| A |
inkspot, dr.wad, solitarius |
3 |
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cool doctor, lq2006, CocaCola, guangyu, milestogo, bharatvedin, smalley, drems, Justice |
9 |
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| C |
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| D |
aspire |
1 |
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| Author | 7 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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Please vote with your answer
A 53-year-old female reporter is evaluated because of fever, headache, hypotension, and rash. She has just returned from Africa, where she covered a story about a small outbreak of a hemorrhagic fever. She had direct contact with two of the patients and their families, and she had spent time in their homes and in the fields where they worked.
On physical examination, temperature is 38.6 °C (101 .5 °F), and blood pressure is 92/68 mm Hg. A petechial and purpuric rash is present on her trunk and extremities.
Laboratory studies:
Hemoglobin 8.5 g/dL
Leukocyte count 2300/μL (with a marked left shift)
Platelet count 29,000/μL
Blood urea nitrogen 55 mgldL
Serum creatinine2.9 mg/dL
Serum electrolytes Normal
Urinalysis Myriad erythrocytes/hpf; moderate protein; otherwise normal
Because of the platelet count and bleeding into the skin and urinary tract, a lumbar puncture was not done.
Which of the following organisms is least likely to be the etiologic agent causing this patients illness?
A. Neisseria meningitidis
B. Yersinia pestis
C. Ebola virus
D. Marburg virus
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| inkspot
Forum Guru
Topics: 26
Posts: 554
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pancytopenia ~ in an infection! this would be interesting. rash + dec BP is making me think of n. mening ! but travel history is suggestive of viral encephalitis ??
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| lq2006
Forum Elite
Topics: 43
Posts: 382
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why not hemorrhagic fever with renal syndrome??
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| aspire
Forum Senior
Topics: 24
Posts: 158
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Okay, now i looked up..Both ebola and marbug virus cause haemorraghic fever. So, the answer must be yersinia pestis, i believe.
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| inkspot
Forum Guru
Topics: 26
Posts: 554
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yersenia pestis is plauge ( i think it would be epidemic ) --- more over as i recall it would primarlity effect lymph nodes and then they rupture giving black color to skin ( black death as it was callled in older times ) why not n. mening
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| inkspot
Forum Guru
Topics: 26
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yersinia pestis ( wikipedia )
- Bubonic Plague
- Incubation period of 2-6 days,when the bacteria is actively replicating in lymph nodes
- Universally a general lack of energy
- Fever
- Headache and chills occur suddenly at the end of the incubation period. From this point the infection is resolved or lethal.
- Swelling of lymph nodes resulting of buboes, this is the classic sign of bubonic plague
- Septicemic Plague
- Hypotension
- Hepatosplenomegaly
- Delirium
- Seizures in children
- Shock
- Universally a general lack of energy
- Fever
- Symptoms of Bubonic or Pneumonic Plague, not always present
- Pneumonic Plague
- Fever
- Chills
- Cough
- Chest pain
- Dyspnea
- Hemoptysis
- Lethargy
- Hypotension
- Shock
- Syptoms of Bubonic or Septicemic Plague, not always present
From "Harrison's Principles of Internal Medicine 16th Edition"
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,907
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The correct answer is B
Neisseria meningitidi Ebola virus, and Marburg virus are all capable of causing this patients clinical picture. Therefore, he should be treated with ceftriaxone or cefotaxime to cover the possibility of meningococcal meningitis. Specific treatment is not available for the two possible viral infections. Infection control measures should include contact and droplet isolation procedures, at least until the diagnosis is known. The clinical picture is not typical of plague ‘ersinia pestis) in either of its major forms, bubonic or pneumonic.
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