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7850 Medicine

A 56-year-old man is having intermittent fevers and malaise for the past 2 weeks. He has no other localizing symptoms. Two months ago, he had valve replacement surgery for a bicuspid aortic valve. A mechanical valve was inserted and his postoperative course was uncomplicated. On examination, his temperature is 38degC, blood pressure 124/80 mm Hg, pulse 72/min, and head and neck are normal. There is a 3/6 systolic ejection murmur, the second heart sound is mechanical, and a 2/6 early diastolic murmur is heard. The lungs are clear and the skin examination is normal. Three sets of blood cultures are drawn and an urgent echocardiogram is ordered. Which of the following is the most likely causative organism?

AStaphylococcus aureus
BS. epidermidis
CS. viridans
Denterococci
Medicine
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7855 Medicine

A 42 -year old man was referred with a 2-week history of fever weakness and bleeding gum. Peripheral smear showed pancytopenia. The bone marrow examination revealed 26% blasts frequently exhibiting Auer rods and mature myeloid cells. An occasional neutrophil with pseudo-Pelger-Huet anomaly was also noted: Which of the following cytochemical stains is most likely to be positive?

AAcid phosphatase
BNon specific esterase
CMyeloperoxidase
DToluidine blue
Medicine
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