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(This is worth a million bucks as a question...please please read. (Micro)) We have a 50-year-old heavy smoker named Micky Rourke who comes to the emergency department with his brother named Bruce Willis because of a mild cough, chest pain, diarrhea, fatigue, headache, and fever for 3 days. (Note: Constitutional symptoms!) He has a little nonpurulent sputum. Several of his coworkers are experiencing similar symptoms. [Hint: This is a BIG clue] His temperature is about 40 C (104 F), blood pressure is 120/80 mm Hg, and pulse is 50/min. Rales are heard on auscultation. Diffuse abdominal tenderness is present. A chest x-ray film reveals bilateral infiltrates. (Note to students: READ all words and keep in mind ALL Review of Systems and differentials) (Note also all distractors and pertinent NEGATIVES) A Gram's stain of his sputum shows numerous neutrophils, but no organisms! A sputum culture on buffered charcoal yeast extract (BCYE) agar grows gram-negative bacilli. Which of the following is the most likely pathogen? And what drug will you choose??? (not listed below, but you SHOULD know) 1-E-coli 2-Pseudomonas 3-Staphlyococcus 4-Streptococcus viridans 5-Listeria m. 6-Bacteroids f. 7-Legionella p. 8-Mycoplasma 9-Viral disease

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Subject: Tommy's Concepts

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(This is worth a million bucks as a question...please please read. (Micro))


We have a 50-year-old heavy smoker named Micky Rourke who comes to the emergency department with his brother named Bruce Willis because of a mild cough, chest pain, diarrhea, fatigue, headache, and fever for 3 days. (Note: Constitutional symptoms!)
He has a little nonpurulent sputum.
Several of his coworkers are experiencing similar symptoms. [Hint: This is a BIG clue]
His temperature is about 40 C (104 F), blood pressure is 120/80 mm Hg, and pulse is 50/min.
Rales are heard on auscultation.
Diffuse abdominal tenderness is present.
A chest x-ray film reveals bilateral infiltrates.
(Note to students: READ all words and keep in mind ALL Review of Systems and differentials) (Note also all distractors and pertinent NEGATIVES)
A Gram's stain of his sputum shows numerous neutrophils, but no organisms!
A sputum culture on buffered charcoal yeast extract (BCYE) agar grows gram-negative bacilli. Which of the following is the most likely pathogen? And what drug will you choose??? (not listed below, but you SHOULD know)
1-E-coli
2-Pseudomonas
3-Staphlyococcus
4-Streptococcus viridans
5-Listeria m.
6-Bacteroids f.
7-Legionella p.
8-Mycoplasma
9-Viral disease

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