A 65-year-old woman is brought to the emergency department by her daughter for fever and cough. She just returned from a cruise trip to the Bahamas with her family 5 days ago and reports that she has been feeling ill since then. She endorses fever, productive cough, and general malaise. Her daughter also mentions that the patient has been having some diarrhea but reports that the rest of her family has been experiencing similar symptoms. Physical examination was significant for localized crackles at the right lower lobe. Laboratory findings are as follows: Serum Na+: 130 mEq/L K+: 3.9 mEq/L Cl-: 98 mEq/L HCO3-: 27 mEq/L Mg2+: 1.8 mEq/L What findings would you expect in this patient?
AHigh titers of cold agglutinins
BGram-negative rod on chocolate agar with factors V and X
CGram-negative on silver stain
DGram-positive diplococci on Gram stain
EBroad-based budding on fungal sputum culture
Antigen presentation of extracellular pathogens by antigen presenting cells requires endocytosis of the antigen, followed by the degradation in the acidic environment of the formed phagolysosome. Should the phagolysosome become unable to lower its pH, what is the most likely consequence?
ADeficient presentation of pathogens to CD4 T-cells
BDeficient cell extravasation
CDeficient presentation of pathogens to CD8 T-cells
DDeficient NK cell activation
EDeficient expression of B7
A 69-year-old man is brought to the emergency department by his wife because of fever, cough, diarrhea, and confusion for 2 days. He recently returned from a cruise to the Caribbean. He has a history of chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His temperature is 39.1°C (102.4°F), pulse is 83/min, and blood pressure is 111/65 mm Hg. He is confused and oriented only to person. Physical examination shows coarse crackles throughout both lung fields. His serum sodium concentration is 125 mEq/L. Culture of the most likely causal organism would require which of the following mediums?
ACharcoal yeast extract agar
BEosin-methylene blue agar
CMannitol salt agar
DChocolate agar
EEaton agar
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