35. A 52-year-old man is brought to the emergency department dueto worsening right leg pain, fever, and confusion. The patientinjured his leg while operating a motorized watercraft on the oceannear Florida 2 days ago. Temperature is 38.9 C (102 F), bloodpressure is 90/50 mm Hg, and pulse is 120/min. The patient islethargic and diaphoretic. Physical examination reveals a smalllaceration on the dorsum of the right foot with surrounding edema,erythema, and several hemorrhagic bullae. Blood and wound culturesyield curved/comma gram-negative rods that are acid labile andoxidase positive. Which of the following is the greatest riskfactor for this patient’s infection?
- Lack of booster immunization
- Exposure to waters contaminated by feces
- Recent broad-spectrum antibiotic use
- Bacterial nasal colonization
- Exposure to infected rodent urine
36. A 78-year-old man is brought to the emergency department dueto three days of fever, cough, and shortness of breath. The patientworks on his families farm. Temperature is 39.4 C (103 F), bloodpressure is 106/62 mm Hg, pulse is 112/min, and respirations are28/min. His fever has not subsided for the past three days. Chestx-ray reveals a left lower lobe consolidation. Sputum microscopyshows gram-negative spore forming bacteria. Which of the followingcharacteristics are these bacteria likely to demonstrate?
- Obligate intracellular
- Optochin resistance
- Catalase positivity
- Facultative intracellular
- Bacitracin sensitivity
- 39. A 38-year-old man comes to the office due to worseningfever, chills, malaise, cough, and shortness of breath. Temperatureis 39.4 C (103 F). There is dullness to percussion and cracklesover the right lung. Leukocyte count is elevated, sodium level isdecreased, and chest x-ray reveals a right lung infiltrate. Thepathogen is found to be a gram-negative and visualized on silverstain. Which of the following is the most likely pathogenresponsible for this patient’s pneumonia?
- Staphylococcus aureus
- Streptococcus pneumoniae
- Pseudomonas aeruginosa
- Legionella pneumophila
- Haemophilus influenzae
