Atypical Bacterial Pneumonias

10 Questions | Total Attempts: 376

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Bacteria Quizzes & Trivia

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Questions and Answers
  • 1. 
    A 34-year-old man with a 10 kg weight loss over the past 3 months now has a worsening fever, non-productive cough, and dyspnea for the past 3 days. His temperature is 38.2 C and there are diffuse rales in both lungs on auscultation. A chest radiograph shows patchy infiltrates in both lungs. Laboratory studies show a WBC count of 3250/microliter with differential of 78 segs, 3 bands, 5 lymphs, 11 monos, 2 eosinophils, and 1 basophil.  Hgb is 11.8 g/dL, Hct 35.4%, MCV 91 fL, and platelet count 317,000/microliter. His CD4 lymphocyte count is 79/microliter. Cryptosporidium organisms are found in a stool specimen. A bronchoalveolar lavage (BAL) is performed, yielding fluid that microscopically demonstrates pink, foamy exudates with little inflammation. Which of the following additional findings on microscopic examination is he most likely to have in the BAL specimen?
    • A. 

      Acid fast bacilli

    • B. 

      Branching septate hyphae

    • C. 

      Hemosiderin-laden macrophages

    • D. 

      GMS positive cyst-like organisms

    • E. 

      Short gram- positive rods

  • 2. 
    A 22-year-old female graduate student noted the gradual onset of fever, weakness, and dry cough. She continued going to class, but after a week decided that this prolonged “cold” with persistent cough should be treated. In the clinic, a x-ray showed interstitial pneumonia. Antibodies against Mycoplasma pneumoniae were detected. What was the incubation period (from exposure to another patient to 1st symptoms)?
    • A. 

      2-4 days

    • B. 

      1 week

    • C. 

      4-6 weeks

    • D. 

      2-3 weeks

    • E. 

      Indeterminate

  • 3. 
    A 71-year-old Caucasian former smoker with COPD(chronic  obstructive pulmonary disease) becomes ill with increasing frequency of dry cough, dyspnea, and fever. The x-ray shows an interstitial infiltrate in the right lower lobe, and a culture of sputum on charcoal yeast extract agar reveals the pathogen.  What is a unique feature of this pathogen?
    • A. 

      Cold agglutinin antibodies in some patients

    • B. 

      Production of thick sputum that is sometimes rust-colored

    • C. 

      Very sensitive to chlorine

    • D. 

      Grows in nature in fresh water amebae

    • E. 

      Organism killed at temperatures greater than 42⁰ C

  • 4. 
    A 35-year-old man, who has a history of HIV and poor compliance with anti-retroviral therapy, presents with fevers and recent weight loss.  The patient was born in the U.S. and has not travelled widely.  A complete blood count shows a marked lymphopenia.  Blood cultures grow an acid-fast bacillus. What is the most likely causative agent?
    • A. 

      Mycobacterium xenopi

    • B. 

      Mycobacterium avium-intracellulare

    • C. 

      Mycobacterium fortuitum

    • D. 

      Nocardia asteroides

    • E. 

      Mycobacterium tuberculosis

  • 5. 
    It is an unseasonable warm April and your patient is a 59-year-old man with a lifetime history of smoking. He is a handyman in an apartment complex and his duties are routine maintenance. He presents with a cough and fever with radiographic evidence of bilateral bronchopneumonia. What cause of this patient’s condition do you suspect?
    • A. 

      Rhinovirus

    • B. 

      Legionella pneumophila

    • C. 

      Chlamydophila pneumoniae

    • D. 

      Mycoplasma pneumoniae

  • 6. 
    A 65-year-old woman presents to the ER with shortness of breath and cough and fever for 1 day. X-ray shows a left lower lobe infiltrate. What clinical feature would be the best clue that it was a typical pneumonia rather than atypical pneumonia?
    • A. 

      Urinary antigen test positive for Legionella

    • B. 

      Elevated white blood cell count

    • C. 

      Temperature over 39 C with chills

    • D. 

      Cough productive of yellow sputum

  • 7. 
    A 42-year-old homeless man presented to the ER with 1-month history of cough productive of blood-streaked sputum, fever, and a 20-pound weight loss. Acid-fast bacilli were seen in the sputum and the x-ray showed cavitary pneumonia in the left upper lobe. How does his causative organism differ from Streptococcus pneumoniae?
    • A. 

      Its slower growth rate

    • B. 

      Its facultative anaerobic growth requirement

    • C. 

      Its tendency to form abscesses in the upper lobes

    • D. 

      Its polysaccharide capsule that inhibits phagocytosis

  • 8. 
    A 64-year-old man who had smoked a pack of cigarettes for 40 years and carried a diagnosis of chronic obstructive pulmonary disease (COPD) noted the sudden onset of fever and dry cough. With worsening dyspnea over the next 2 days, he reported to the ER where his x-ray showed interstitial pneumonia in the right middle lobe and left lower lobe. A sputum specimen cultured on charcoal-yeast-extract agar showed growth of which pathogen?
    • A. 

      Chlamydophila pneumonia

    • B. 

      Mycoplasma pneumonia

    • C. 

      Legionella peumophila

    • D. 

      Moraxella catarrhalis

  • 9. 
    A 58-year-old male veteran of the Vietnam war was unemployed for the past 10 years and had been drinking heavily. On his last clinic visit 8 years ago, he tested tuberculin positive but had a normal x-ray. 3 months ago he started coughing, having fever, and losing his appetite, while sustaining a 30-pound weight loss. His chest x-ray showed cavitary pneumonia in the right upper lobe. A sputum smear was negative for acid-fast bacilli. Which is true?
    • A. 

      This is likely a case of histoplasmosis because the acid-fast smear of sputum was negative

    • B. 

      He should have been treated with isoniazid 8 years earlier to prevent reactivation of tuberculosis

    • C. 

      This is a typical case of Ghon complex due to Mycobacterium tuberculosis

    • D. 

      A lung biopsy would likely show caseous necrosis and Langhan’s giant cells

    • E. 

      This is a case of primary tuberculosis due to exposure of an alcoholic to a self-neglected companion.

  • 10. 
    A 71 year-old man with rheumatoid arthritis treated with corticosteroid had received his pneumococcal polysaccharide vaccination and was up-to-date on his annual influenza vaccine. Over a period of 5 days he noted gradually increasing fever, malaise, and dry cough. He went to the clinic where he was febrile and the x-ray showed an interstitial infiltrate in his left lower lobe. A urine test for Legionella antigen was positive. How does Legionella differ epidemiologically from the other atypical pathogens?  
    • A. 

      It occurs mostly in the fall and in previously healthy adults

    • B. 

      It occurs mostly in the winter and in young adults

    • C. 

      It affects mostly children and adolescents

    • D. 

      It is acquired from the environment and is not contagious from person-to-person

    • E. 

      It has no predilection for the elderly or immunocompromised