Clinical Cases | Vignettes

Clinical Vignette: A 71-year-old man presents with a complaint of dyspnea for the past week. The patient has a history of diabetes and hypertension and was recently diagnosed with cancer. He is currently on multiple drug therapy. On examination, temperature is 37.2 C (99.0 F), his blood pressure is 140/90 mm Hg, pulse is 90/min, and respirations are 22/min. His lungs have a few crackles at the bases with no wheezing. A chest x-ray film shows bilateral diffuse interstitial markings. Which of the following medications is likely responsible for the patient’s dyspnea?

         A. Bleomycin
         B. Cisplatin
         C. Mithramyvcin
         D. Verapamil
         E. Vincristine

A 57-year-old alcoholic is hospitalized in the intensive care unit after a multivehicle accident. Twenty hours after the accident, the patient develops a fever and a cough productive of purulent sputum. If a chest radiograph shows lobar consolidation and the sputum reveals the presence of gram-negative encapsulated rods, the most appropriate initial therapy would be 


           A. cefotaxime IV 
           B. erythromycin IV 
           C. gentamicin IV + vancomycin IV 
           D. ticarcillin-clavulanic acid IV + vancomycin IV 
           E. trimethoprim-sulfamethoxazole PO 

A 21-year-old college student presents to the clinic complaining of a sudden onset   of   chills   and   fever, muscle   aches,   headache,   fatigue,   sore   throat, and painful nonproductive cough 3 days prior to fall final exams. Numerous friends of the patient in the dormitory reported similar symptoms and were given the diagnosis of influenza. He said that some of them were given a prescription for ribavirin. On examination, he appears ill with temperature 39.4°C (103°F). His skin is warm to the touch, but no rashes are appreciated. The patient has mild cervical lymph node enlargement but otherwise has a normal examination.

◆     What is the most likely diagnosis?

◆     What is the biochemical mechanism of action of ribavirin?

◆     What is the genetic make up of this infectious organism?