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A 21-year-old college student with a history of hypertrophic cardiomyopathy and a systolic murmur heard best at the left sternal border presents to the emergency room with a temperature of 102.3 F, worsening shortness of breath, chest pain and productive cough. He states that two days ago upon returning from Spring Break in Australia he drank a significant amount of alcohol and had an episode of vomiting. He recalls little about the evening. His electrocardiogram displays a regular sinus rhythm and his chest x-ray is shown in Figure A. Which of the following is the most likely etiology of his illness?
Impaired cough reflex
Close living quarters
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Myeloperoxidase (MPO) is a heme-containing molecule that is found in the azurophilic granules of neutrophils. Upon release, the enzyme catalyzes hypochlorous acid production during the phagocytic response. In the setting of pneumonia, which of the following is the end result and clinical significance of this reaction?
Green color of sputum
Shortness of breath
A 48-year-old male dies in the intensive care unit following a severe Streptococcus pneumonia pneumonia and septic shock. Autopsy of the lung reveals a red, firm left lower lobe. What would you most likely find on microscopic examination of the lung specimen?
Eosinophilia in the alveolar septa
Vascular dilation and noncaseating granulomas
Alveolar exudate containing neutrophils, erythrocytes, and fibrin
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT
Thorax. 2003 May;58(5):377-82. PMID: 12728155 (Link to Abstract)
A demonstration of egophony and it's clinical context.