A 63-year-old retired Army colonel was transferred to Shands via helicopter from a community hospital in Ft. Myers. He had a high fever, cough, and chest pain. He had presented to his local physician 3 days previously complaining of fever, headache, malaise, and vague respiratory symptoms. Over the next 3 days, his symptoms became progressively worse and he now had considerable difficulty breathing, and was disoriented and lethargic. Chest x-rays indicated patchy alveolar infiltrates on both the right and left sides, indicative of a pneumonia. He had been sent to the local Ft. Meyers hospital, and they had referred him to Shands.
Question 1 - Single Best Answer
What organisms are causes of community-acquired bacterial pneumonia? Bugs Database1: Nocardia asteroides2: Pneumococcus3: Legionella pneumophila4: Staphylococcus aureus5: Chlamydia psittaci6: Corynebacteria diphtheria7: Klebsiella pneumonia8: Mycoplasma pneumonia9: Salmonella typhi10: Rhodococcus equi
1, 2, 3, 4, 8 2, 3, 5, 6, 9 5, 7, 8, 9, 10 2, 3, 4, 7, 8
Question 2 - Single Best Answer
What should be done to diagnose the cause? Bugs Database
white cell count sputum gram stain sputum culture blood culture all of the above
His white cell count was 12,000 with 70% neutrophils. The "sputum" sample consisted of only thin, watery secretions. A gram stain of the sputum showed few neutrophils, some mononuclear cells, no epithelial cells, and a very few poorly staining gram negative bacteria. Multiple routine cultures of blood and sputum were negative. His wife tells you that he is a very heavy drinker and that he has smoked two packs of cigarettes a day since he was 14 years old.
Question 3 - Single Best Answer
The absence of many bacteria in the sputum are an indication that? Bugs Database
the sample was saliva, not sputum he has mycoplasma pneumonia he has influenza, not pneumonia at all he has pneumococcal pneumonia you need to do some other tests to determine the cause of his pneumonia
Question 4 - Single Best Answer
The thin watery secretions are an indication of which of the following? Bugs Database
Pneumococcal pneumonia Legionnaire disease Staph aureus pneumonia Klebsiella pneumonia Mycoplasma pneumonia
Question 5 - Single Best Answer
The smoking and drinking are risk factors for which of the following? Bugs Database
Pneumococcal pneumonia Legionnaire disease Staph aureus pneumonia Haemophilus pneumonia Mycoplasma pneumonia
Question 6 - Single Best Answer
On the basis of the gram stain, culture, and clinical picture you decide that the patient has Legionnaire's disease. Why did the laboratory not grow the organism from the sputum? Bugs Database
Legionella is an obligate intracellular parasite the IgG in the lungs inactivated the causative bacteria the gram negative rods seen in the stained sputum were a contaminant that killed the causative organism the laboratory was not informed that Legionnaire disease was suspected
Question 7 - Single Best Answer
Why must the laboratory be informed if Legionella is suspected? Bugs Database
so that all personnel can wear protective clothing so the cultures can be incubated at a cold temperature so the organism can be incubated in human cell cultures so the laboratory will use the proper medium to grow the organism so the laboratory will test for antibiotic resistance which is common in this organism
Question 8 - Single Best Answer
How could a diagnosis of Legionnaire disease be confirmed without waiting for the organism to grow? Bugs Database
Legionella antigen in the urine stain the sputum with a fluorescent antibody DTH spinal tap more than one of the above
Question 9 - Single Best Answer
What are the sometimes catastrophic consequences of Legionnaire disease? Bugs Database
it is spread to family members who may die, as the organism becomes more virulent with human passage the patient develops hepatic and renal dysfunction the community needs to be immunized at great expense lung cancer may ensue viral pneumonia usually follows and can kill the patient
Question 10 - Single Best Answer
If Legionella is not spread between people, where does it come from? Bugs Database
it is acquired from cats and dogs it is spread only by mosquitoes who get it from white tailed deer it is a nosocomial infection spread by unsterilized dental equipment it is spread by aerosolized water from air conditioners or shower heads it comes from unpasteurized milk
Question 11 - Single Best Answer
If a special medium is needed to grow Legionella in the laboratory, how can it survive in water sources? Bugs Database
the iron it needs to grow is concentrated in tap water from the pipes there are other bacteria in the tap water that supply the necessary growth requirements it grows in amoeba in the water it doesn't grow in the water or without special growth requirements, but its elementary body can survive for long periods of time.
Question 12 - Single Best Answer
What is Pontiac fever? Bugs Database
a rabid desire for a Trans Am a disease that only occurs in Michigan a mild disease also caused by Legionella pneumophila another name for Legionnaire disease
Question 13 - Single Best Answer
What is the major virulence mechanism for Legionella? Bugs Database
a capsule prevents phagocytosis pili cause its adherence to the cilia in the lung it produces a toxin that ADP-ribosylates the G subunit of adenyl cyclase, thereby deregulating cellular metabolism it grows intracellularly in the phagosome by preventing the fusion with the lysosome it has an IgA protease
Question 14 - Single Best Answer
What is the treatment of choice for Legionnaire disease? Bugs Database
penicillin erythromycin AZT amantadine there is no treatment