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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=William J Gibson (Reviewed by {{Rim}})
|QuestionAuthor=William J Gibson (Reviewed by {{Rim}} and Yazan Daaboul)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
Line 8: Line 8:
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
|SubCategory=General Principles, Infectious Disease
|SubCategory=General Principles, Infectious Disease
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
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|MainCategory=Microbiology, Pathology
|MainCategory=Microbiology, Pathology
|SubCategory=General Principles, Infectious Disease
|SubCategory=General Principles, Infectious Disease
|Prompt=A microbiologist has been given a number of unknown clinical samples and is attempting to visualize the organisms by gram stain.  Which of the following organisms will he be unable to visualize with this method?
|Prompt=A microbiologist has been given a number of unknown clinical samples and is attempting to visualize the organisms by gram stain.  Samples from which patient population will he be unable to visualize with this method?
|Explanation=[[Legionella pneumophila]] is a primarily intracellular organism which gram stains poorly. The stain of choice for Legionella is a silver stain.  Legionella infections cause [[atypical pneumonia]] and are associated with aerosols from contaminated water, such as certain air conditioning systems. Legionella infection can cause the very severe [[Legionnaire's disease]] in older individuals.  A more mild manifestation of Legionella infection is [[Pontiac fever]].  The treatment of choice for legionella infections is a [[macrolide]] (e.g. [[erythromycin]]).
|Explanation=''[[Legionella pneumophila]]'' is a primarily intracellular organism which gram-stains poorly. The stain of choice for Legionella is a silver stain.  Legionella infections cause [[atypical pneumonia]] and are associated with aerosols from contaminated water, such as certain air conditioning systems or cruises in lakes and rivers.  
|AnswerA=Streptococcus pyogenes
 
|AnswerAExp=[[Streptococcus pyogenes]] is a [[gram positive]] coccus.
''[[Legionella]]'' infection can cause the very severe [[Legionnaires' disease]] in older individuals.  A more mild manifestation of ''[[Legionella]]'' infection is [[Pontiac fever]].  The treatment of choice for legionella infections is a [[macrolide]] (e.g. [[erythromycin]]).
|AnswerB=Haemophilus influenzae
|AnswerA=Sexually active college dormitory students
|AnswerBExp=[[Haemophilus influenzae]] is a [[gram negative]] rod.
|AnswerAExp=''[[Nisseria meningitidis]]'' is a [[gram-negative]] dipoloccus.
|AnswerC=Bacteriodes fragilis
|AnswerB=Adult patients with a history of alcoholism
|AnswerCExp=[[Bacteriodes fragilis]] is a [[gram negative]] rod.
|AnswerBExp=''[[Klebsiella pneumoniae]]'' is a [[gram-negative]] rod.
|AnswerD=Legionella pneumophila
|AnswerC=Infants of pregnant women who were not screened during 3rd trimester
|AnswerDExp=[[Legionella pneumophila]] is a primarily intracellular organism which gram stains poorly.  The stain of choice for Legionella is a silver stain.
|AnswerCExp=''[[Group B streptococcus]]'' is a gram-positive coccus.
|AnswerE=Corynebacterium diptheria
|AnswerD=Patients with recent exposure to contaminated air conditioning systems
|AnswerEExp=[[Corynebacterium diptheria]] is a [[gram positive]] rod.
|AnswerDExp=''[[Legionella pneumophila]]'' is a primarily intracellular organism which gram-stains poorly.  The stain of choice for ''Legionella'' is a silver stain.
|EducationalObjectives=[[Legionella pneumophila]] is a primarily intracellular organism which gram stains poorly.  The stain of choice for [[Legionella]] is a silver stain.
|AnswerE=Elderly patients with osteoarthritis who recently underwent a total hip replacement by prosthesis
|AnswerEExp=''[[Staphyloccocus epidermidis]]'' is a gram-positive coccus.
|EducationalObjectives=''[[Legionella pneumophila]]'' is a primarily intracellular organism which gram-stains poorly.  The stain of choice for ''[[Legionella]]'' is a silver stain.
|References=First Aid 2014 page 121
|References=First Aid 2014 page 121
|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Bacteria, Microbiology, Legionella, Gram stain, Stain,
|WBRKeyword=Bacteria, Microbiology, Legionella, Gram stain, Stain, silver, air condition, air conditioning
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 22:08, 1 August 2014
Author [[PageAuthor::William J Gibson (Reviewed by Rim Halaby, M.D. [1] and Yazan Daaboul)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Microbiology, MainCategory::Pathology
Sub Category SubCategory::General Principles, SubCategory::Infectious Disease
Prompt Prompt::A microbiologist has been given a number of unknown clinical samples and is attempting to visualize the organisms by gram stain. Samples from which patient population will he be unable to visualize with this method?
Answer A AnswerA::Sexually active college dormitory students
Answer A Explanation [[AnswerAExp::Nisseria meningitidis is a gram-negative dipoloccus.]]
Answer B AnswerB::Adult patients with a history of alcoholism
Answer B Explanation [[AnswerBExp::Klebsiella pneumoniae is a gram-negative rod.]]
Answer C AnswerC::Infants of pregnant women who were not screened during 3rd trimester
Answer C Explanation [[AnswerCExp::Group B streptococcus is a gram-positive coccus.]]
Answer D AnswerD::Patients with recent exposure to contaminated air conditioning systems
Answer D Explanation [[AnswerDExp::Legionella pneumophila is a primarily intracellular organism which gram-stains poorly. The stain of choice for Legionella is a silver stain.]]
Answer E AnswerE::Elderly patients with osteoarthritis who recently underwent a total hip replacement by prosthesis
Answer E Explanation [[AnswerEExp::Staphyloccocus epidermidis is a gram-positive coccus.]]
Right Answer RightAnswer::D
Explanation [[Explanation::Legionella pneumophila is a primarily intracellular organism which gram-stains poorly. The stain of choice for Legionella is a silver stain. Legionella infections cause atypical pneumonia and are associated with aerosols from contaminated water, such as certain air conditioning systems or cruises in lakes and rivers.

Legionella infection can cause the very severe Legionnaires' disease in older individuals. A more mild manifestation of Legionella infection is Pontiac fever. The treatment of choice for legionella infections is a macrolide (e.g. erythromycin).
Educational Objective: Legionella pneumophila is a primarily intracellular organism which gram-stains poorly. The stain of choice for Legionella is a silver stain.
References: First Aid 2014 page 121]]

Approved Approved::Yes
Keyword WBRKeyword::Bacteria, WBRKeyword::Microbiology, WBRKeyword::Legionella, WBRKeyword::Gram stain, WBRKeyword::Stain, WBRKeyword::silver, WBRKeyword::air condition, WBRKeyword::air conditioning
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