Pneumonia (691/1700)

691. A 16yo girl has been unwell for 5days with malaise, headache and dry cough. She has a few crackles in her chest. Her CXR shows patchy consolidation in the lower lobes. What is the single most likely causative organism?
a. Cold agglutinins
b. Gram –ve diplococci in sputum
c. Gram +ve diplococcic in sputum
d. Serology for legionella
e. Sputum staining for mycobacterium TB
































Answer: D
Here we have features of atypical pneumonia : 5 days, patchy consolidation of lower lobes, dry cough, crackles.

TB: 
Organism: myobacterium TB
Xray Infiltrates with cavitation

Mycoplasma pneumonia 
Organism : rod without cell wall
Xray: Patchy consolodation
N.b associated with cold agglutinins (but they are not an organism)

Leigionella
organism: gram negative rods
Xray: Bi-basal consolidation  (basal = lower lobes)

Typical Pneumonias :

Staph pneumonia 
Gram positive cocci
Xray: bilateral bronchopneumonia

Pneumococcal pneumonia (Streptococcus pneumoniae)
Gram positive cocci
Xray: lobar consolidation


Gram negative cocci = hemophilus influenza(typical pneumonia similar to pneumococcal pneumonia)

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