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Contributor score: 10
Comments ...
myoclonictonicbionic
The qstem said "lower extremity in rigid extension" which made it sound like extension at the knee joint rather than at the hip. Confusing wording
+2
j44n
if you lay on your back and kick your leg straight up this is lower extremity extension, hes doing that to prevent any weight being placed on his psoas, I know because ive had psoas problems before and you will do ANYTHING to keep your hip from flexing (like doing a sit up or pulling your knees toward your chest) getting in and out of a car was a nightmare
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Subcomments ...
sympathetikey
Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy.
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chillqd
Isn't E. Coli also an encapsulated organism? What makes Strep pneumo more likely in this question just because its the more common cause?
+28
studentdo
Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why?
+1
mgoyo89
The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :(
+2
kard
Everyone is correct about the Encapsulated microbes, but this is one of those of "MOST LIKELY",
and by far the most likely is S.Pneumo>>H.infl>N.Mening. (omitting that patients with history of splenectomy must be vaccinated.
+2
djinn
Gram negative are more common in DIC my friends
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drzed
Correct me if I am wrong, but I am pretty sure that E. coli is NOT a common cause of pneumonia because it must be aspirated to enter the lung. Thus, only patients with aspiration risk (e.g. stroke, neurogenic conditions) would be at a chance of getting E. coli pneumonia.
+2
The major motion of Psoas major is flexion of hip. This patient is held in "rigid extension", hence he does not want to flex. Psoas is the only muscle on this list that connects the lumbars to lower extremity "holds his right lower extremity"