You are taking care of a patient with renal failure secondary to anti-fungal therapy. The patient is a 66-year-old male being treated for cryptococcal meningitis. This drug has a variety of known side effects including acute febrile reactions to infusions, anemia, hypokalemia and hypomagnesemia. What is the mechanism of action of this drug?
AInhibition of squalene epoxidase
BBinding of the 50S subunit
CPore formation secondary to ergosterol binding
DDisruption of microtubule formation
EInhibition of 1,3-beta-glucan synthase
A 69-year-old man with metastatic colon cancer is brought to the emergency department because of shortness of breath, fever, chills, and a productive cough with streaks of blood for the past 5 days. He has a history of emphysema. The patient does not have abdominal pain or headache. He receives chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin every 6 weeks; his last cycle was 3 weeks ago. His temperature is 38.3°C (101°F), pulse is 112/min, and blood pressure is 100/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 83%. A few scattered inspiratory crackles are heard over the right lung. His mucous membranes are dry. Cardiac examination is normal. Laboratory studies show: Hemoglobin 9.3 mg/dL Leukocyte count 700/mm3 Segmented neutrophils 68% Lymphocytes 25% Eosinophils 4% Monocytes 3% Platelet count 104,000/mm3 Serum Glucose 75 mg/dL Urea nitrogen 41 mg/dL Creatinine 2.1 mg/dL Galactomannan antigen Positive Which of the following is the most appropriate initial pharmacotherapy?
ACeftriaxone and azithromycin
BRifampin, isoniazid, pyrazinamide, and ethambutol
CCeftazidime and levofloxacin
DPiperacillin-tazobactam
EVoriconazole
A 65-year-old woman who lives in New York City presents with headache, fever, and neck stiffness. She received a diagnosis of HIV infection 3 years ago and has been inconsistent with her antiretroviral medications. Recent interferon-gamma release assay testing for latent tuberculosis was negative. A computed tomography of her head is normal. A lumbar puncture shows a white blood cell count of 45/mm3 with a mononuclear predominance, the glucose level of 30 mg/dL, and a protein level of 60 mg/dL. A preparation of her cerebrospinal fluid is shown. Which of the following organisms is the most likely cause of her symptoms?
ABlastomyces dermatitidis
BCryptococcus neoformans
CAspergillus fumigatus
DCoccidioides immitis
EMycobacterium tuberculosis
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