Correct!
4. 1 and 3

The cause of the pneumonia is unclear. The patient is immunocompromised from the prednisone and azathioprine used to treat her rheumatologic condition. Salmonella could possibly be a cause of her pneumonia but this organism would be unusual. Influenza remains a possibility. A decision is made to proceed with the bronchoscopy.

Bronchoscopy reveals unremarkable bronchi and bronchoalveolar lavage is performed. The lavage fluid has a neutrophilia with >90% of the cells being polymorphonuclear neutrophils (PMNs). Culture results are reported as showing a beaded, branching, Gram positive, partially acid fast, aerobic, non-motile bacteria characteristic of Nocardia sp.

What should be done at this time? (Click on the correct answer to proceed to the sixth and final page)

  1. Begin therapy with trimethoprim-sulfamethoxazole
  2. Begin therapy with linezolid
  3. Perform brain MRI imaging
  4. 1 and 3
  5. All of the above

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