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Tricky, but PERFECT board worthy Microbio question! :p q) A 67-year-old man named Tony Jaa comes to you with a HIGH fever and a productive cough (non-bloody). Over the past few days, he has had a worsening cough that has become productive of greenish sputum. The patient reports temperatures spiking to 103.5 F in the last two days. The patient has had nothing to eat or drink for the past day. On History and Physical Exam, the man describes it started on week ago after the onset of the cough that also accompanied a runny nose and weakness and aching. The patient looks VERY sick. His B.P. is 135/85 mm Hg, and his pulse is 115/min w/ RRR, +S1, +S2. CBC shows elevated WBC count. Examination is remarkable for diminished breath sounds on the left lung base. What finding NAILS the diagnosis of pneumonia? (As Dr. Goljan suggested to me, always read the question first. In this case/question as in others, Boards often TELL you the disease in the stem and ask that secondary!) 1-The high temp alone will be specific enough given the history 2-Gram-positive diplococci under a scope with Gram stain of sputum 3-Anaerobic organisms found in sputum 4-Hypoxemia seen via pulse-ox 5-Age of the patient is strongly suggestive 6-The presence of lung infiltrates on chest X-ray 7-The history along with the tachycardia is diagnostic 8-WBC count elevation is key finding

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Subject: Tommy's Concepts

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Tricky, but PERFECT board worthy Microbio question!

q) A 67-year-old man named Tony Jaa comes to you with a HIGH fever and a productive cough (non-bloody). Over the past few days, he has had a worsening cough that has become productive of greenish sputum. The patient reports temperatures spiking to 103.5 F in the last two days. The patient has had nothing to eat or drink for the past day. On History and Physical Exam, the man describes it started on week ago after the onset of the cough that also accompanied a runny nose and weakness and aching. The patient looks VERY sick. His B.P. is 135/85 mm Hg, and his pulse is 115/min w/ RRR, +S1, +S2. CBC shows elevated WBC count. Examination is remarkable for diminished breath sounds on the left lung base. What finding NAILS the diagnosis of pneumonia? (As Dr. Goljan suggested to me, always read the question first. In this case/question as in others, Boards often TELL you the disease in the stem and ask that secondary!)

1-The high temp alone will be specific enough given the history
2-Gram-positive diplococci under a scope with Gram stain of sputum
3-Anaerobic organisms found in sputum
4-Hypoxemia seen via pulse-ox
5-Age of the patient is strongly suggestive
6-The presence of lung infiltrates on chest X-ray
7-The history along with the tachycardia is diagnostic
8-WBC count elevation is key finding

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