29. A 34-year-old man comes to the emergency department due to2 days of fever, malaise, and myalgia. He has also had worseningshortness of breath and cough. The patient works in the mail roomat a large company, does not smoke cigarettes, and drinks alcoholoccasionally. Chest imaging shows lung infiltrates and prominentwidening of the mediastinum. Sputum and blood cultures yield large,spore forming gram-positive rods in chains that form coloniesresembling a “Medusa head.” Which of the following is the mostlikely bacterial virulence factor contributing to this patient’scondition?
A.Peritrichous flagella
B.Intracellular polyphosphate granules
C.Antiphagocytic polysaccharide capsule
D.IgG-binding, outer membrane protein
E.Antiphagocytic protein capsule
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30. A 56-year-old woman is brought to the emergency departmentdue to a 2-day history of high fever, headache, mild confusion, anddry cough. She also has mild abdominal discomfort and waterydiarrhea. The patient recently returned from a cruise to Hawaii.Her other medical problems include hypertension and hyperlipidemia.Her temperature is 40 C (104 F), blood pressure is 104/63 mm Hg,pulse is 85/min, and respirations are 24/min. Lung examinationreveals lower lobe crackles with no wheezing. Chest x-ray showsbilateral lower lobe interstitial infiltrates. Which of thefollowing additional findings is most likely to be present in thispatient?
A.Gram-positive diplococci on sputum Gram stain
B.Elevated circulating eosinophil count
C.Low serum sodium
D.Positive polymerase chain reaction assay for influenza ARNA
E.Presence of cold agglutinins
