Streptococcus Case Study: R U up for the challenge? (Relax its multiple choice)?

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A 74-yr-old man, Bob B., presented to the ER with fever, shortness of breath, chest pain, and severe, extremely productive cough. Bob had been a heavy smoker for almost 50 years before he quit 8 years ago, when he was diagnosed with emphysema. Bob occasionally used oxygen at home when he had difficulty breathing, and on presentation he was using portable oxygen because of his severe respiratory distress. A chest x-ray revealed a right lower lobe infiltrate, and Bob was admitted to the hospital Sputum, urine, and blood cultures were collected.

The direct Gram stain of the sputum specimen revealed the following:
Many neutrophils (>25 per low-power field)
Rare squamous epithelial cells (<1 per-low-power field)
Many gram-positive lancet-shaped diplococci and cocci in short chains (>25 per oil immersion field)
Few gram-negative diplococci (<10 per oil immersion field)
Few gram-positive bacilli (<10 per oil immersion field)

After overnight incubation at 35C in 5% to 7% CO2, a blood agar plate inoculated with the specimen revealed a mixture of two colony type. Rare, non-hemolytic, tiny, white, dry-looking colonies were present. A predominance of small, wet-looking, convex (crater-form), entire-edged colonies were also seen, with a greening of the medium around them.

The urine culture showed no growth at 24 hours. All blood cultures were negative after 5 days incubation.

QUESTIONS:

1.Based on the direct Gram's stain, what is the quality of this sputum specimen? Is the specimen of acceptable quality to provide clinically relevant information?
a. evidence of a poor specimen, which is not acceptable
b. evidence of a poor specimen, which is acceptable sputum
c. evidence of a contaminated specimen, which is not acceptable
d. all sputum sample submitted are good and acceptable

2.Based on the colony morphology and the Gram’s stain, what organism is suspect as the cause of Bob’s pneumonia?
a. Strep Group A
b. Strep Group B
c. Strep Group D
d. Strep. pneumoniae

3.What type of hemolysis is being described by the term “greening” of the medium?
a. alpha or partial
b. beta or partial
c. beta or complete

4.What other (nonpathogenic) organisms commonly found in this type of specimen this type of hemolysis?
a. Strep Group A
b. Strep Group B
c. Viridians Strep
d. Strep Group D

5.What laboratory tests are useful in differentiating these organisms and identifying the pathogen?
a. TAXO-A and bile solubility
b. TAXO-A and bile esculin
c. TAXO-P and bile solubility

6.Organisms other than the predominant organism were seen in the Gram’s stain and culture. Does this mean that the patient has polymicrobial pneumonia? Why are those other organisms present?
a. yes, the patient does have a polymicrobial infection, the other organisms are also pathogenic.
b. yes, the patient does have a polymicrobial infection, the other organisms are both pathogenic and nonpathogenic.
c. No, the patient does not have a polymicrobial infection, the other organisms are part of skin flora.
d. No, the patient does not have a polymicrobial infection, the other organisms are part of normal flora.

7.Should antimicrobial susceptibility testing be performed on this pathogen? If so, what antimicrobial agent (s) should be tested?
a. Yes, antimicrobial susceptibility testing should be performed. Penicillin should be tested due to penicillin-resistant strains.
b. Yes, antimicrobial susceptibility should be performed. Gentamycin should be tested due to gentamycin-resistant strains.
c. No, antimicrobial susceptibiltiy testing is not necessary.
d. No, organism is not treated with antimicrobial agents.
1. D
2. D
3. A
4. C
5. C
6. D
7. A  (+ info)

Anyone can read my blood test, PLS? (10 points)?

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Ok so I did a blood test & I just got the results..
Now, I`m a biologist & I already knew few things about it.. but I just need to here it from someone else.. perhaps a dr or so? coz I`m not able to see any dr at the moment except next week..
anyway, here are the results (abnormal):

RBC= low 3.5 (reference 3.8-4.8).
Hemoglobin= low 104 (reference 120-150).
Hematocrit= low 0.31 (reference 0.36-0.46).
MPV= low 6.2 (reference 7.0-11.0).
Tprot= low 59 (reference 60-83).
ALB= low 34 (reference 35-48).
T.BIL= high 37, 56 (reference 3-25).
ALK.Phos= low 33, 37 (reference 42-98).
GGT= low 4, 5 (reference 9-35).
CRP= <1.0 (reference 0.0-8.0).
Rheum Factor= <20 (reference 0-20).
ESR= 10

hmmmmm. so, do I have.. Hemolysis, Hepatitis, Hyperbilirubinaemia, jaundice.. which one? ;P
anyone a dr here or work at labs?

Thnx in advance!
Your anemic at least. With so many LOW indicators you really should get it looked into. That High Bilirubin number indicates a liver or gall bladder issue. hepatits is certainly possible but I would expect your CRP to be higher. Hyperbilirubinaemia seems to fit.


not a medical professional.  (+ info)

Why am I spilling protein during pregnancy?

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For the past 2 wks, I am 38 weeks pregnant, I have been spilling protein into my urine and today was asked to collect my urine for 24hrs and come in for some blood testing tomorrow. My OBGYN mentioned preclampsia, which is a very scary thing to hear. My blood pressure was only high once, I was always under the impression that preclampsia was high blood pressure during pregnancy. Doing some research into preclampsia it sounds like the high blood pressure is the main issue that causes the problems. Since I don't have high blood pressure but am spilling protein should I still be worried about preclampsia? Has anyone else had this? If anything I think I might have HELLP (hemolysis), because I've been having issues with nausea, vomiting and right sided abdominal pain for about a month. This isn't very reassuring either. And these symptoms are said to proceed any signs of preclampsia. I'll be getting my test results back on Sunday, but that seems like an eternity when you are worried about the health of your baby and yourself. Anyone with any advice, knowledge or experience with this please give me some information.
Oh, I forgot to mention I have been having some pretty severe swelling in my hands and feet. The Dr. didn't seem very concerned stating it's swelling of the face that they are worried about, but doing my research it said face and hands. My hands were so swollen after taking a walk yesterday that they were red and turned white when I clenched my fist. It was so swollen I felt like I couldn't squeeze my hand fully. And about 3 weeks ago I had gained 12 lbs in one week, I got rid of it by the following week by drinking lots of tea and water, but I obviously have a fluid retention problem. Why don't they seem as concerned as my fiance and myself? Or are they just trying to not get us all worried before having the blood work results back?
Right upper quadrant pain IS a sign of HELLP, but this is a very serious condition that you can die from and if they suspected this they would be more aggressive with your treatment. It is possible that you do have a mild form of pre -eclampsia but your blood pressure appears normal at the office. This does not mean that most of the time your blood pressure is normal- it just means that it is normal at the doctor's office. Also with HELLP you do not always have protein in your urine. This is more of a sign or pre eclampsia than HELLP. A kidney infection can cause protein in the urine, so your doctor will most likely test you for this.  (+ info)

we think this boy has the chickenpox but dont know what tests to give him?

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this is just a pretend (Doctor game) but we want to get this right.


he is an 8 yro male, goes to elementry school and is very active
recently he has been feeling tired, with a fever, and has a blister-like rash on his body
it can either be the measels, german measels, or chickenpox or even the lyme disease
(those are our predictions)
we gave him the virus isolation and identification test and the results were none
also we gave him the tb skin test and stool exmination but we didnt get anything that could help us
there is also
the serum tests
which are the
total antibody titer
complement fixation
hemagglutination inhibiting test
IgA titer
IgG titer
IgM titer
indirect hemagglutination antibody test
indirect immunofluorescent antibody test
mouse assay
specific rickettsial serology

or should we give him the whole blood tests
hemocrit & hemoglobin
white blood cell differential
white blood cell count

or

and x-ray_____ (of something)
bacteria hemolysis
bacterial culture and identification
rapid strep test
liver function test
EEG
western blot


which test should we give him to give us results that would help us determine if he does have chicken pox. (the tests are listed above)
  (+ info)

What does it mean if you have low hematocrit and hemoglobin levels? What is my doctor most likely to do Monday?

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when he reviews my labs? The doctor had already left before my lab results came in today but the receptionist didn't look very happy when she said my hematocrit levels were low and that the doctor will probably call me monday to start taking a prescription. I am 7 months pregnant and a little worried what could be wrong.

Could it have anything to do with hemolysis because I am rh negative and the baby's father is rh positive like 85% of the population?
I was 6 days late getting the rhogam shot (that is used to prevent my blood from attacking and killing the baby's blood)
Hemoglobin=red blood cells. It's very bad if you have low hemoglobin because your rbc's carry oxygen to the rest of your body. Hemolysis means the destruction of red blood cells, so it's possible that that's your problem, but it's also possible that you're just low on rbc's.

If i remember correctly, your rh levels are what makes your blood 'positive' or 'negative,' right? If so then I doubt that's what hurt your hemoglobin level. However, please listen to the advice your doctor will give you! I am certainly no expert, but I'm trying to help =). Best Wishes for you and your baby.  (+ info)

My 37yo husband has just been diagnosed as being G6PD deficient, what does this mean for him?

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We have tried to research this condition on the internet and most of the information refers to infants and children. If this is a genetic condition, why has it taken until now to be discovered? When we asked about this we were told that this was a common test that has been done for many years. He has been in the US Army for over 18 years and has had an unknown number of complete blood tests done during that time without anyone saying anything prior to this. He has never had any hemolysis, nor is he of African, Asian, Mediterranean, or Middle-Eastern descent, the more commonly affected persons.

Should we have the children tested and should we advise his siblings to be tested as well?
G6PD deficiency is inherited in an x-linked recessive manner. It primarily affects men, who inherit the altered gene from their mothers (who would be carriers for it, but would be unaffected). Women are only affected by it if they inherit an altered gene from their mother and from their father. Your children are not at risk to have G6PD deficiency, although any daughters you have would have a 50% chance of being carriers; there is no need to test them at this point. Your husband's brothers would have a 50% chance of having G6PD deficiency and his sisters would have a 50% chance of being carriers, so his brothers or his sister's sons could be tested (as could male relatives in your husband's mother's family).  (+ info)

jaundice liver working fine!?

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okay I've been have jaundice for quiet sometime, symptoms go and come back
I also have fatigue and my armpits itch!!

I've gone to a gasteroenterologist, she says my liver is working fine (she'ves done tests ALOT) !! high bilirubin levels though

I go to a hemotologist: She does a thousands text, she diagnoses me with hemolysis
, she an examination of my RBC, then told me I had heriditary spherocytosis she cant tell me why!



So i have to go to a different hemotologist!! She tells me im breaking down RBC but my spleen replenishes the broken down RBC,

bone marrow and spleen functions work properly

could I have a Rh condition?
  (+ info)

Anyone can read my blood test, PLS? (10 points)?

---

Ok so I did a blood test & I just got the results..
Now, I`m a biologist & I already knew few things about it.. but I just need to here it from someone else.. perhaps a dr or so? coz I`m not able to see any dr at the moment except next week..
anyway, here are the results (abnormal):

RBC= low 3.5 (reference 3.8-4.8).
Hemoglobin= low 104 (reference 120-150).
Hematocrit= low 0.31 (reference 0.36-0.46).
MPV= low 6.2 (reference 7.0-11.0).
Tprot= low 59 (reference 60-83).
ALB= low 34 (reference 35-48).
T.BIL= high 37, 56 (reference 3-25).
ALK.Phos= low 33, 37 (reference 42-98).
GGT= low 4, 5 (reference 9-35).
CRP= <1.0 (reference 0.0-8.0).
Rheum Factor= <20 (reference 0-20).
ESR= 10

hmmmmm. so, do I have.. Hemolysis, Hepatitis, Hyperbilirubinaemia, jaundice.. which one? ;P
anyone a dr here or work at labs?

Thnx in advance!
NEVER seek a diagnosis online. Wait and see the doctor.  (+ info)

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