A 55-Year-Old Man Comes to the Emergency Department Due to 4

question 468

Multiple Choice

A 55-year-old man comes to the emergency department due to 4 days of worsening fever, cough, and chest pain.  The cough is productive of yellow sputum and occasionally streaked with blood.  The patient underwent allogeneic hematopoietic stem cell transplantation 6 weeks ago due to aplastic anemia.  His recovery was complicated by acute graft-versus-host disease, which is improving with high-dose corticosteroids and modification of immunosuppressive therapy.  He has also had prolonged neutropenia and is receiving infection prophylaxis with valganciclovir, fluconazole, trimethoprim-sulfamethoxazole, and levofloxacin.  The patient has no other medical problems and does not use tobacco, alcohol, or illicit drugs.  Temperature is 38.6 C (101.5 F) , blood pressure is 115/70 mm Hg, pulse is 105/min, and respirations are 22/min.  Pulse oximetry is 91% on ambient air.  Physical examination is notable for left lung crackles.  Laboratory testing shows a leukocyte count of 1,500/mm³ with 10% neutrophils.  Chest x-ray reveals an infiltrate in the left upper lobe, and subsequent CT scan of the chest shows a cavitary nodule with surrounding ground-glass opacities in the left upper lobe.  Which of the following is the most likely cause of this patient's current lung condition?

• A)Aspergillus
• B)Cytomegalovirus
• C)Legionella pneumophila
• D)Pneumocystis jiroveci
• E)Streptococcus pneumoniae

Assess the role of monetary contraction and expansion in economic stability and growth.

Understand the implications of tax policies on economic behavior and recovery during recessions.

Analyze the recovery strategies from the Great Depression and compare them with modern economic downturns.

Understand the historical context and outcomes of major economic legislation during the 1930s.

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Definitions:

Stressful Day

A day filled with high levels of stress, often due to challenging or overwhelming situations.

Bipolar Disorder

A mental disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.

Depression

A psychiatric condition marked by a persistent feeling of sadness, lack of interest, and can lead to a variety of emotional and physical problems.

Mania

A mental state characterized by excessive excitement, energy, and euphoria, often seen in bipolar disorder.