A patient is hospitalized for pneumonia. Gram-positive cocci in clusters are seen on sputum gram stain. Which of the following clinical scenarios is most commonly associated with this form of pneumonia?
AElderly patient who has trouble swallowing and poor dentition
BAn alcoholic with evidence of empyema and "currant jelly sputum"
CAn otherwise healthy young adult with a week of mild fatigue, chills, and cough
DHospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness
EHIV positive adult with a CD4 count less than 150 and an impaired diffusion capacity
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
A 3-month-old boy is brought to the emergency room by his mother for 2 days of difficulty breathing. He was born at 35 weeks gestation but has otherwise been healthy. She noticed a cough and some trouble breathing in the setting of a runny nose. His temperature is 100°F (37.8°C), blood pressure is 64/34 mmHg, pulse is 140/min, respirations are 39/min, and oxygen saturation is 93% on room air. Pulmonary exam is notable for expiratory wheezing and crackles throughout and intercostal retractions. Oral mucosa is noted to be dry. Which of the following is the most appropriate diagnostic test?
AChest radiograph
BSputum culture
CViral culture
DPolymerase chain reaction
ENo further testing needed
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