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Respiratory System Infection Case
Studies And Homework Questions With
Detailed Answers 2025.
At the Mount Union hospital, a 5-year old white male child in good general health and physical condition was presented at the Saturday walk-in clinic by his mother. He was brought in because he had a fever, was cranky and had complained of a sore throat for about 24 hours. On physical examination by the attending resident, the patient had a fever of 39.3C, and he had considerable swelling and drainage of the pharynx and in the conjunctivae. His tonsils were enlarged and coated with a white patchy exudate. He had a red throat and swollen anterior cervical lymph nodes. His ears were clear. His chest sounded clear and he had no additional remarkable findings on routine examination.
- What would be your presumptive diagnosis for this child? Why?
- What diagnostic testing would be indicated to follow this exam?
- What is the most likely treatment for this illness? Why is it important?
- What factors of this case allowed you to make a presumptive diagnosis?
- The patient has streptococcal pharyngitis. The patient has classical symptoms of the disease such as inflammation of the throat (presented as a sore throat), swollen anterior cervical lymph nodes, a low- grade fever, and white exudate in the throat.
- A rapid strep test would be done to indicate S. pyogenes.
- A penicillin-based drug would be prescribed except in the case that the patient is allergic to penicillin. Treatment would last about 10 days on the antibiotic. This is important to prevent complications and other illnesses such as scarlet fever and rheumatic fever.
- Lack of cough and clear lungs, exudate on the tonsils and pharynx, low-grade fever, and patient history.
You and your friends are driving to the mall; it is late October. A public service announcement comes on the radio urging people to get their flu vaccinations. You are a second-year nursing student and you mention that the nursing staff at your university is holding a vaccine clinic next week.
Your friend Susan says, "I'm not getting a flu shot! The last time I did, it gave me the flu." Others in the car agree with her. But Heather asks you if it's true that the vaccine can give you the flu.
- What would your answer to Heather's question be?
- Heather says that because she had a flu shot last year she's going to skip it this year. Respond, with an explanation.
- What is the most likely treatment for this illness? Why is it important?
- What factors of this case allowed you to make a presumptive diagnosis?
- Susan wants to know why you don't have to get other vaccines annually.
- Another friend, Dru, says that even though she had the flu shot last year she got terribly sick with the stomach flu over Thanksgiving break and missed most of her vacation. What is your explanation for this?
- The flu shot cannot give you the flu because it contains inactivated viral particles.
- Doug's condition has not responded to the antibiotic. List two possible reasons for this finding.
- What are some other conditions caused by this microorganism?
- Should Julie worry that Doug can transmit the infection to her or to their daughter?
- What precautions can be taken by other workers who may be regularly or heavily exposed to bat or bird droppings?
- The tentative diagnosis is Histoplasmosis.
- The recent move from Arizona to Ohio and Doug's work as a park ranger.
- One possible reason is that the infection is fungal, not bacterial. Another reason is that the strain may be resistant to the antibiotic.
- Fever, chest pain, and cough.
- No, unless there is an underlying health condition such as an organ transplant.
- Personal protective equipment such as a mask.
It is mid-July. You are working as a triage nurse in the emergency department of a small suburban hospital in Arizona. A young, athletic-looking man in his early 20s is helped into your office by his girlfriend. He greets you and sits down, but is feverish and his breathing is labored. The girlfriend answers your questions for him. She says the symptoms began about 24 hours ago and seemed to worsen quickly. It looks like the flu to you, but the season is wrong. So you ask about the man's activities over the past week to 10 days. Nothing in this history points to an obvious etiology for the disease. And the girlfriend, rather defensively, adds that she is a "neat-freak" and is constantly cleaning and
disinfecting the house they share. But of course, respiratory infections are very common and can be acquired anywhere. After listening to his chest you decide that it may be bronchitis or influenza. You decide to isolate him from the rest of the people in the waiting room until an examining room becomes free.
Forty-five minutes later the girlfriend comes barreling into your office. "I think he's choking!" she screams. You and the attending physician arrive at his bed where he indeed seems to be suffocating. His face is red and he is gripping his throat. The doctor calls out, "acute respiratory distress," and a team moves in to try to restore his breathing.
Later that evening, on your way out, you learn that the patient has died. Several days later the charge nurse tells you what the patient's lab work revealed. It identified an infection that he probably acquired a few weeks earlier while he and his girlfriend stayed in an isolated cabin his family owned but seldom used.
- What is the diagnosis?
- What connection does the diagnosis have with the cabin?
- You overhear the charge nurse say to herself: "I knew there was a good reason not to clean my house." To what could she have been referring?
- This case is from Arizona. These infections were first seen in the United States in May of 1993 in the Four Corners area of the Southwest, which includes Arizona, Colorado, New Mexico, and Utah. Can we assume that this disease is only found in the Southwest? What factors determine the places this virus might be present.
- Hantavirus pulmonary syndrome
- Since the cabin was seldom inhabited, rodents have likely begun to live there and contaminated the cabin with little ventilation.
- Since the virus was found in rodent hair and droppings, when cleaning, the virus was aerosoled to be inhaled.
- Further supportive care, like continuing to use the vaporizer to relive symptoms and a fever reducer.
When you left for school this morning your 3-month-old son was wheezing a bit and he had a slight fever of 99.8°F. Your mother is watching him while you come to school to take your anatomy and physiology exam. Your pager goes off halfway through the exam. The baby's fever is rising and he is having more trouble breathing. Your mother says she is taking him to the emergency room. You rush over to the hospital. When you get there, he is in an examining room and the doctor is signing papers to admit him to intensive care. She says she suspects some kind of pneumonia. She mentions the type of pneumonia but you don't recognize the name and you are too worried about your son to pin her down at this moment. You do note that she mentions that the hospital has seen a dozen pediatric cases of the same type of pneumonia in the past week and a half.
The doctor swabs your son's nose but says the results won't be back for several days. In the meantime, they will give him supportive therapy, including an inhaled spray, but no antibacterial drugs. The doctor says that she feels sure that he child will recover since the infection was caught very early. Nonetheless, after she leaves, your mother is frantic and indignant. She fires off the following questions to you.
- What kind of pneumonia is it?
- Why aren't they giving him antibacterial drugs?
- Do you believe that this is a bacterial or viral disease? Why?
- What further treatment is indicated for this case?
- Viral pneumonia; respiratory syncytial virus
- It's a viral infection so antibacterial drugs won't work.
- Multiple cases of the same thing over the past week and a half.
- She has already been exposed and most children this age have already been exposed and built up a strong enough immunity to it.
One autumn in the late 1990's, a number of people became ill after working at a single building at an industrial plant in a neighborhood of Baltimore, Maryland. Their symptoms ranged from simple coughing and other respiratory symptoms to pneumonia. At least one of the 70 people reporting symptoms died.
The company voluntarily closed the building upon the recommendation of the Maryland Department of Health and Mental Hygiene. After all of the water systems at the plant were evaluated and disinfected, it reopened and no new cases were reported.
- Health departments often have even less information than this when they have to start hypothesizing about the causative organism and its source. What is your first guess?
- Describe the transmission characteristics of the suspected bacterium.
- Is there a risk for a continuing community outbreak from these initial infections? Why or why not?
- Would the health department be likely to identify this bacterium by performing routine water- screening procedures, such as serial dilution or filter collection followed by inoculating on eosin methylene blue (EMB) or nutrient agar? Explain.
- Legionnaire's disease.
- The transmission occurs via aerosols. The virus replicates within phagocytes and releases with apoptosis. It kills the lining of the air sacs.
- Yes, if it is in the water supply, the water supply is contaminated. That is why it is important to disinfect the water systems at the plant.
A 68-year old patient with Alzheimer disease was brought to the emergency room by the staff of a local nursing home. He presented as lethargic with a sallow complexion. He had an admission temperature of 102.4F and a respiratory rate of 33/minute. During respiration, the right side of his chest moved better than the left. He showed dense consolidation of the lower lobe of the left lung on physical exam. A sputum sample revealed blood and a greenish color.
A chest x-ray showed tight consolidation of the left lung with evidence of formation of cavities in the lung tissue from cytotoxic damage. The patient complained of chills in the exam room, combined with his fever. A smear of his sputum demonstrated no acid-fast bacteria.
- What is your presumptive diagnosis for this case?
- What evidence could the sputum give for this case?
- Is the reduced respiration rate and unequal chest movement indicative of the pathology?
- Is this a bacterial or viral disease?
- The presumptive diagnosis for this case is bacterial pneumonia.
- The sputum having blood and a greenish color indicate that bacteria. Gram-negative rods.
- Yes, the lung damage and consolidation would lead to observable changes on a chest X-ray.
- Bacterial, which warrants antibiotic use.
You are a physician's assistant at a local pediatrician's office. Five-year-old Michael is brought to the office by his father. Michael is crying and complaining that his mouth hurts. His father has been at work and does not know whether the boy has had a fever during the day. Currently his temperature is 103°F. The physician notices that Michael's breath smells rotten. Lymph nodes in his neck are swollen and visual
examination of the throat reveals a white packet adhering to the left tonsil. Much of the soft palate is red.
- What laboratory tests are called for?
- What types of infections are in the differential diagnosis (a list of diseases or conditions presenting similar symptoms)?
- Your practice has recently been overrun by sore throats and now, late in the evening, there are no supplies for performing the proper test. Should the physician prescribe antibiotics or not?
- In deciding whether to prescribe antibiotics, should the physician be extra careful not to prescribe an unnecessary antibiotic, or be careful not to let a bacterial infection go untreated?
- What are the possible sequelae (pathological conditions resulting from a disease) of untreated sore throats?
- Throat culture and rapid antigen test.
- Pediatric pharyngitis.
- If there have been other cases, it is likely to be a case of step. The physician should prescribe antibiotics.
- Careful to not a bacterial infection to go untreated due the possible of the infection developing into scarlet fever or rheumatic fever.
- Scarlet fever or rheumatic fever
(b) The chest X-ray should be abnormal and the interferon gamma release assay should be positive.
(c) The chest X-ray should be abnormal and the interferon gamma release assay should be negative.
(d) The chest X-ray should be normal and the interferon gamma release assay should be negative.
- If the microscopy and culture of Kelsey's sputum sample do not confirm acid-fast bacilli, what would the X-ray and interferon gamma release assays show?
(a) The chest X-ray should be normal and the interferon gamma release assay should be positive.
(b) The chest X-ray may still be abnormal and the interferon gamma release assay should be positive.
(c) The chest X-ray may still be abnormal and the interferon gamma release assay should be negative.
- Explain why you did not order a tuberculin skin test.
(a) Patients who received the bacillus Calmette-Guérin vaccine will have a positive tuberculin skin test result regardless of tuberculosis infection status.
(b) The patient does not show signs and symptoms of an active or latent tuberculosis infection.
(c) The patient is showing signs of a latent tuberculosis infection, and the tuberculin skin test is only positive for active cases of tuberculosis.
(d) The tuberculin skin test is expensive and difficult to interpret.
- Why is the patient's HIV status important in this case? Select all that apply.
(a) Individuals with HIV are more likely to contract and display active forms of tuberculosis infection.
(b) Tuberculosis is a leading cause of death for HIV/AIDS patients. Thus the prognosis and care plan may change accordingly.
(c) Certain test results (such as the tuberculin skin test) may appear different in HIV/AIDS patients than in non-HIV/AIDS patients.
(d) Individuals with HIV are unable to receive combination drug therapy, leading to MDR and XDR TB infections.
- Explain why you put Kelsey in isolation.
(a) Patients with anorexia must be placed into isolation.
(b) Kelsey received the live, attenuated bacillus Calmette-Guérin vaccine and will thus be able to spread the tuberculosis pathogen to other patients.
(c) Patients must be placed in isolation when manifesting a fever.
(d) Kelsey may have an active case of tuberculosis and is at risk for exposing other patients to the illness.
- Why did the physician who first saw Kelsey assume she had bronchitis? Select all that apply.
(a) Outbreaks of bronchitis are mostly localized to southeastern Asia where Kelsey works.
(b) Earlier in her infection, Kelsey was not displaying all of the classic signs of tuberculosis. Instead, she was displaying symptoms of bronchitis.
(c) Bronchitis is a very common infection, especially compared to tuberculosis.
(d) Kelsey did not receive a vaccine protecting her against bronchitis.
- If the chest X-ray comes back abnormal, but bacteria are not observed in or cultured from the sputum, and the interferon gamma release assay is negative, what are some possible differential diagnoses based on the patient's symptoms?
(a) Scarlet fever
(b) Pneumococcal pneumonia
(c) Diptheria
(d) Otitis media
- A -- Active case of tuberculosis
- B -- The chest X-ray should be abnormal and the interferon gamma release assay should be positive.
- C -- The chest X-ray may still be abnormal and the interferon gamma release assay should be negative.
(c) Histoplasma capsulatum is an endemic fungus that prefers soils enriched with bat guano, whereas Aspergillus fumigatus is a ubiquitous soil fungus.
(d) Individuals are not as routinely vaccinated against Aspergillosis as compared to Histoplasmosis.
C -- Histoplasma capsulatum is an endemic fungus that prefers soils enriched with bat guano, whereas Aspergillus fumigatus is a ubiquitous soil fungus.
An otherwise healthy 20-year-old college student and an archaeological research team travelled to Northwest Arizona to excavate Navajo ruins. One month after returning, the student develops a flu-like cough with a low-grade fever accompanied by a non-pruritic maculopapular rash on the extremities. The microorganism causing the illness appears as a mold on Sabouraud agar when incubated at room temperature for 10 days. Based on the case information and laboratory results, which of the following diseases is the patient most likely afflicted by?
(a)Blastomycosis
(b) Histoplasmosis
(c)Coccidioidomycosis
(d) Mucormycosis
C -- coccidioidomycosis
A fungal species which can grow in varied climates and under diverse conditions is termed
(a) normal.
(b) endemic.
(c) ubiquitous.
(d) mycosis.
(e) microbiotic.
C -- ubiquitous
An endemic fungal infection that is found in the semi-arid to dry soils in the southwestern United States and Mexico is
(a) histoplasmosis.
(b) coccidioidomycosis.
(c) blastomycosis.
(d) murcomycosis.
(e) aspergillosis.
B -- coccidioidomycosis
Histoplasmosis should be suspected in cases of fungal respiratory infections found in
(a) dog owners.
(b) the Mississippi and Ohio River valley regions.
(c) HIV-AIDS patients.
(d) cattle or dairy farm workers.
(e) construction workers.
B -- the Mississippi and Ohio River valley regions.
Which statement does not apply to pneumocystis pneumonia and its causative organism, Pneumocystis jirovecii?
(a) HIV-AIDS patient are high-risk for this infection.
(b) The fungus does not make spores.
(c) The organism has some characteristics found in protozoans rather than fungi.
(d) Serological evidence suggests that most people are exposed to the organism in early childhood.
(a) pink, rod-shaped organisms arranged in pairs
(b) pink, spherical-shaped organisms arranged in chainlike formations
(c) purple, spherical-shaped organisms arranged in chainlike formations
(d) purple, spherical-shaped organisms arranged in grapelike clusters
- How will the prescribed penicillin kill S. pyogenes that is causing Shelly's infection?
(a) Penicillin will poke holes in the plasma membrane, weakening the cell and leading to cellular lysis.
(b) Penicillin will interfere with peptidoglycan synthesis, ultimately weakening the cell wall and leading to cellular lysis.
(c) Penicillin will disrupt the outer membrane, leading to a loss of structural integrity and death of S. pyogenes.
(d) Penicillin will attach to bacterial ribosomes and inhibit protein synthesis, which will lead to the death of S. pyogenes.
- What effect will the penicillin have on Shelly's cells?
(a) There will be no impact on Shelly's cells because penicillin targets the flagella, which are found only in bacteria.
(b) The penicillin will not have any impact on Shelly's cells because it targets peptidoglycan, which is found only in bacteria.
(c) The penicillin will kill some of Shelly's cells because it targets the ribosomes, a structure found in both prokaryotes and eukaryotes.
(d) The penicillin will also kill some of Shelly's cells by disrupting the structure of the plasma membrane.
- Prokaryote only: B -- capsule
Eukaryote only:
A -- nucleus, E -- Rough endoplasmic reticulum, F -- Golgi apparatus, H -- Mitochondria
Both: C -- Cytoplasm, D -- Plasma membrane, G -- Flagella, I -- Ribosomes
- C -- purple, spherical-shaped organisms arranged in chainlike formations
- B -- Penicillin will interfere with peptidoglycan synthesis, ultimately weakening the cell wall and leading to cellular lysis.
- B -- The penicillin will not have any impact on Shelly's cells because it targets peptidoglycan, which is found only in bacteria.
Twenty-one-year-old Marjorie comes to the family practice office for evaluation of a dry cough that has not gotten better over the last seven days. Before she started coughing, she had a mild fever, runny nose, and sneezing for 10 days, but she was able to carry out her usual routine. She reports "coughing spells" frequently during the day and recalls one episode in which she gagged and vomited. She has a mild coughing episode while in the office, and although it is paroxysmal, there is no "whoop" noted. Marjorie is a part-time college student attending evening classes and helps her aunt with her younger cousins during the day. Her cousins are five years old and six weeks old and also come to the same office for health care. Both cousins appear well, without any signs or symptoms, and a review of their charts reveals they are current for all scheduled vaccines. Marjorie's last vaccine was at age 16.
- Should a lower respiratory infection such as pertussis be considered the cause of the symptoms instead of rhinitis or sinusitis for this patient? Why?
(a) No, this patient would have had the DTP vaccine as a child.
(b) No, she is not presenting with the characteristic deep "whoop" cough.
(c) Yes, pertussis may occur in older individuals.
(d) No, pertussis is a disease of young children.
- Which of the stages listed is NOT considered one of the clinical stages associated with pertussis?
(a) paroxysmal
(b) latency
(c) convalescence
(d) catarrhal
