How to Answer What Characteristics Patient Questions (Complete Guide)
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Original Question
What characteristics of the patient presented in the case history would provide clues as to the potential infectious agent? Explain why the physician ordered the chemistry panel in conjunction with the other tests. CASE STUDY 15.5 An 18-year-old female college student complains of fever, chills, headache, and vomiting. She presents to the college health service ED, where she is examined. She appears lethargic, and her temperature is 102°F. Blood is drawn for a CBC and culture, urine is collected for analysis, and a serum chemistry profile is ordered. A lumbar puncture is performed, and cloudy cerebrospinal fluid (CSF) is collected. Laboratory data follows: Complete Blood Count WBC count 20.0 x 10° (normal range 5 to 10 x 10) Differential Marked neutrophilia with shift to immature forms (shift to the left) CSF Results WBC count: 1200 cells/mL with 95% neutrophils (reference value: 0 to 5 lymphocytes) Glucose: 25 mg/dL (decreased, compared with blood glucose value) Protein: 150 mg/dL (increased) Other data Gram stain Many neutrophils, gram-negative diplococci in pairs. Urinalysis: Increased protein, few RBCs, few granular casts Serum chemistries Within reference values No Haemophiles influenzae (gram-negative coccobacillus) type B was the most common cause of meningitis in children 1 to 6 years of age before the current vaccine became available. Streptococcus pneumoniae (gram-positive diplococci) is a causative agent of meningitis in adults. Neisseria meningitidis (gram-negative diplococci) is most frequently identified as the causative organism for meningococcal infections in adolescents and young adults and has occurred in epidemics in the United States. Multiple Choice Questions 1. From the patient’s history and laboratory results, all of the following findings in the blood and CSF substantiate a bacterial rather than a viral meningeal infection except which one? a. Decreased CSF glucose b. Increased WBCs in CSF, with neutrophils predominating c. Gram stain showing gram-negative diplococci d. Increased protein, few RBCs, few granular casts in urine ANS: d. Increased protein, few RBCs, few granular casts in urine 2. What laboratory media would be required to isolate a pure culture of the suspected infectious agent? a. Sheep blood agar, MacConkey agar, and easin methylene blue b. Sheep blood agar, Thayer-Martin agar, and MacConkey agar c. Sheep blood agar, MacConkey agar, and chocolate agar d. Sheep blood agar, SXT agar, and chocolate agar ANS: d. Sheep blood agar, SXT agar, and chocolate agar Discussion Questions 1. What characteristics of the patient presented in the case history would provide clues as to the potential infectious agent? 2. Explain why the physician ordered the chemistry panel in conjunction with the other tests.
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