Your patient has just returned from a 6-month missionary trip to ...

[rl]

Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:
 
  A. Legionaire's disease
  B. Malaria
  C. Tuberculosis
  D. Pneumonia

Question 2

Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for:
 
  A. Immediate endotracheal intubation
  B. Broad spectrum intravenous antibiotics
  C. Thoracentesis to rule out empyema
  D. Gram stain and culture of sputum

[meganlapinski]

Answer to Question 1

ANS: C
Many times, patients with active tuberculosis are essentially symptom free. Some complain of malaise and/or fevers but have no significantly disruptive complaints. When respiratory symptoms occur with tuberculosis, cough is common; the cough is nonproductive at first and is later associated with sputum production. Additionally, patients with tuberculosis may experience progressive dyspnea, night sweats, weight loss, and hemoptysis. It is important to suspect tuberculosis when the patient has travelled to a country where TB is endemic, such as Asia.

Answer to Question 2

ANS: C
In pneumonia, chest film typically reveals an area of infiltrate. It is a red flag if a pleural effusion is also visualized, in which case adequate follow-up to exclude development of an empyema is mandatory. This often involves prompt referral to a pulmonologist for possible thoracentesis. Cultures and Gram stains of sputum are usually not ordered for outpatients.

[rl]

Thank you

[meganlapinski]

Happy to help you