Shortness of Breath Answers 69include dyspnea, pleuritic chest pain, and hemoptysis.GI symptomsinclude
nausea, vomiting, diarrhea, and anorexia. Neurologic symptomsinclude
headache, altered mental status, and rarely, focal symptoms. Urine antigen
testingis highly specific and sensitive and, if available, very rapid in making
the diagnosis.
Streptococcus pneumoniae(a)is the most common etiology of commu-
nity-acquired pneumonia among adults. It is found in the nasopharynx of
almost half of the population and may manifest itself as a lobar pneumonia.
Haemophilus influenzae(b)is common among patients with COPD, alco-
holism, malnutrition, or malignancy. Mycoplasma pneumoniae(c)is another
common cause of community-acquired pneumonia in patients under the
age of 40. It presents as a mild, nonproductive cough with low-grade
temperatureand the typical chest x-ray appearing much worse than expected
with diffuse infiltrates. Bullous myringitis may also be an associated symptom.
Chlamydophila pneumoniae(d)is an intracellular parasite that is transmitted
between humans by respiratory secretions or aerosols. It remains a relatively
uncommon cause of pneumonia in the community.
60.The answer is e.(Rosen, pp 1110-1130.)This patient is showing signs
and symptoms of CHF,which is classified as either right- or left-sided.
Right-sided heart failure manifests as jugular venous distention, ascites, and
peripheral edema. Left-sided heart failure manifests as pulmonary edema or
shock. This patient has both as left-sided failure often leads to right-sided
failure. Outpatient management for CHF includes a β-blocker to decrease
cardiac stress and improve contractility, a loop diuretic to aid in diuresis of
excess fluid; and an ACE inhibitor for both BP management and renal-
protective effects. Patients should also take a daily aspirin (b)for cardiac pro-
tection. Calcium channel blockers (d)are not specifically indicated for CHF.
61.The answer is c.(Rosen, pp 986-998.)PCPis a commonly seen oppor-
tunistic infection in the HIV/AIDS population. It typically presents with mild
subjective symptoms of cough and general malaise. Objectively, patients are
hypoxic and have a chest radiograph with a bilateral interstitial process. Risk
factors include a CD4 count < 200. Serum lactate dehydrogenase (LDH) is
also considerably higher in AIDSpatients with PCP. In fact, greater the ele-
vation in LDH, worse the prognosis. Despite the classic PCP radiograph
demonstrating bilateral diffuse interstitial infiltrates, beginning in the peri-
hilar region and extending into a “bat-wing” pattern, the chest radiograph
may be normal in up to 30% of patients. In addition to Kaposi sarcoma