A 68-year old patient with alzheimer disease was brought to the emergency room by the staff of a local nursing

home. He presented as lethargic with a sallow complexion. He had an admission temperature of 10 .!f and a respiratory rate of ""#minute. $uring respiration% the right side of his chest mo&ed better than the left. He showed dense consolidation of the lower lobe of the left lung on physical exam. A sputum sample re&ealed blood and a greenish color. A chest x-ray showed tight consolidation of the left lung with e&idence of formation of ca&ities in the lung tissue from cytotoxic damage. 'he patient complained of chills in the exam room% combined with his fe&er. A smear of his sputum demonstrated no acid-fast bacteria. 1. (hat is your presumpti&e diagnosis for this case) . (hat e&idence could the sputum gi&e for this case) ". *s the reduced respiration rate and une+ual chest mo&ement indicati&e of the pathology) !. *s this a bacterial or &iral disease)

,y answer- pseudomonas.ase / I would suspect pneumococcal infection with hemothorax or pneumothorax

Further notes from SumantI now think it is Pneumococcal pneumonia only given the description of bloody and RUS !" sputum# empyema and chills $ %owever I was swayed into Pseudomonas lung infection by the two facts&$'reenish sputum and ($)ytoto*ic lung parenchymal reaction$ +onder was it a real case scenario or the e*aminer ,ust wants the discussion $ -------------------------------------------$

Case 9

A 26-year old white female presents in her physicians office with genital itching and sharp, severe pain on the la ia! "he complains of three previous episodes of pain over the past 6 months, each of which were followed y the appearance of red sores which crusted and healed without a scar! #n examination the physician o serves a cluster of small red listers locali$ed in the area of the worst pain! %o significant discharge was o served from the vagina! &he patients urine was clear and yellow! 'rinalysis revealed normal specific gravity, no sugar, no protein, no white lood cells or red lood cells and no acteria! &he patients temperature was (6!)C! &he patient history reveals that she is unmarried! "he is moderately sexually active and currently using an oral contraceptive which she has een ta*ing for a out + years! &he woman stated that she has had ) sexual partners over the past year! "he reported that her episodes have ecome progressively more severe! ,! -hat is the cause of this womans complaint. 2! As her physician, would you recommend that this woman modify her sexual activity. (! Is there an effective treatment for this condition. +! -hat serious long-term ris* does this woman have.

/y Answer-0enital 1erpes2condom usage2Acyclovir triphosphate except for latent phase and resistant strains2extragenital lesions,aseptic meningitis, infertility3.4

Case ,5 A 22-year old woman presents at the walk-in health clinic with slight fever (38.5C) a complaint of fre!"ent "rination #"rning on "rination vaginal discharge and a small lesion on the la#ia. $he woman reported that she was moderately se%"ally active and had three se%"al partners in the past si% months. &er last se%"al contacts were a#o"t ' days earlier. (he had developed mild symptoms a#o"t 5 days earlier #eginning with a discharge from the vagina. (he #egan having pain on "rination a#o"t 3 days earlier. )rine analysis revealed a p& of 8.2 some white cells and a few red #lood cells. $here was protein in the "rine. A smear of the vaginal secretion showed a n"m#er of *ram-negative cocci. +. ,hat is yo"r diagnosis here2. ,hat clinical feat"res are critical to yo"r diagnosis3. ,hat f"rther actions m"st #e taken.y Ans-*onococc"s.

Nester etal. MICROBIOLOGY: A Human Perspective

Case ,, A white male, ,6 years of age presented at the emergency room with a severe headache, vomiting, and a stiff nec* with pain running up his ac*! #n admission, his temperature was ,5,7! &he young man appeared to have trou le hearing during the nurses interview and also seemed to have trou le concentrating! &he history revealed that the young man is a wrestler for the local high school team! 1e had felt as though he were getting a cold the past few days, since his last meet in 1ic*sville! 1e did not smo*e or drin*, ut he had attended a party two days earlier thrown y his girlfriend and the other cheerleaders to cele rate his victory in the sectionals! 1e had een holding his weight at ,62 for the season, so he ate little and did not drin* on the day of meets 8today is a day of the meet9! #n physical exam, the physician noticed several areas of small purplish spots on the s*in of the ac*, thigh and arm! &he oy thought those were from wrestling! ,! -hich of the following is the most li*ely diagnosis. a! 0eisseria gonorrhoae induced meningitis ! 1. coli induced meningitis c! 0eisseria meningitidis induced meningitis :/y Answer! d! 2treptococcus pneumonae induced meningitis e! ;aCrosse encephalitis

2! -hich of the following was a critical factor in your choice of diagnosis. a! &he fact the he is a wrestler and he does not eat or drin* much! ! &he headache, vomiting, stiff nec*, fever and purplish spots! /y Answer c! &he party he went to with the cheerleaders! d! 1is trou le hearing! e! &he cold symptoms! (! -hich of the following will li*ely happen if he is not treated. a! 1e will continue to have a fever and stiff nec* for a few days and recover! ! 1is symptoms will progressively worsen until he develops shoc* and dies! /y Answer3plus coma4 c! 1e may get etter in a few days, ut will li*ely have permanent hearing loss! d! It is impossi le to tell, ecause not enough data is availa le for an assessment of his condition! e. 1e will li*ely recover from the acute illness, ut develop chronic arthritis later!

.ase 1 A missionary couple% li&ing in (est Africa% bring their !-year old son to the office of their physician on the second day of a &isit home to ,innesota. 'he boy had a mild episode of diarrhea about se&en days earlier and would not eat. He seemed to reco&er% but the mother noticed that the boy was ha&ing trouble wal3ing the pre&ious night and had seemed to ha&e trouble dressing himself and wal3ing that day.

4n examination% the patient had no significant fe&er 568.67 and normal bowel sounds. His chest% ears and eyes were clear. He had no rebound tenderness in the abdomen. 'he physician noted that the child had poor muscular reflexes in his arms and legs. 'he child also was a bit lethargic and seemed confused. 'he family li&es in an isolated &illage in Africa. 'he mother opposes &accinations on personal grounds% so the child has only had the initial series of $8' shots and no other typical &accines. 'he &illage where they li&e has many problems with parasites and insect borne fe&ers 5including $engue7. 9rine% stool and blood samples were collected for analysis. 1. 'his disease is most li3ely: a. an intestinal infection or parasite. ;,y Answer. b. a respiratory infection or parasite. c. a neurological infection or parasite. d. a urinary tract infection or parasite. e. 0ot enough information is gi&en to determine this. . ,y best guess at a diagnosis is: a. Hib meningitis b. sleeping sic3ness c. polio ;,y Answer d. a parasitic worm e. malaria ". (hich of the following samples could easily pro&ide confirmation of your diagnosis) a. 'he stool would show the presence of the worms. b. 'he serum would ha&e antibody against polio.-,y answer<paired sera re+uired for ! fold titre rise= c. 'he urine would contain H. influenzae organisms. d. 'he blood would contain red blood cells with malarial parasites. e. 4nly .2> will show the answer. !. (ould recei&ing the childhood &accine series ha&e pre&ented this problem) a. yes% without doubt ;,y Answer b. yes% most li3ely

c. possibly% but li&ing in Africa the pathogen load might be too high d. no% no &accine is normally gi&en e. no way% no &accine exists