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+--- Thread: nbme2 - serious (/showthread.php?tid=81512)
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nbme2 - serious - ArchivalUser - 03-31-2006
A premature 18 hour old newborn is intubated and mechanically ventilated because of progressive respiratory distress. Labor was complicated by maternal fever and increased leukocyte count, membranes ruptured 36 hours before delivery. His blood pressure and urine output have decreased since birth. The newborn appears acutely ill, and peripheral pulses are not palpable; the skin is pale, cool, and mottled. The liver edge is palpated 4 cm below costal margin. His leukocyte count is 5000/mm3, platelet count 48,000/mm3, and partial thromboplastin time is 60 sec. An x-ray film of chest shows acute, bilateral interstitial infiltrates. What is the most likely causal organism?
A Chlamydia trachomatis
B Clostridium botulinum
C Clostridium tetani
D Group A Streptococcus
E Group B Streptococcus
F Listeria monocytogenes
G Neisseria gonorrhea
H Streptococcus pneumonia
0 - ArchivalUser - 03-31-2006
E!
0 - ArchivalUser - 03-31-2006
I agree, E.
0 - ArchivalUser - 03-31-2006
E. group B streptococcus
0 - ArchivalUser - 03-31-2006
thanks guys....just making sure.
0 - ArchivalUser - 03-31-2006
CHLUMYDIA TRACHOMATITIS CAN CAUSE NEW BORN BILATERAL MUCOPURULENT CONJUNCTIVITIS BUT AFTER ONE WEEK. treatmentt is oral erythromycin. clostrodium will occur after child start taking solid food and honey is mixed in it so probably it will be after 3 month. and symtoms will be peculiar like floppy baby.drooling and baby who was doing fine suddely look like has lost his mile stone of development far below . clostrodium tetani occur in baby delivered at home or in a unsterile set up due to cutting off the umbilical cord with a dirty tetani- ladden blade. group a streptococcus causes scarlet fever and erysipelas but in much later months . maternal antibody are protecting him now. listeria monocytogenes could have been colonizing vagina but it causes meningitis rather than pneumonia, meningitis in newborn may get unnoticed and can presnt as ards but it is a second choice here.
neisseria gonorrhea is a sexually transmitted disease which can affect the eye of child during passage of vagina but it will cause opthalmia neonaturum not progressive respiratory distress.
so , group b streptococcus is the most notorious here who might have colonized in vagina and cause neonatal infection and septicemia.thrombocyto penia and ards liver may be invoved and pt ptt is high because of multiorgan failure involving liver.
so e will be the answer,
listeria is also a possibility , i have to check
rupture of vagina is clue for these infection.
e
0 - ArchivalUser - 03-31-2006
Does Group B Streptococcus pneumonia presents with interstitial infiltrates?
0 - ArchivalUser - 03-31-2006
Does Group B cause Xray findings like that..wat about Chalmydia can cuase pnemonia??
0 - ArchivalUser - 04-01-2006
I will pick F, since mother was ill before the delivery. I am not sure mother woulde be sick with group B strep. Please let me know what you think.
0 - ArchivalUser - 04-01-2006
amygdala, after reading the stem I was not sure what it was. My first instinct was F, but do not have a good explanation for that. Then I saw E given by att and felt no reason not to agree.
I read the stem again, now I do felt F is more likely considering all evidence. These NBME questions are really good! That is why they are better diagnostic tests than others.