61.A 32-year-old woman presents to the ED with a 1-month history of gen-
eral malaise, mild cough, and subjective fevers. She states that she is human
immunodeficiency virus (HIV) positive and her last CD4 count, 6 months
ago, was 220. She is not on antiretroviral therapy or any other medications.
Initial vitals include a HR of 88 beats per minute, a BP of 130/60 mm Hg, and
an RR of 12 breaths per minute with an oxygen saturation of 91% on room
air. Her chest radiograph shows bilateral diffuse interstitial infiltrates. Subse-
quent laboratory tests are unremarkable except for an elevated lactate dehy-
drogenase level. Given this patient’s history and physical examination, which
of the following is the most likely organism responsible for her clinical
presentation?
a. Coccidioides immitis
b. Mycobacterium tuberculosis
c. Pneumocystis jiroveci
d. Mycoplasma pneumoniae
e. Haemophilus influenzae
62.A 27-year-old woman presents to the ED complaining of an intensely
pruritic rash all over her body, abdominal cramping, and chest tightness. She
states that 1 hour ago she was at dinner and accidentally ate some shrimp.
She has a known anaphylactic allergy to shrimp. Her BP is 115/75 mm Hg,
HR is 95 beats per minute, temperature is 98.9°F, RR is 20 breaths per
minute, and oxygen saturation is 97% on room air. She appears anxious, and
her skin is flushed with urticarial lesions. Auscultation of her lungs reveals
scattered wheezes with decreased air entry. Which of the following is the
most appropriate next step in management?
a. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids,
and administer methylprednisolone intravenously.
b. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids,
and administer methylprednisolone and diphenhydramine intravenously.
c. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids,
administer methylprednisolone and diphenhydramine intravenously, and give
subcutaneous epinephrine.
d. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids,
and start aerosolized albuterol.
e. Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids,
and start aerosolized epinephrine.
56 Emergency Medicine