A 61-year-old man presents with four days of fever, a dry cough and increasing breathlessness. His wife reports he has been muddled since yesterday and has passed several loose bowel motions. The previous weekend he spent two days landscaping his garden, opening and spreading several bags of commercial potting mix. His temperature is 39.1°C, heart rate 104/min, respiratory rate 24/min and oxygen saturation 91% on room air. Chest x-ray shows consolidation in the right lower lobe; serum sodium is 126 mmol/L (135–145) and alanine aminotransferase 88 U/L (<40). Which one of the following is the most likely causative organism?
Keep going — a set of ten like this one, one at a time.
Practise moreMore from Respiratory
See allA 71-year-old man with severe chronic obstructive pulmonary disease presents with three days of increasing breathlessness and green sputum. On arrival he is dro…
Pre-internship · middle twist
A 58-year-old man was started on oral amoxicillin five days ago for right lower lobe pneumonia. He returns because his fevers have continued and he is more brea…
Pre-internship · middle twist
A 26-year-old woman with asthma is reviewed after three hours of emergency department treatment with inhaled salbutamol and ipratropium, systemic corticosteroid…
Pre-internship · middle twist
A 24-year-old woman with asthma remains breathless after repeated nebulised salbutamol and ipratropium, intravenous hydrocortisone and oxygen. She can speak onl…
Clinical rotations · common
A 54-year-old man presents with five days of fever, dry cough, headache and diarrhoea after returning from a Mediterranean cruise. He is confused, respiratory r…
Clinical rotations · middle twist