpreasposing ator, ‘thi patents orpratery symptoms? “Ths hamipepe patent has late val ins tat pono an acute infecen, produce coup with ousting JG spam and infitrtes inthe ight lng, whch together re ighly uppcus of mpraton preumonia What pedaposes OTL peters aspraton? 2a ing a assisted-tving community 2s actor for preumerta because of th hance age and ede tuctonal sus of the inhabitant wel ap exponre to ote ik contacts hin he corny. However, ning ah ased-hng Commun doesnt oreispeseaspratonpreumoni Specialy ane this woman has amore signa sk factor that ‘Should be considered. | tory of stolen would predlpoce an ada o chronic absvucive pulmonary ageaee (COPD which cn beak ‘tacos kr sspratios i sevtaos.enoneas tips petite nee ort tone GEIS wi mre ceammesnei iOm Bstwl Soe + 80> "Atay sing del pepo neal hon ane pulmo dec (COPD whch cane SE. factor for arpratonpraumons: wows the worman coer ot hae ote fesuee of COPD sucha chr coush, ‘aheean, ora barrel ces, making COPD an unikaly cause of he spationpreuren Pet try feel abe may pt th patent rik or many fren conctons, sh at hepateaafunetion and etebal ‘soph. However, only cure alco bute could be considera a ik fcr or aspiration pevmonia, 8 ay repay Unrested hypertension can be ak fate for toe, awl fr carvan desses that cn aft preuania coutames. However, on Som, unteses hypertension snot ans ect fr pneumonia lech sok predupose to aspiration sneumons by pot impaing the sallowng anor cough mechan. Ee therefore recommensea tat stent th stroke be ven fod and wae nar evahuevon bya speca. Cass conmonypresems wth elastic abdominal pin, nausee and vomtng. Complications of ass nude teeing cers ang gate arstomas. Henever, casts dots At preaspos to espton prewar as Uerels ne en associatedBs all “> o Ree oe yt es — ‘began 6 days ago, He also reports that he has had 3 episodes of watery diarthea per day for the last 2 days. He appears = E ieee 2 ‘Urea nitrogen 18 g/at. ‘an xray ofthe chest shows patchy inflates in bth lungs Which ofthe floning she mos appropriate prarmacotera? 2a o (®) Leto pea (©) Temeropriniserethoxazsie ‘amoxiein (B) Osskamir (©) arene a aS Tren naions Posnoy tgs souen REUSE< stim > ouns a oO - 1552-yarold man brought tthe emergency daparmant th shornet of breath and lom-ctadefevrthat ae began 6 days ago He so fepors that he fas hed 3 elsodes of er dy forthe est 2 dys He appears Sy pal is emgeratre 28.06 (1604, pulse sma respons ate 15min, an iced pressure 6190 76 ee {east count 15,00 mi Peer coun 150000/mm* i. — eat bent 02 mai Hos 2omevt 2 Ureemuogen 18g) ‘an xray ofthe chet shows EYRE nb lungs Wich ofthe floning ste mos appropriate prarmacotera? . “The patent has matey dream combiraton wih sans of ey peumontincuing dyson, dy cough, and Io-ade eve these etues ogee fh ponte sd an X-ray wheal pay ates suggest econ set Legion peamephe 2a Levofloxacin isthe esment of chic for leone Leonel has wa incl manfestaons:Fonac Fever and Lgionatercseae, oruac fer amd Mute condo thas sling. Legioaes cece pects wth pia {ese Acceptable second-line reatment fr eonelsisicude macrelds sucha ztromyen & tesonetonons a <2 +i > LEvrioxain isthe veatment of oie to egonelsis, Legionelloss Nas to cimcal manestatons: Pomac Tver and Legionnaires deste Pontiac fevers a mil uke eonetion tha self-limiting. Legionnaires cease presents with typical {est Acceptable secondtinereatments fo eionlinss include macrolides such a azithromycin g B teionetions “Trimethoprinsilfaveoxazoe (TPS maybe admistered incase of gional, but only as aerate fled or Cnvainesed fst ine therapy. TMP SA ao used oust Prounoyst pneumonia PC), wrch also presents wth Immunocompromsed patent nd des not resert wih watery data or cereased Serum secur ‘moxie he drug of cots fr eating commuty-acqured lobar pneumonia, whch may pretnt th ry cough Shores of best, and lon-afade fever. Hower a chest 7a of lobar pneumonias yal notable fran eens pact nas esis one play lode an hs patent ay shows laa pathy tates. These nang, Crear ited 0 wrest nfluensa and, which may present wth dy cough, shores fast, and wade fv omer influenza doesnt yi orodue watey dates nad andro etecabe with wary aren testing. Paailonaly tease serum Sodium an tral patchy ives on Chest 12 ate a pal or aenza fifarpin one he rst-tne agents to eat ubetculsis which may presen wh dy cough spre, and low=gade fever. omer, dus patents Mypanavemiactea andy igs Would note expected tubesOunss < wri > ‘8:13-yar-old gl comes ta the physcian because of sore trot and subject favre forthe pst 2 wens. he hat been felng thro end is uebl to tend Sool She as 2 istry of mule sede oF sreptcocca pangs ‘ete wih amos She iia th ear to We Unie Stats om China 10 yess ago. she apes tha. Her tempereture 37.8¢ (100) pls 97min and ood resus 90/60 mm ig tamination shows pharyngeal ‘thera and enarged tosis wth exudates and pala eters, Theres cervical Imphaderopaty. The spleens palpated 2 cm blow the et cost magi. Her hemoglobin concentration is 12 gl ako court 514700 mn wth Sst mphoctes (124 atypical mphocte) an placket counts 280,000 Aeerophi agalatinton ets onto be (@ Foeumenia (© nasooharwaeal arcmoma (© Goomerlonepvcsa ouns a and subjective fevers forthe pst 2 woo. Sh haz rox {8:15-yar-old gl comes i the phyoian bec of been fel thro end is unebl to attend Shoal She has a istory of mule episodes of sreptcoca panos ‘estrperte a 47 (1007, pen nd oad pre 50/0 aan erga = th exists an pl peteense Teri cee hmpnadenonsny. he ‘nthera and enarged 2 cm bon the et costal magi. Her hemogiobin concentration 12. ake (2k eye phocytes) ane platelet our 280,000)? Ste nderig cae of tas patents symptom moe Hey fo cosa onc ‘his gi as fever, sore shot, phargelenthema,elaged tons, cereal mphadenopathy, and plenomegay Lumokecyosis andthe poste heterophilaniboay fs corm tha this patents nectevs MenoneleDss Is uO ONL pstinsar vis “a hau fr 2 dled nflmmstory equla of group A f-hemelye sepococal (CAS) pharyagis hat ype afc Imaal 515 ears of age wehin 2-4 weeks of infect. although rs patent has sore thos, parynaeal eres, sages rons and airy a vcurrtsueptococeal ha yah she presets wi spierorezaly ana Nes ostie Ieterpil gglutnaion es uhh adeates fects manoncions stead Preumania is poten complaton of comegaovius infecon,perculslyfrmmunacomromeed nail (2 HIV pst ransglataton) CV can cate a monanuceos- ke nyrome (MV monoraciesas) Sirdar nections rmononuceess, symtoms inclu eer, malaise, mali artala, atau, headere, and Sorat HOME, fe ronospe htrophie abodes woul be negatve- nara clecsbons, tang on aging, can occur the context of apeg orn association wih eran daeaes e.g, en ec eee gee ee ee eeenara clecsbons, tang on aging, can occur the context of apeg orn association wih eran daeaes e.g, ‘exoplaxmon.Creraltoxeplaments 3 pot eompeaton of toxplasmoss, bu aft: mrunocorpromid Dates es ADS patents) ands rot characte by rac caleaton®. spon sazcoma not aut by peter ru (huran erp rs 4 HH) but ls rest, the aman epesvius& V-6 Homer both HHV-t and MHY-8 are oncviuses that Can ed o malignancies Nasopharmgel carcinoma potential complication of infectious mononucleosis caused by Epsten-Ba us EBV. ‘Addon complains of Vitec ncde Burt moms 4nd hay aoa Necrotning eth s 2 potent complication of cyomegaowius (MV infection. More than SON of individuals infected wth {hv remain asymzomati CMV can cause a mononuckos~ ike syatome (MV moronudees) Smit oinfecious rmononuceous ympoms inclu fer, male, malaga, fargu,heudahe and oreo. Mowe, the ronospo est woud be meget Clomarloneprits my acu «compat flowing an infection (eg, afer svepracoccal fect), Fosttepococal lomerlneghita sear approsmate 10-30 day following an aut nfcton wih foup AB-hemehie suepncaes (cepecily stor eproccel pray) though hi pte har ote out pharyigea erytema enlarged 2062 Inston of erent sreptoocclonryna, se resents we Slenomenat andes a postive heteropie agaltnatonouns a ‘This queson spar of sequence of questions. Answering this queston wil uleck he follow-up questions Hower, You Won't be able to change his answer 25 soon a5 You hee ened the folon=up question. | ‘.6-yeaold man comes toe physician fora madi carace prt a sche igh inguinal hei rea He Te . fete wll Hs fate ed of clon cance a the age of 54 years Hehe srcked to packs of gure day for 44 yar emperaueis 371°C (9867), pie 88min and bioodoressur 116/72 mm Ha Examination shows eal breath gt Suns ltt. Cada examaraion shows no mts, bs, o gulp. Trees 2 educble nguial hvac me ght sie Laboratr tsa stom no abnormalities, nay of th hes abows a Ine erally ested soe : Pulmonary rodent nah upper una ela Thee are no previous x-rays ofthe patent arable, ACT scan ofthe ‘hes shows regular metgis an spicules. hich ofthe elning she most appropiate next ten Managemen? Fosivonemisionomagrashy Follow-up chestxayin 3 monte reo (CT-guided wansthorcc biopsy ica 4 ‘This queson spar of sequence of questions. Answering this queston wil uleck he follow-up questions Hower, You Won't be able to change his answer 25 soon a5 You hee ened the folon=up question. Py, lea eer eagle ret pe Temperatures 37.1098. pulses 38min, ad blood pressures 116/72 mm Ha Exarnation shows ual breath Suns itty. Cada exararaion shows no mums, bs, o gulp. Trees a educble nga hria cate i te nah upper luna fied Thee re no previous x-avs ofthe avent availble, A CT scan ofthe ‘hes shows ragulr margins and spices. Which of me Foloning she most appropri nxt ste In management? Gioia aaeaecre eee a em eee set ope ean pe oe rae ee ees ee eee eee eee eee Fees cna ses as eho obs oe te err les Trt ner ueon 2a ae GT OR scray ent peal orb 1s) Poston emsson torah v ‘whan nearest rosanty at msignany ts ta conony conaicaa fr patents win sgh part of ag5 ihr kop fu PE cat pera a ranabronchal opcy Soe comsncedfo sls ema ocelotouns a < rin > Poston embsion tomegrephy (PE) he nen appropiate ste or patent wh sod pulmonary nodule 2 Brn naze ‘nen an itermesite posable ot maignane. Pit Ato commany conte fo paint wh a ahr ae pr of aging ie ion co Bopsy Is PET Scan postive, a arsbonchial bop shoud be conducted for Ws cea aad tuner Some cases, sural excision may be consiere. the PCTs rege, he het Ut tp Is ary Seemed on 2 e-by-cte sana, ad may nclage CT curvelans ot een biopsy 2 Bly cancer -fotiow-up Ox not canted for solar plenary nodule eqrng re-evaluation: he Bet imaging medal fer folonapis act scan. Seal CT scan montoning is ppropnaten patents presen wth ether: soe pulmonary nodule > & mm and low raignancy probabil nodule betneen > + end Sr with any malignancy proba (ne pods aly cccding to ize ora slid nodule = 4mm ith an intermediate or igh magrancy proba This patent presents wth a plone Podule» s mm tat has anntradate probly of magnate. (T-guies wansthorac biopsy is perfomed na paver wth 2 penser Sold pulmonary nodule = & mm wha nah proatiy t malgnncy geease rhs patent presents wth «cena located soe puna nodular woul be i {access tansthorecaly, th method sot muti for cbtaning tinue smi. Raton, hs pete ony he Inermacte probably af maligneny, rearing anata icrenton would mot ty be conducted ft Before Bap.Cad CrearBi tng cancer ‘Afollon-up Cx snot conducted fo Slay suena nodule requ re-evastion: he Best manina moalty fr Totmupis act scan. Serial CT scan monitoring i appropriate inpatients presenting with ete: Soi pulmonary nodule > 8 rm and low raignanc proba, 2 old nodule btweer > + and Br wh any malignancy prbasiy(e psads ay acccdig 12 Size ora sold nodle = 4mm th an intermediate or igh migancy probity his patent presents wth a plmonay rode > 8 rm tat hasan incre rebity o malanany. (-uided wansthoraccbiosy i perfoned na patent with a prgheral so pulmonary od ® 8mm wih igh probably of malignancy eeause ths patent presente wh «cena cated fold pulmonary nodule tat wou be ct {oacesetanathoracaly, ths meted etna for cbtaning 2 aruc sal. Reon, he pate ony Rat 2 Ice probably of malignancy, rearing anoter Interven woud Mosely e conducted frst Before BOD. No frteresaston eld be zpproprte hs patent hada previous xray nth mls nding 2 zl aodle 5 & me ‘ith low malnancy sn pabents wth peeing cndions associated with ulonary nodules fg, sacldos tert mycobacterium tuberculosis) rer evaluation may as abe teased, Tis pet Mas suspicious wodule ad mui skst all < «> ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. Festron emission omearaph s conducted and nicats a mabannt rede. Bronchoscopy wh transbronchi B95 5 perfomed and a specmen sale ofthe nodes sant for one ston arasin The tate sare mot ikl fo a ini tumor oe) ‘Seuamous cl enor |G +ouns a < 2ri0 > ‘Ths quesoon spar ofa sequence of questions and nas unlocked by ansvanng 2 redous Eston. Festronemsion omeraph sconces andi a Ro or roan secon alse The sue sales mos ily © ace a ee Za Large cel ling atoms on-smal el lng cancer a pvpheral tumor has carcterize by Ite metastanes an cares # poor pteaness On hogy, large cl aronams ecarstertes by poor earned isomorphic ant cel ijough age cel arcnomais associated wih smoking, 1s ess common than othe associated pes of cence and hs ‘ronchalcrcinoid tumor yp arated by lao pth opacis. Patents Can develop carcino synarome characterize by artes funhing spre, and wheering. These symptoms ae absent ins pabet Adio, he has outve sling hatry ad carota roel acne ewan artcated with in. luna edenecarcinoma i more common in women and ipl aes the peripheral paso the ngs tay also ead to hypeeopic ostearvopaty (cutting of tnges and ots, pal sweling oes an 109 bates. On Mistley. sMenocteinoma i seen a urdu umor with uri podkcing elt uta pave sith a pontive aokng Senile eer ane eaeomuns al < aria > Lung adenocarcinoma i more corman in women and typically fet the perishes parts of the ings haya eas hypeepic osteaarhropathy (esting of fingers and oe, pal swaling moins an long banes On Meloy, adenocarcinomas Seen 2a garda tumor wth mucln-poducing cls ut a paver wh a postive Smoking Mery, omer ye of tumors mare aly Squamous cl ng carcinoma SCO the most hey dagnos this patent as 5 the most commmon lun cance Sets. SEC ypcaly aes the cera pars of wean ar may present wih nyperclcmea a a feu a2 prosucton of pasty hormone elated prte TM). On histoigh SSCs a oid pela tumor ta an have trellis nd wera pears, Bang cancer SCLE type este ane ars oe ngs. tea very aggre tuner th eay meats. On Retiey, ELE ie Characterize by small, dar tumor cals wh mypercwomatc nucle and sate cytoplasm Although CLC Sng ‘sodted wth solange atte moet common ng earcrses in sok. ‘Colorectal cancer may metastasize hematogenous he ve uns, Bone, an ra and Can spread Nmphatialy 0 re-artic, ond pelvic mph des Patients mpl preset ith comtitutonal ymptoms, Won defieney ha i gh-sded CRC) a changes m bol habits blood-steaked sol, and cack abana paln On lefesied oR. though he paver nthe gree has a posite fami stay of coon cance he doesnt have ay of the ‘ypc! symptoms hick makes we agosto cltetl carer uke. Adora, atough sine redules ate esse, Pulmonary metastasis spel assed wth muliple dls om a chest =r.ouns a < aria > 2 {30-year-old man comes the argancy department bcaut f progres worsening shortness of beat and fever x se for day: He has a non-producive cough aswel He does not have chet pin ar headache He has chvonic myled a leur anc had ane marow wansplan2 mors go is Curent medeaons nde usar, mycopherlae - ‘fel teoimus and methyredaaalone Hs temperature &36-1C (1026P, pls i 103 mun repratons are & 25min, an boed pressure 130/70 ma, Pulse oxime an room ar shows an oxygen seu of 936 Pulmonary = ‘raninavon revels ise cracles. The pln papaed cr bsow he le costal mag Laban ties Be Pee count 160,00/ram? oie 95 mgmt pss agen Poste ‘urns i normal an xray of the rest shows ase Dae irarstl aes An ECG shows sms tachycardia W lich af he fallening ithe most approptioepharacothespy? aOuns al 2 is {A3e-yer-ot man ces oe wrangerydepriert ecu of openly woes IE ac ez eet for 2 days. He has @ non-producuve a5 well, He does not have chest pain or headache, He has chronic myeloid = area ee ne ee ee re or ee eee | RS a eee ce ree . Platelet count "160,000 rm? — are TS SE TE TOS = La . Levofloxacin 52 fuoroquinlone ith road-specium animicobiel act ans conmonly used the westmer of acterl preumona cling sia paumonia Style peumoni can ao present rth eve, ough, apnea ad fore vee oar) infivate an chat sray. Hone, gh th acer ty of ane mao Waneplatton and igh Tkenoed of CMV fection, a dierent uesmereopton is more aogropiea a>! on chest xray. However, gan te recent stor Sone mtr wapianttion a gh Ikenoed of CMY fection, «erent uesiment option Is more aorepie ‘ra! valgncio can be use te tastment of nan-stvere CMY infecion im adults CMV paumonia i ely his patent ‘it diene pulmonary teal infivates fever, ough a spre ell bose marr rasparation CMY rae ye cl fee eset el wees cree ‘cyte i sean the treaent of ancl (V2) o herpes (HS) neon. laugh hese wuss ca ala ause umonar ease i immunocompromiss patent, this pent ested sstve fr ppES arin, a marer of acve MW Fepcation While CMV also belongs one fry of herpes va, ayclot doesnot effect et CMY preuaniabecese ‘lack the enzyme thymine Kinase, wich equedto ake up and etna ayant ‘partnthe estes of cote fer ci pulmonary nl hich may seo present wth coughing, acca and Shores of best. However, the mstry ang laboratory figs af more cnsster whan alteratveclegnest ana this Patents O- aime eves re ow (e500 nL essential ling out ae PE 1Vfoscazne or gaccow enay-desed, combined with rmmunoglbuo therapy, the ese weacment or CMY Peimona which kaly ins aaen with dase plonayIerssialnhvaes, feet, cough, ans Syspoea flag Sone maron wanplataton, Foams espealy prefered patents wth newtopena Whe ther pathogens may ease Incest on seas as walk his bent sted postve for pees anagen& maka of acive CMV repeaon. The megane Galcemannan agen testexcuses nase pulmonary espera, Patents wh have hed bone maton vanspatation ae cessed ik of CMV infection paren wt the es 100 days afer tanpltation& peo = OT D&E all < aria > Lung adenocarcinoma i more corman in women and typically fet the perishes parts of the ings haya eas hypeepic osteaarhropathy (esting of fingers and oe, pal swaling moins an long banes On Meloy, adenocarcinomas Seen 2a garda tumor wth mucln-poducing cls ut a paver wh a postive Smoking Mery, omer ye of tumors mare aly Squamous cl ng carcinoma SCO the most hey dagnos this patent as 5 the most commmon lun cance Sets. SEC ypcaly aes the cera pars of wean ar may present wih nyperclcmea a a feu a2 prosucton of pasty hormone elated prte TM). On histoigh SSCs a oid pela tumor ta an have trellis nd wera pears, Bang cancer SCLE type este ane ars oe ngs. tea very aggre tuner th eay meats. On Retiey, ELE ie Characterize by small, dar tumor cals wh mypercwomatc nucle and sate cytoplasm Although CLC Sng ‘sodted wth solange atte moet common ng earcrses in sok. ‘Colorectal cancer may metastasize hematogenous he ve uns, Bone, an ra and Can spread Nmphatialy 0 re-artic, ond pelvic mph des Patients mpl preset ith comtitutonal ymptoms, Won defieney ha i gh-sded CRC) a changes m bol habits blood-steaked sol, and cack abana paln On lefesied oR. though he paver nthe gree has a posite fami stay of coon cance he doesnt have ay of the ‘ypc! symptoms hick makes we agosto cltetl carer uke. Adora, atough sine redules ate esse, Pulmonary metastasis spel assed wth muliple dls om a chest =r.‘Aci used m the treseant of ancl (V2) or eres (tS nections, Although these wuss canals cause pulmonary see in mmunocompromisd pate, his patent ested poste fr pps arian, a marer of active CAN ‘pct. We CMV alae belongs othe larly of eres via, eneloi dees wt eft test CMY pcinmanin boca Ielack he ene thyrisie kina, wich equa take up an achat atone Heparin the weatment of choice for acute pulmonar bom, which may also presen with coving ached nd sorts of bres. Homeve. the nstry and laborer ings ar more conser wih an altar agro an this Patent» Once levels re a (e SOD i; essential ruling out aut P- vfscaene or ganciov uanasy-dosed, combined with immunoglobulin therapy, he Re-ne wean or CMY pPrsumon which kal inthe ae with dune pulmonary Interline, fer, cough, sta cypea flag one marron wansolantaton.Fscamet'especaly prefered in patents wh neuropena Whe the petogens may cu5e Inca ong seas as wel his pavents sted postive or pp6S anager, a muha of acne CMV replaion. The negathe Catctomannen anger text excuses man pulmonary sspergion Patients whe hav hd bre mato araplanation ae 2 cent ik of CMV infection paren wt th es 100 days ata ransplamation. bo ‘Actiromyein is x macokdeantibc a an be weed nthe rate of atypia prumant fepectly fer Cronin ‘a pneumoniae or & pneuophia. pia pemonia can aso present with eve, cough, dyspnea and se rss lobe Inne on ees xa Homer, ge he cert Moy Of one maton varsplaaton at hgh IaelRzOd of CAN Infection, a fret eatment opin mare sporopate