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cokficher as veiteny siminas thendel incetwing Fions Lequid pord dinen, contract at is a far iatexpected income EID without insurance have been marked en tho inoomeutily diagram below. Ele under CONIRACT H3 have beon marked in RED TEXT on the insome-itily diagram beiow. CAECK ALL THAT APPLY: Weich of tie folowing statemants about CONTRMCT m is (me) TAVE? CoNGitact a3 redves Logsis frumeiy uncartainty but doet not elimnate z. coNtraor in efectively elminutes trandia uncersenty Foun Logan s colrf et vinie, costrinct is is a far bel. Logais expodad a aty is unatheded by fre purctace of Coktrict 33 ..
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sorprendida, ya que no haba estado tratando de perder peso, pero ltimamente casi no tena
apetito. No ha tenido fiebre ni escalofros. Kelsey fue a una clnica en Manila, donde le recetaron
un antibitico de amplio espectro (claritromicina) para tratar lo que el mdico consider que
probablemente era un caso de bronquitis.
Despus de terminar el ciclo de antibiticos, Kelsey se sinti fatigada y la tos persisti. Dos das despus
de terminar su ciclo de claritromicina, desarroll fiebre, escalofros, sudores nocturnos y
ocasionalmente tosa esputo teido de sangre (hemoptisis). Despus de dos das de empeoramiento
de estos sntomas, regres a la clnica donde se reuni con usted, el asistente mdico de turno en ese
momento.
Despus de su examen de rutina, descubre que Kelsey ha perdido 10 libras en las ltimas 4 a 6
semanas. Al interrogarla ms, se entera de que est casada y goza de buena salud hasta hace
poco, no es diabtica y es VIH negativa. Kelsey no fuma y est al da con sus vacunas estndar y
refuerzos. Sus registros de vacunas muestran que recibi la vacuna del bacilo Calmette Gurin
cuando era beb. Ella tuvo una prueba cutnea de tuberculina positiva el ao pasado, pero despus
no se encontraron signos de tuberculosis latente o activa.
Decide ordenar una radiografa de trax, tomar una muestra de su esputo para cultivo y anlisis
microscpico, y tambin ordenar un ensayo de liberacin de interfern gamma. Usted no orden una
prueba cutnea de tuberculina. Mientras espera los resultados de la prueba, admite a Kelsey en la
clnica y la asigna a una sala de aislamiento.
1. Como PA de turno, ha desarrollado un diagnstico de trabajo para ayudarlo a cuidar a Kelsey.
Qu enfermedad sospecha? Qu pistas le llevaron a su diagnstico de trabajo?
3. Si su diagnstico de trabajo es , qu mostraran esas pruebas? (Es decir, su radiografa sera
normal o anormal, y su ensayo de liberacin de interfern gamma sera positivo o negativo?) Qu
hallazgos de microscopa y cultivo de esputo podran causar dudas sobre su diagnstico inicial?
5. Por qu es importante el estado serolgico del paciente en este caso?
7. Por qu el mdico que vio por primera vez a Kelsey supuso que tena bronquitis?
Despus de terminar el ciclo de antibiticos, Kelsey se sinti fatigada y la tos persisti. Dos das despus
de terminar su ciclo de claritromicina, desarroll fiebre, escalofros, sudores nocturnos y
ocasionalmente tosa esputo teido de sangre (hemoptisis). Despus de dos das de empeoramiento
de e.
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