Two part multiple choice question. Select the best answer: You are treating to p

Question

Two part multiple choice question. Select the best answer:

You are treating to patients. Jane a 57-year-old obese, white female with type 1 diabetes mellitus and Bob a 47-year-old man from Cincinnati, Ohio. You diagnose Jane with strep throat and prescribe penicillin. You suspect Bob has community-acquired pneumonia. So you also treat him with antibiotics. A week after you prescribe the penicillin Jane returns complaining of a sore mouth and white patches on the tongue. Your examination confirms the white pseudomembranous lesions. Material from the lesion is obtained and prepared for microscopic examination. When Bob failed to improve, histoplasmosis was considered. Among the tests you ordered for Bob were serology, direct examination, and culture of sputum.

Part 1) Your suspicion of the most likely clinical diagnosis for Jane will be confirmed by observation of buccal epithelial cells, leukocytes and which of the following?

A. gram positive bacteria

B. gram negative bacteria.

C. hyphae with septa and acute angle branching

D. spherules containing endospores

E. yeast cells, hyphae and pseudo-hyphae

Part 2) In the Bob's culture, the microscopic morphology most useful in identification of the etiologic agent causing is?

A. Arthrocondia,

B. Micronidia

C. Sclerotic bodies

D. Spherules

E. Tuberculate Macronconida

Explanation / Answer

Answer:

Part 1: (E) Yeast cells, hyphae and pseudo-hyphae

Jane is suffering from Pseudomembranous candidiasis.

Candida is a rounded and oval-shaped yeast measuring 3-30 µm in diameter. It reproduces asexually through a budding process in which protoplasmic protrusions or buds (blastoconidia) emerge from the mother cell and grow until they finally detach to form a new cell. The daughter cells occasionally do not detach and form chains of cells called pseudohyphae, which can be mistaken for hyphae.

Part 2: (E) Tuberculate Macronconida

Identification of the tuberculate macroconidia allows a presumptive diagnosis of histoplasmosis.

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