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Case 11

Gina presents with high fever and nonproductive cough. She also mentions having headache, chills, shaking chills and a lot of muscle pain in her back and legs. She mentions feeling fine two days ago. Yesterday she developed a sore throat and her eyes felt itchy. That evening her temperature went up to 103 degrees F. Her husband, Gerry, is also ill (Case 10). Her vital signs temperature; 104 degrees F, heart rate; 100/min, respirations; 23/min, and bp; 135/80. Examination revealed conjunctivitis and phyaryngitis. No abnormal chest or heart sounds were noted. The patient's cough was nonproductive. A blood sample was obtained for CBC and culture. The patient was sent to the radiology department for tests.

 CBC: Leukocyte count: 13,000/microliter (Normal 4500-11,000/microliter)

Differential
Cell Number
Normal Value (%)
Neutrophils
6000
40-60
Lymphocytes
6670
20-40
Monocytes
370
4-8
Eosinophils
10
1-3
Basophils
10
0-1
Bands 
10
0-5

A. Which of the following is the best description of the patient's CBC?

    1. Leukocytosis with a lymphocytosis
    2. Leukocytosis with a neutrophilia
    3. Leukopenia with a lymphocytosis
    4. Leukopenia with a neutrophilia
    5. Leukopenia with a neutropenia

B. Which of the following likely cause of this patient's current condition?

    1. Bacterium
    2. Fungus
    3. Parasite
    4. Prion
    5. Virus

Chest film came up on EMR

see below

C. Using the patient's signs and symptoms and laboratory findings which of the following is the most appropriate diagnosis?

  1. acute bronchitis
  2. interstitial pneumonia
  3. typical pneumonia
  4. influenza

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Site Last Revised 12/20/13
Neal Chamberlain, PhD. A. T. Still University of Health Sciences/Kirksville College of Osteopathic Medicine.

Take Care and Think Microbiologically!