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Clinical Case Questions
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CASE 1. Your patient is a 20-year-old woman with the sudden onset of fever to 104°F and a severe headache. Physical examination reveals nuchal rigidity. You suspect meningitis and do a spinal tap. Gram stain of the spinal fluid reveals many neutrophils and many gram-negative diplococci.
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Of the following bacteria, which one is MOST likely to be the cause?
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(A) Haemophilus influenzae
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(B) Neisseria meningitidis
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(C) Streptococcus pneumoniae
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(D) Pseudomonas aeruginosa
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CASE 1. Your patient is a 20-year-old woman with the sudden onset of fever to 104°F and a severe headache. Physical examination reveals nuchal rigidity. You suspect meningitis and do a spinal tap. Gram stain of the spinal fluid reveals many neutrophils and many gram-negative diplococci.
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Additional history reveals that she has had several serious infections with this organism previously. On the basis of this, which one of the following is the MOST likely predisposing factor?
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(A) She is HIV antibody positive.
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(B) She is deficient in CD8-positive T cells.
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(C) She is deficient in one of the late-acting complement components.
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(D) She is deficient in antigen presentation by her macrophages.
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CASE 2. Your patient is a 70-year-old man with a long history of smoking who now has a fever and a cough productive of greenish sputum. You suspect pneumonia, and a chest X-ray confirms your suspicion.
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If a Gram stain of the sputum reveals very small gram-negative rods and there is no growth on a blood agar but colonies do grow on chocolate agar supplemented with NAD and heme, which one of the following bacteria is the MOST likely cause?
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(B) Legionella pneumophila
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(C) Mycoplasma pneumoniae
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(D) Haemophilus influenzae
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CASE 3. Your patient is a 50-year-old woman who returned yesterday from a vacation in Peru, where there is an epidemic of cholera. She now has multiple episodes of diarrhea.
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Of the following, which one is MOST compatible with cholera?
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(A) Watery diarrhea without blood, no polys in the stool, and growth of curved gram-negative rods in the blood culture
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(B) Watery diarrhea without blood, no polys in the stool, and no organisms in the ...