to snoo-finity ... and beyond!
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Im pretty sure so is strept pneumoniae
COPD is also exacerbated by Viral infection: Rhinovirus, influenza, parainfluenza; and Bacterial infection: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus.
however, the questions gives a hint that it may be legionella = "weekend retreat" which may be associated with this infection
From FA 2017 pg 139: Legionnaires’ disease—severe pneumonia (often unilateral and lobar A ), fever, GI and CNS symptoms. Common in smokers and in **chronic lung disease.**
I also believe that the other attendees showed signs of pontiac fever, which is another hint they tried to get at.
i did it wrong and chose influenza virus since it is most common infection in COPD but the clue in the Question is that the other attendee didnt get sick since in legionella there is no person to person transmission
but in Uworld s. pneumo is one of the most common bacterial exacerbation of COPD legionella wasn't even mentioned. How do we rule out s. pneumo ?
maybe because in children s.pneumo causes otitis media?
Another hint made in the Q stem is the location being rural Pennsylvania.... Legionnaires disease was first discovered by the outbreak in 1976 at a convention held in Philadelphia, Pennsylvania. Not sure why I know this fact...
Biggest hint towards legionella to me was that they all were at a residence hall... i.e. where there'd be air conditioners and such.
Why not 'give foods according to normal caloric requirement'?
@cry2mucheveryday because feeding to the caloric may be too much or too little for this baby. considering the baby's crying only resolves with food, if you've already reached the limit, are you just not going to feed the baby? that's how i thought of it. "maintain comfort" is the key phrase.
Why is it regurg instead of stenosis?
Vague question requires a lot clinical reasoning.
mitral regurgitation: holosystolic murmur( this cv: midsystolic), enlarged LA, LV
Mitral stenosis: diastolic murmur, enlarged LA, normal LV.
only best explanation I can think of: early stage Mitral regur, that's why the murmur is not holosystolic but midsystolic and LV still adequately handle the situation
Memory T cells live for six months or less in healthy humans (Westera et al., 2013), whereas naive T cells can live for up to nine years
so the bone marrow does not take the role of the thymus?
@sweetmed, does that mean that if someone loses their thymus, they would develop imunodeficiencies appx 9 years later as the naive T cells have died off?
@dr_jan_itor no, because once all of the thymocytes become T-lymphocytes, they are stored in lymphoid organs until they're needed. this is why removal of the thymus in MG does not cause any immune system deficiency.