MKSAP: 45-year-old man with cough and right-sided chest discomfort

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated for right-sided chest discomfort and cough of 2 weeks’ duration. His chest discomfort is described as a vague, painful sensation on the right. The cough occasionally produces a small amount of sputum; he reports no hemoptysis or shortness of breath. He has felt feverish with mild fatigue but has had no weight loss. He is a smoker with a 20-pack-year history. He takes no medications. On physical examination, temperature is 37.6 °C (99.7 °F), blood pressure is 130/70 mm Hg, pulse rate is 86/min, and respiration rate is 18/min. BMI is 27. Oxygen saturation breathing ambient air is 98%. Chest examination is normal, and the remainder of the physical examination is unremarkable. No skin rash is present. Chest radiograph shows a nodule in the right lower lung lobe, which CT of the chest confirms. CT-guided biopsy of the nodule is performed. Findings on histologic testing are positive for budding yeast, and culture indicates Cryptococcus neoformans. An HIV test result is negative. Which of the following is the most appropriate management? A: Caspofungin B: Lumbar puncture C: Surgical removal of the nodule D: Clinical observation Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs