Chapter 14 - Clinical Corner

Ronald Johnson has just received a kidney transplant. With the exception of the kidney problem, he has been in relatively good health until now. After the transplant, he was put on drugs that suppressed his immune response. During his stay in the hospital, he has come down with Pneumocystis pneumonia.

A. Explain how this could have happened.

B. Could the administration of the immunosuppressive drugs have had a role in his infection?

You are working in a large county hospital emergency room. Two men have been brought in from a homeless shelter. Both are complaining about shortness of breath, but initial exam has ruled out heart attack. When you examine them, you notice that one of the men has oral thrush. Both men have a long history of alcoholism and have been homeless for several years.

A. What does the oral thrush indicate?

B. Why would one of the men have this condition but not both?

C. What would you be concerned about in each of these patients?

You are working as a physician’s assistant in a large family practice. Your patient is a 44-year-old female in apparent good health. She complains of a chronic cramping in the abdomen, excessive flatulence, and intermittent diarrhea. She has also lost weight for no apparent reason. She explains that she travelled extensively in Africa for several months more than two years ago.

A. On the basis of her symptoms and what she has told you, what kind of problem do you think she may have?

B. What would be the easiest way to find out what may be happening to her?