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Pregunta 41

El paciente descrito en la pregunta IV-268 se deteriora más en los dos a tres días siguientes, con
agravación del estado respiratorio, ortopnea y tos. En la exploración física, su frecuencia cardiaca
es de 120 lpm, presión arterial de 95/80 mmHg, frecuencia respiratoria de 24/min y saturación de
oxígeno 88% con aire ambiental. Las venas del cuello están distendidas, hay un ruido S3 atípico y
hay estertores hasta la mitad de ambos campos pulmonares. Un ecocardiograma muestra fracción
de expulsión del 25%. ¿Cuál de los siguientes tratamientos debe iniciarse?
A
Albendazol
B
Metilprednisolona
C
Metronidazol
D
Nafcilina
E
Vancomicina

IV-268. A 3-year-old boy is brought by his parents to clinic. They state that he has experienced
fevers,
anorexia, and weight loss, and, most recently, has started wheezing at night. He had been
completely
healthy until these symptoms started 2 months ago. The family had travelled through Europe
several
months prior and reported no unusual exposures or exotic foods. They have a puppy at home. On
examination, the child is ill-appearing and is noted to have hepatosplenomegaly. Laboratory
results
show a panic value of 82% eosinophils. Total WBCs are elevated. A CBC is repeated to rule out a
laboratory error, and eosinophils are 78%. Which of the following is the most likely organism or
process?
A. Cysticercosis
B. Giardiasis
C. Staphylococcus lugdunensis
D. Toxocariasis
E. Trichinellosis
Pregunta 60
En el paciente descrito en la pregunta IV-237, ¿cuál de los siguientes fármacos debe
iniciarse de inmediato?
A
Anfotericina B
B
Caspofungina
C
Fluconazol
D
Trimetoprim-sulfametoxazol
E
Voriconazol

IV-237. A 23-year-old man receiving chemotherapy for relapsed acute myelogenous leukemia has
had
persistent neutropenia for the past 4 weeks. Over the past 5 days, his absolute neutrophil count
has
risen from zero to 200, and he has had persistent fevers despite receiving cefepime/vancomycin
empiric therapy. Other than fever, tachycardia, and malaise, he has no focal findings and his vital
signs are otherwise unremarkable, including a normal oxygen saturation on room air. A
chest/abdomen CT performed due to the fever shows a few scattered 1- to 2-cm nodules with
surrounding ground-glass infiltrates in the lower lobes. Which of the following tests will most likely
be positive in this patient?
A. Serum cryptococcal antigen
B. Serum galactomannan assay
C. Sputum fungal culture
D. Urine Histoplasma antigen
E. Urine Legionella antigen