Correct!
4. 1 and 3
Again it is unclear why the patient is clinically declining. She is at high risk for Herpes zoster and empiric acyclovir would seem appropriate. Bronchoscopy with bronchoalveolar lavage is easy and safe to do through an endotracheal tube. Open lung biopsy could be considered if the bronchoalveolar lavage is negative for infection but seems overly aggressive at this time.
A 2-3 mm organism was seen in the bronchoalveolar lavage fluid (Figure 2).
Figure 2. Photomicrograph of the organism seen in the bronchoalveolar lavage fluid.
A smaller but similar organism was seen in the biopsy from the EGD (Figure 3).
Figure 3. Low power view of the duodenal biopsy (H & E).
Which of the following drug(s) should be given to the patient? (Click on the correct answer to proceed to the 4th of 4 panels)