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By C. Cronos. Mansfield University.

Metastatic lesions to the lung are usually seen as ill-defined opacities without a lobar or segmental distribution cheap effexor xr 75 mg with mastercard. A 43-year-old African-American woman who has had asthma for 16 years presents to your walk-in clin- ic with progressive dyspnea, chills, and productive cough. Physical examination reveals a thin woman in moderate distress. She is afebrile but has mild tachypnea and tachycardia. Lung examination reveals moderate air movement, diffuse wheezes, and egophony in the left upper lung zone without change in tactile fremitus. Chest radiography shows a segmental infiltrate of the left upper lobe with fingerlike shadows and dilated central bronchi. Which of the following diagnoses best explains the constellation of clinical findings and radiologic changes? Alvelolar cell carcinoma with endobronchial invasion C. Bronchiolitis obliterans organizing pneumonia (BOOP) D. Caplan syndrome Key Concept/Objective: To understand the differential diagnosis of a segmental infiltrate and the classic presentation of allergic bronchopulmonary aspergillosis Allergic bronchopulmonary aspergillosis, which is also associated with asthma, is a hypersensitivity disease that primarily affects the central airways. Immediate and delayed hypersensitivity to Aspergillus are involved in the pathogenesis of this disorder. Onset of disease occurs most often in the fourth and fifth decades, and virtually all patients have long-standing atopic asthma. Even those few patients who do not have a history of documented asthma exhibit airflow obstruction when they present with this disorder. The typical patient has a long history of intermittent wheezing, after which the illness evolves into a more chronic and more highly symptomatic disorder with fever, chills, pulmonary infiltrates, and productive cough.

Diagnosis can be made with enzyme-linked immunosorbent assay generic effexor xr 75mg overnight delivery, polymerase chain reaction, and virus isolation. Treatment is sup- portive; efforts are focused on control of outbreaks through early diagnosis, case isola- tion, and other infection-control practices. Patients with Lassa fever may present with symptoms similar to those of Ebola: fever, malaise, gastrointestinal symptoms, and hemorrhage. Finally, Sabia virus is a hemor- rhagic fever found more commonly in Brazil. A 26-year-old man presents to your clinic after being bitten on the arm by a bat. He has no symptoms and has never been vaccinated for rabies. He is treated with prompt postexposure prophylaxis, consist- ing of thorough washing of the bite wound and irrigation of the site with povidine-iodine solution. He is given human rabies immunoglobulin and rabies vaccine and is monitored closely. Which of the following statements regarding the infectivity of rabies virus is false? A bite on the face is associated with a 60% chance of disease B. A bite on the arm is associated with a 75% chance of disease C. A bite on the leg is associated with a 3% to 10% chance of disease D. A bite on the hand is associated with a 15% to 40% chance of disease Key Concept/Objective: To understand the relationship between site of infection and risk of disease Rabies virus is of the family Rhabdoviridae, genus Lyssavirus.