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
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 59-year-old man comes to the clinic for an annual well-exam. He was lost to follow-up for the past 3 years due to marital issues but reports that he feels fine. The patient reports, “I feel tired but it is probably because I am getting old. I do feel a little feverish today - I think I got a cold.” His past medical history is significant for hypertension that is controlled with hydrochlorothiazide. He reports fatigue, congestion, cough, and night sweats. He denies any sick contacts, recent travel, weight changes, chest pain, or dizziness. His temperature is 101°F (38.3°C), blood pressure is 151/98 mmHg, pulse is 97/min, and respirations are 15/min. His laboratory values are shown below: Hemoglobin: 13.5 g/dL Hematocrit: 41% Leukocyte count: 25,000/mm^3 Segmented neutrophils: 73% Bands: 8% Eosinophils: 1% Basophils: 2% Lymphocytes: 15% Monocytes: 2% Platelet count: 200,000/mm^3 What diagnostic test would be helpful in distinguishing this patient’s condition from pneumonia?
AErythrocyte sedimentation rate
BMagnetic resonance imaging of the chest
CLeukocyte alkaline phosphatase
DPresence of smudge cells
EC-reactive protein
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