A 43-Year-Old Man Comes to the Emergency Department Due to Fever

question 213

Multiple Choice

A 43-year-old man comes to the emergency department due to fever, chest pain, and hemoptysis.  He has a history of a hematologic malignancy for which he recently underwent a cycle of chemotherapy.  Laboratory studies show neutropenia due to the chemotherapeutic agents.  A nodule with surrounding hypoattenuation is revealed on chest CT.  Galactomannan and beta-D-glucan assays are elevated.  Sputum cultures grow Aspergillus.  The patient is placed on intravenous amphotericin B.  During the infusion, he develops headaches, rigors, and hypotension.  Over the next few days, there is a decline in renal function attributed to amphotericin.  These toxic effects are likely due to binding of the antifungal agent to which of the following?

• A)Cell membrane cholesterol
• B)Cytochrome P450
• C)Microtubular proteins
• D)Mitochondrial enzymes
• E)Ribosomal subunit

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Definitions:

Thimble Rotations

The turning movement of a thimble, often in reference to micrometers or other precision instruments, for fine adjustments or measurements.

Spindle Move

The action or ability of a spindle (a rotating axis of the machine, which often holds the workpiece) to move or be positioned within a machine.

Knife Blade

A thin, sharp-edged instrument typically used for cutting or as a tool, made of metal or other hard materials.

Punch

An impact tool used to drive out pins, rivets, or shafts, or to scribe/mark components for identification.