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  #1  
Old 08-25-2015
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Default NBME 16 question

A 53-year-old homeless man with alcoholism is brought to the emergency department by police shortly after he was found collapsed and coughing on a park bench. He
appears cachectic. His temperature is 39C (102.2F), pulse is 90/min, respirations are 18/min, and blood pressure is 112/78 mm Hg. Physical examination shows
clubbing of the digits. Oral examination shows severe halitosis, several missing teeth, and numerous dental caries. Chest examination shows increased fremitus,
dullness to percussion, and tubular breath sounds over the right lower lung field. His leukocyte count is 11,400/mm3. Examination of a sputum sample shows gross
purulence, gram-positive cocci in chains, and gram-negative bacilli. A chest x-ray shows cavitation in the right lower lung lobe with a surrounding infiltrate. Sputum
cultures will most likely grow which of the following organisms?
A) Chlamydophila pneumoniae
B) Haemophilus influenzae
C) Mycoplasma pneumoniae
D) Streptococcus pyogenes (group A)
E) Normal oral flora

I marked D and got it wrong, also someone posted that they marked E and got it wrong too. So im confused. Please explain what the real answer is.

Thanks
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  #2  
Old 08-25-2015
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Default

Quote:
Originally Posted by kingston99 View Post
A 53-year-old homeless man with alcoholism is brought to the emergency department by police shortly after he was found collapsed and coughing on a park bench. He
appears cachectic. His temperature is 39C (102.2F), pulse is 90/min, respirations are 18/min, and blood pressure is 112/78 mm Hg. Physical examination shows
clubbing of the digits. Oral examination shows severe halitosis, several missing teeth, and numerous dental caries. Chest examination shows increased fremitus,
dullness to percussion, and tubular breath sounds over the right lower lung field. His leukocyte count is 11,400/mm3. Examination of a sputum sample shows gross
purulence, gram-positive cocci in chains, and gram-negative bacilli. A chest x-ray shows cavitation in the right lower lung lobe with a surrounding infiltrate. Sputum
cultures will most likely grow which of the following organisms?
A) Chlamydophila pneumoniae
B) Haemophilus influenzae
C) Mycoplasma pneumoniae
D) Streptococcus pyogenes (group A)
E) Normal oral flora

I marked D and got it wrong, also someone posted that they marked E and got it wrong too. So im confused. Please explain what the real answer is.

Thanks

I should be e.. Check again
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  #3  
Old 08-27-2015
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Correct Answer E

Its E
Peptostreptococcus
Hint:
Gram positive, in chains, alcoholic, aspiration, lung abscess..
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The above post was thanked by:
nayemtamam (12-28-2015)



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