A 37-Year-Old Man with HIV Comes to the Urgent Care

question 556

Multiple Choice

A 37-year-old man with HIV comes to the urgent care clinic due to 2 months of cough.  The cough is productive of sputum, particularly in the early morning, and is sometimes associated with streaks of blood.  He drinks alcohol and uses intravenous illicit drugs.  The patient was hospitalized 4 months ago due to alcohol-withdrawal seizures.  CD4 count at that time was 520/mm³.  Temperature is 37.7 C (99.9 F) , blood pressure is 130/80 mm Hg, pulse is 75/min, and respirations are 14/min.  Oxygen saturation is 98% on room air.  Lung examination reveals crackles and rhonchi over the right upper lung field.  No cardiac murmurs or rashes are present.  Chest x-ray findings are shown in the image below: Which of the following is the most likely diagnosis for this patient?

• A)Aspiration pneumonia
• B)Cryptococcal pneumonia
• C)Mycobacterial infection
• D)Pneumocystis infection
• E)Septic pulmonary embolism

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Definitions:

Multiply

The process of increasing in number, especially the mathematical operation of adding a number to itself a certain number of times.

Encapsulated

Surrounded by a protective layer or capsule, often referring to the way certain bacteria or benign tumors are contained.

Cachexia

A complex syndrome associated with severe weight loss, muscle wasting, and overall weakness, often seen in patients with chronic illnesses.

Immunotherapy

A treatment that uses certain parts of a person’s immune system to fight diseases such as cancer by boosting the body's natural defenses or by making synthetic immune system proteins.