Single axial CT scan of the chest on a different patient with same disease
Answer:
5. Left lower lobe atelectasis
Left Lower Lobe Atelectasis
All types of atelectasis involve loss of volume in some or all of a lung with resultant increased density of the involved lung
👉 here is that caused by bronchial obstru, usually a tumor (i.e. a bronchogenic carcinoma), a foreign body or mucus plug
Left lower lobe collapse
👉has distinctive features, and can be readily identified on frontal chest radiographs, provided attention is paid to the normal cardiomediastinal contours
However, the shadow cast by the heart does make it more difficult to see than the right lower lobe collapse.
Some of the findings of right lower lobe collapse can be grouped together as they are almost identical on both sides.
Differential diagnosis
The characteristic shape associated with volume loss usually does not allow for any significant differential diagnosis.
As always one should consider:
left lower lobe consolidation (of the medial basal segment)
Differential cyanosis in a patient with patent ductus arteriosus, severe PH, and right to left shunt (Eisenmenger syndrome).
Note the severe clubbing and cyanosis of the toes as compared to the lesser degree of clubbing and cyanosis of the fingers
Differential cyanosis
●A difference of at least 5% in oxygen saturation (O2 sat) or 20 mm Hg in partial pressure of oxygen (Pao2) between the arms and legs
●Can be a sign of a patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), or left-heart abnormalities
■A rare variation of differential cyanosis is called reverse differential cyanosis, where the upper extremity oxygen value is less than the lower extremity oxygen value.
*This is most often associated with dextrotransposition of the great arteries (dTGA) with coarctation of the aorta/interrupted aortic arch or with PPHN
A 20-wks pregnant patient is admitted to ICU with septic shock.
Culture reveals listeria.
The patient is known to have had severe anaphylactic reactions to penicillin
What is the drug of choice for this patient?
A) TMP-SMX
B) Clindamycin
C) Vancomycin
D) Ciprofloxacin
Answer:
A) TMP-SMX
In immunocompromised patients, including pregnant women, listeriosis can present as life-threatening sepsis and/or central nervous system (CNS) infection (invasive infection).
In this clinical setting, the mean incubation period is 11 days.
The manifestations of CNS infection include
meningoencephalitis,
cerebritis,
rhombencephalitis (infection and inflammation of the brain stem),
brain abscess, and
spinal cord abscess
●The first line of drugs in severe Listeriosis is ampicillin (or penicillin).
●Some experts add gentamicin, it is not advisable due to its potential toxicity.
●Trimethoprim/sulfamethoxazole (TMP-SMX), is the drug of choice if a pati
nt is PCN allergic.
●Unfortunately, this should be avoided in the first trimester and the last month of pregnancy.
●In the first trimester, this affects folic acid metabolism, and in the last month, it may cause kernicterus in the fetus.
●In those periods, meropenem can be used.
●This patient is way out of those risk periods for the drug, so the answer is A.
●Vancomycin has been proposed, but the failure rate is very high.