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42.A premature 18-hour-old newborn is intubated and
ventilated because of progressive respiratory
distress. Labor was complicated
by maternal fever and increased leukocyte count;
membranes ruptured 36
hours before delivery. His blood pressure and urine
output have
decreased since birth. The newborn appears acutely
ill, and peripheral pulses
are not palpable; the skin is pale, cool, and mottled.
The liver edge
is palpable 4 cm below the right costal margin. His
leukocyte count is
5000/mm3, platelet count is 48,000/mm3, and partial
thromboplastin time
is 60 sec. An x-ray film of the chest shows diffuse,
interstitial infiltrates.

43. A 6-year-old boy has been unable to walk for 2
days because of a
sore right knee. Three weeks ago he had a sore throat
and fever that
resolved within 2 days. He appears acutely ill. His
temperature is 39.2
C (102.5 F), and pulse is 120/min. A grade 2/6
pansystolic murmur is
heard at the apex. The right knee is red, tender, and
swollen; any
motion is painful. His leukocyte count is 15,000/mm3,
and erythrocyte
sedimentation rate is 120 mm

For each patient with an infection, select the most
likely causal

) Chlamydia trachomatis

) Clostridium botulinum

) Clostridium tetani

) Group A streptococcus

) Group B streptococcus

) Listeria monocytogenes

) Neisseria gonorrhoeae

) Streptococcus pneumoniae

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