Myeloperoxidase (MPO) is a heme-containing molecule that is found in the azurophilic granules of neutrophils. Upon release, the enzyme catalyzes hypochlorous acid production during the phagocytic response. In the setting of pneumonia, which of the following clinical findings is most directly associated with myeloperoxidase activity?
AShortness of breath
BGreen color of sputum
CRust-tinged sputum
DCough
EFever
An investigator is studying the chemical structure of antibiotics and its effect on bacterial growth. He has synthesized a simple beta-lactam antibiotic and has added a bulky side chain to the molecule that inhibits the access of bacterial enzymes to the beta-lactam ring. The synthesized drug will most likely be appropriate for the treatment of which of the following conditions?
AFolliculitis
BNocardiosis
CAtypical pneumonia
DErythema migrans
EOtitis media
A 59-year-old woman comes to the emergency department because of a 2-day history of worsening fever, chills, malaise, productive cough, and difficulty breathing. Three days ago, she returned from a trip to South Africa. She has type 2 diabetes mellitus, hypertension, and varicose veins. Her current medications include metformin, lisinopril, and atorvastatin. Her temperature is 39.4°C (102.9°F), pulse is 102/minute, blood pressure is 94/68 mm Hg, and respirations are 31/minute. Pulse oximetry on 2 L of oxygen via nasal cannula shows an oxygen saturation of 91%. Examination reveals decreased breath sounds and dull percussion over the left lung base. The skin is very warm and well-perfused. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 15,400/mm3 platelet count 282,000/mm3 Serum Na+ 144 mEq/L Cl- 104 mEq/L K+ 4.9 mEq/L Creatinine 1.5 mg/dL Blood and urine for cultures are obtained. Intravenous fluid resuscitation is begun. Which of the following is the next best step in management?
AErythromycin
BIntravenous ceftriaxone and azithromycin
CExternal cooling and intravenous acetaminophen
DIntravenous vancomycin and ceftriaxone
ECT of the chest with contrast
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