NBME 20

nbme20/Block 2/Question#14

A 23-year-old woman has had fever, hypotension, and ...

Streptococcus pneumoniae

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submitted by monoloco(27),

Encapsulated organisms run rampant in patients who have no spleen, whether physically or functionally. (Recall the wide-array of sequalae sickle cell patients experience thanks to their functional autosplenectomy.)

sympathetikey  Agreed -- went with E. Coli like a dingus, just because I didn't associate DIC with S. Pneumo. Thought it was too easy. +  
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? +1  
studentdo  Pseudomonas aeruginosa is encapsulated as well. I think the right answer has to do with DIC but why? +  
mgoyo89  The only reason i found was S. pneumo is more common, I went with Pseudomonas because of the "overwhelming sepsis" :( +  

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submitted by yotsubato(54),

This question is bullshit. The woman would most likely be vaccinated to Strep pneumo, especially if she had a splenectomy.

E coli is also an encapsulated bacterium that causes pneumonia, so that is more likely IMO.