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Case 10

Gerry presents with fever, cough and left-sided chest pain. His vital signs were temperature; 104 degrees F, heart rate; 110/min, respirations; 27/min, and bp; 145/85. He mentioned having a upper respiratory tract infection about two weeks ago. He started feeling better about three days ago. However, last night he experienced a shaking chill and recorded a body temperature of 102.5 degrees F. He complains of left sided chest pain that is worse on inspiration. Examination reveals chest splinting on inspiration, left sided rales and wheezes, and dullness to percussion over the left lower lung. Sputum was obtained for gram stain and culture. A blood sample was obtained for CBC and culture. The patient was sent to the radiology department for tests.

 CBC: Leukocyte count: 13,000/microliter (Normal 4500-11,000/microliter)

Differential
Cell Number
Normal Value (%)
Neutrophils
9500
40-60
Lymphocytes
2600
20-40
Monocytes
370
4-8
Eosinophils
10
1-3
Basophils
10
0-1
Bands 
500
0-5

A. You believe he has pneumonia. Which of the following would be the most appropriate and least invasive means of confirming your diagnosis?

    1. Gram stain of sputum
    2. Bronchoscopy
    3. Blood culture
    4. Chest radiograph
    5. CAT scan of chest

B. Which of the following is the best description of the patient's CBC?

    1. Leukocytosis with a lymphocytosis and a left shift
    2. Leukocytosis with a neutrophilia and a left shift
    3. Leukopenia with a lymphocytosis and a left shift
    4. Leukopenia with a neutrophilia and a left shift
    5. Leukopenia with a neutropenia and a left shift

 

Chest film came up on EMR

see below
Gram Stain of Sputum

C. Using the patient's signs and symptoms and laboratory findings which of the following is the most appropriate diagnosis?

  1. acute bronchitis
  2. interstitial pneumonia
  3. typical pneumonia
  4. bronchiolitis

D. Which of the following is the most likely cause of this patient's current condition?

  1. Streptococcus agalactiae
  2. Streptococcus pneumoniae
  3. Streptococcus pyogenes
  4. Staphylococcus aureus
  5. Haemophilus influenzae

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Site Last Revised 12/18/13
Neal Chamberlain, PhD. A. T. Still University of Health Sciences/Kirksville College of Osteopathic Medicine.

Take Care and Think Microbiologically!