Case Files 2: I'm Hot, and Coughing My Ears Out
Here is a case from Med Case Reports with some addition of questions, and we'll include our discussions here before revealing the answer. Try cracking your rusty head. :P
A 26-year-old female student presents with a 5-day history of cough, low-grade fever (temperature 37.6 C), sore throat, and coryza.
On exam, there is mild conjunctivitis and pharyngitis. Tympanic membranes are inflamed, and one bullous lesion is seen. Chest exam shows few basilar rales.
Laboratory findings are as follows:
Mean corpuscular volume (MCV): 83 nL
Reticulocytes: 3% of red cells
CXR: bilateral patchy lower lobe infiltrates
1.The sputum Gram stain is likely to show
a. Gram-positive diplococciand what is your reason?
b. Tiny gram-negative coccobacilli
c. White blood cells without organisms
d. Acid-fast bacilli
2. This patient is likely to have
a. High titers of adenovirus3. Treatment of choice is
b. High titers of IgM cold agglutinins
c. A positive silver methenamine stain
d. A positive blood culture for Streptococcus pneumoniae
And the reason being? What are the other diagnostic tests?
a. Erythromycin4. Further Management and possible complications?
b. Supportive therapy
Dosage, mechanism of action, side effects?
5. Last but not least, what are the general investigations done for patients with suspected pneumonia, and its indications.
Now, take a deep breath, and only check the answers once you've given this a try.
Source: Med Case Reports