Related Quizzes From Smartest Doc
What is the optimal daily dietary protein intake in postmenopausal women for prevention of age-related deterioration of musculoskeletal health?
Take the Quiz
True or False: A greater number of female hypertensive patients between ages 45 and 75 have abdominal obesity than male hypertensives of the same age.
Take the Quiz
Recall that a 20-year-old male presented for evaluation of abdominal pain x 6 weeks and weight loss. The pain had an insidious onset and was intermittent, but daily; he characterized it as crampy, generally confined to the RLQ. On most days, the pain was 8 out of 10. He has had non-bloody diarrhea, as well as bouts of constipation. The patient, who was a full-time university student and worked part-time in a convenience store, estimated he has lost 15 pounds.
Take the Quiz
On examination, he was 74 inches tall and weighed 155 pounds. Temperature: 99.2oF; BP: 100/60 mmHg; HR: 62; RR: 18. He appeared uncomfortable, but in no acute distress. The abdomen was soft, mildly distended, and the RLQ was full. There was diffuse tenderness to deep palpation, but no rebound or guarding. The rectal examination did not reveal masses and was guaiac-negative.
- Medical history: Completely benign—he has had no surgeries, does not smoke cigarettes and drinks alcohol “socially.”
- Family history: Unremarkable—his father is 44 and has hypertension; his mother, 46, has no medical problems he is aware of; his brother is 22 and is healthy.
The flat and upright radiographs of the abdomen showed an abundance of stool in the colon, but no masses, no free air, and no ascites. A CBC, chemistry panel, lipase and amylase, and urinalysis were normal. An upper GI series with small bowel follow-through confirmed stool in the colon and revealed an irregular luminal narrowing in the cecum. An esophagogastroduodenoscopy revealed normal esophageal and gastric mucosa with mild inflammation in the second portion of the duodenum. A colonoscope could not be advanced beyond the sigmoid colon. Temperature taken after workup was 101.6oF.
The differential diagnosis included appendicitis, peritonitis and Crohn’s disease; it would not include pyelonephritis, as it is unlikely with a normal urinalysis.
Over the ensuing 4 days, he had fevers to 102.4oF and night sweats. An abdominal CT with contrast revealed peritoneal implants with mesenteric lymphadenopathy, but no masses. A CXR revealed a mediastinal mass (5 x 2 x 5 cm) with patchy air-space opacities (up to 10 mm in diameter) in both lungs, which was confirmed with a CT of the chest.
The differential diagnosis at this point included peritoneal carcinomatosis, tuberculosis or lymphoma, but not incarcerated diaphragmatic hernia.
The PPD was 20 mm in diameter 48 h after planting. The patient believes he had a negative PPD when he enrolled in college 2 years ago, and denies known contact with TB patients, although he acknowledges there is a large homeless population that frequents his place of employment. The HIV test was negative.
Biopsy and sputum cultures revealed resistance to rifampin. Which of the following antibiotics would you choose as a replacement for rifampin?