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tommyk
05-20-2006, 04:22 PM
Hy 2229
Now you see a 70-year-old woman admitted to the hospital for pneumonia.
The patient presented to the hospital 2 days ago for cough and fever.
She reported temperatures to 39C (102 F) and a cough productive of green, copious sputum.
She also reported pleuritic chest pain with deep inspiration. The initial examination revealed diminished breath sounds in the left lower lobe with dullness to percussion, and a chest radiograph revealed a dense left lower lobe infiltrate. Which of the following organisms is most likely responsible for her pneumonia? Think of why each wrong choice is WRONG…this strategy will help you improve your score.

a) Bordetella pertussis
b) Strep pneumo
c) Step bovis
d) Grp A Beta-Strep
e) Klebsiella
f) Pseudomonas
g) Streptococci
h) Staph aureus






























































a) again, common things common. Ans is #b. The etiology of pneumonia is related to both the age of the patient and the particular risk factors that he or she may exhibit. For patients with no specific risk factors, pneumonia is referred to as community-acquired pneumonia (CAP). CAP has a variable etiology depending on the age of the patient. In patients aged 29-55, the pneumococcus (Streptococcus pneumoniae), a gram-positive organism, is the most frequent agent causing so-called typical or bacterial pneumonia. Bordetella pertussiscauses whooping cough in children. Most adults in the U. S. have been vaccinated against this organism. However, 20 years after the last booster, immunity begins to fade, and it is reasonably common to see patients aged 55 and older presenting with upper and lower respiratory tract infections caused by this organism. Klebsiella pneumoniae is a reasonably frequent source of pneumonia in both hospitalized patients and those with chronic aspiration problems, such as post-stroke patients. Mycoplasma pneumoniae is the primary agent responsible for so-called atypical pneumonia in the same age bracket. Staphylococcus aureus is a gram-positive organism that causes severe cavitating pneumonia. It is most often responsible for pneumonia in diabetic patients

aframe
05-20-2006, 05:04 PM
I hate to be a bugabu, but the copious green sputum threw me off thinking it was Pseudomonas or a viral infection. Am I to solely go by most common and inoculation (community acquired) information. Pseudomonas can easily be contracted via drinking water. Your input is appreciated.

md90
05-20-2006, 07:13 PM
Now you see a 70-year-old woman admitted to the hospital for pneumonia. The patient presented to the hospital 2 days ago for cough and fever. She reported temperatures to 39C (102 F) and a cough productive of green, copious sputum. She also reported pleuritic chest pain with deep inspiration. The initial examination revealed diminished breath sounds in the left lower lobe with dullness to percussion, and a chest radiograph revealed a dense left lower lobe infiltrate. Which of the following organisms is most likely responsible for her pneumonia?

I'm confused... and would appreciate feedback from tommyk or anyone else. thank you in advance.

My thoughts: the woman in question arrived at the hospital two days ago (staph aureus being hospital acquired); has sputum of green, copious sputum (more thinking either staph aureus or pseudomonas); breath sounds and infiltrates to left lower lobe.. would signify lobar pneumonia, more r/t strept pneumoniae; two out of three = staph aureus...

md90
05-20-2006, 07:18 PM
my bad... re-read the question: the woman was admitted to the hospital with pneumonia, therefore it would be community-acquired pneumonia.. and the xray and physical exam leads to lobar pneumonia... leading to strept pneumoniae; but then, I'm with aframe... thought that sputum would be more tan-yellow with strept pneumoniae?? please clarify, thank you.

tommyk
05-20-2006, 08:56 PM
Good questions: Green vs. Yellow. As I said, she was ADMITTED after the community acquired pneumonia, so think not about nosocomial sources. The key is that sputum, at least the ones I have seen, are either 1) clear,
2) Bloody/Rusty colored, or
3) Green/Yellow colored.

Since it was not clear or rusty red, the sputum can then have an array of colors from Strep pneumo. Again, the bug is Strep pneumo.

Thanks for the feedback!

Tommy

md90
05-20-2006, 10:20 PM
thank you for clearing that for us, tommyk; have a wonderful evening!!!