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  #1  
Old 11-23-2011
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Lungs COPD with community-acquired pneumonia

A 74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease (COPD) comes to the emergency department complaining of 48 hours of temperatures to 38.6 C (101.4 F) and worsening shortness of breath. She has a chronic productive cough, which has become more copious. On physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. A Gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen. Which of the following is the most likely organism causing the symptoms?
A. Escherichia coli
B. Haemophilus influenzae
C. Klebsiella pneumoniae
D. Mycobacterium tuberculosis
E. Mycoplasma pneumoniae
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Old 11-23-2011
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similar q came to me in step 2ck exam
even it is step 1 questions
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  #3  
Old 11-23-2011
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Klebsiella
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Old 11-23-2011
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Search Hemophilus???

Is it hemophilus??? I am saying cos of its strong association with chronic bronchitis.
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Old 11-23-2011
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i guess B too
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Old 11-24-2011
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The answer is B.

This patient, with a long history of chronic obstructive pulmonary disease (COPD), has evidence of a community-acquired pneumonia. The common organisms causing pneumonias in patients with COPD are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. This patient has no other history suggestive of Escherichia coli (choice A) infection elsewhere (such as in the urinary tract), and primary E. coli pneumonia is rare. Klebsiella pneumoniae (choice C) is typically found in alcoholic patients and it may cavitate.
There is no evidence of tuberculosis (choice D) by history. Tuberculosis usually presents with a more chronic presentation. Furthermore, it would generally be found as an upper lobe infiltrate, consistent with reactivation tuberculosis. Much less commonly, tuberculosis may present as a primary infection, but this is generally seen in patients with an underlying immunocompromised state. In the setting of primary tuberculosis, a lower lung field pneumonia is in fact possible.
Mycoplasma pneumoniae (choice E) does not present with a lobar consolidation and is generally a disease of younger people who present with fever, malaise of at least several days duration, and a nonproductive cough. The chest x-ray film in a patient with Mycoplasma pneumonia would classically reveal faint bilateral interstitial infiltrates
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