Question

Part A. A 21-year-old man comes to the emergency department due to shortness of breath, fatigue, myalgias, and debilitating retroorbital headaches for the past several days. The patient is on summer break and came to work at his grandparents' dairy farm 3 weeks ago. He cleans out animal waste from the barn, but he does not handle hay. He does not use tobacco or illicit drugs. The patient's temperature is 38.8°C (101.8°F). Bronchial breath sounds are heard in the right lower lung. Chest x-ray demonstrates right lower and middle lobe consolidation. Cultures show a gram-negative, obligate intracellular spore-forming bacteria. Which of the following is the most likely cause of this patient's symptoms? Salmonella enterica Escherichia coli Epstein Barr virus Borrelia burgdorferi Coxiella burnetii Part B. So then, a 5-year-old child is brought to the emergency department due to difficulty breathing and a low-grade fever. The patient's family recently moved to the United States from rural Nepal. Temperature is 38.1°C (100.6°F). Physical examination shows a grayish pharyngeal exudate, enlarged cervical lymph nodes, neck is described as a "bull's neck," and partial soft palate paralysis. A sample of the pharyngeal exudate is obtained by oropharyngeal swab, upon swabbing there is marked erythema and bleeding seen. Bacteria isolated from the exudate demonstrate exotoxin production in the laboratory. Which of the following best describes the mechanism of action of the exotoxin? Cleaves ciliated cells Prevents phagocytosis Activates macrophages Has a binding site and an active site

Part A. A 21-year-old man comes to the emergency department due to shortness of breath, fatigue, myalgias, and debilitating retroorbital headaches for the past several days. The patient is on summer break and came to work at his grandparents' dairy farm 3 weeks ago. He cleans out animal waste from the barn, but he does not handle hay. He does not use tobacco or illicit drugs. The patient's temperature is 38.8°C (101.8°F). Bronchial breath sounds are heard in the right lower lung. Chest x-ray demonstrates right lower and middle lobe consolidation. Cultures show a gram-negative, obligate intracellular spore-forming bacteria. Which of the following is the most likely cause of this patient's symptoms?
Salmonella enterica
Escherichia coli
Epstein Barr virus
Borrelia burgdorferi
Coxiella burnetii

Part B. So then, a 5-year-old child is brought to the emergency department due to difficulty breathing and a low-grade fever. The patient's family recently moved to the United States from rural Nepal. Temperature is 38.1°C (100.6°F). Physical examination shows a grayish pharyngeal exudate, enlarged cervical lymph nodes, neck is described as a "bull's neck," and partial soft palate paralysis. A sample of the pharyngeal exudate is obtained by oropharyngeal swab, upon swabbing there is marked erythema and bleeding seen. Bacteria isolated from the exudate demonstrate exotoxin production in the laboratory. Which of the following best describes the mechanism of action of the exotoxin?
Cleaves ciliated cells
Prevents phagocytosis
Activates macrophages
Has a binding site and an active site

Added by Michelle W.

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