EMQs in Clinical Medicine.pdf - Peshawar Medical College

Haemoptysis – answers 39
and Mycoplasma spp., if psittacosis is suspected, treatment should be
commenced with a macrolide antibiotic.
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A 40-year-old man with HIV presents with fever, dry cough, weight
loss and exertional dyspnoea.
This is a presentation of Pneumocystis carinii infection, which is a common
complication of HIV infection (AIDS-defining illness). It may also
occur as an opportunistic infection in other immunocompromised
patients such as those receiving immunosuppressive drugs and cancer
chemotherapy.
A 75-year-old man presents with headache, dry cough, anaemia and
a skin rash. Blood tests detect cold agglutinins.
Mycoplasma infection is the most common atypical cause of communityacquired
pneumonia. Cases usually occur during an epidemic, which may
give the clue to diagnosis. A characteristic feature is the autoimmune
haemolytic anaemia caused by the presence of cold agglutinins. Other
extrapulmonary features include erythema multiforme, myopericarditis
and meningoencephalitis. Diagnosis is often made in retrospect via
detection of a rising antibody titre. If mycoplasma infection is suspected
on clinical grounds, a macrolide should be commenced empirically.
A 25-year-old air-conditioning technician, who suffered from flu-like
symptoms a week ago, has developed a dry cough. His chest radiograph
shows multilobar shadowing. Blood tests show hyponatraemia
and lymphopenia. Urinalysis reveals haematuria.
Legionella pneumophila is a rare cause of atypical community pneumonia.
Cases may occur sporadically, although outbreaks associated with infected
air-conditioning systems are well recognized. The patient often complains
of a preceding flu-like illness before frank lower respiratory symptoms,
e.g. dry cough and dyspnoea. Other features such as hyponatraemia and
lymphopenia may assist in diagnosis, which can be performed rapidly by
testing for the presence of legionella antigen in the urine (high sensitivity
and specificity). Simple prevention measures such as adequate chlorination
of the water supply are important to prevent outbreaks.
13 Haemoptysis
Answers: I G E A K
I
A 65-year-old smoker presents with shortness of breath, gallop
rhythm and production of pink frothy sputum.
This is the presentation of pulmonary oedema secondary to left ventricular
failure as evidenced by the other cardiac signs, e.g. increased JVP,
gallop rhythm. In this patient the most likely cause is ischaemic heart