A74-year-old woman, who has been followed for the past 25 years for chronic obstructive pulmonary disease comes to the ed complaining of 48 hours of temperature to 38.6 c and worsening shortness of breath. she has a chronic productive cough, which has become more copious. on physical examination, she has rhonchi and increased fremitus in the posterior mid-lung field. a gram's stain reveals many epithelial cells and multiple gram-positive and gram-negative organisms; no neutrophils are seen. which of the following is the most likely organism causing the symptoms? - escherichia coli- haemophilus influenzae- klebsiella pneumoniae- mycobacterium tuberculosis- mycoplasma pneumoniae

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A92-year-old man with a 45-year history of chronic obstructive pulmonary disease is intubated in the icu because of a bout of viral pneumonia that fails to improve after 72 hours of antibiotics. although the inspired fraction of oxygen is 100%, the patient's po2 remains at 57 mmhg. positive-end expiratory pressure (peep) is added to allow the inspired fraction of oxygen. twelve hours after the introduction of peep the patient suddenly become hypotensive. at the same time, his oxygen saturation drops from 92% to 61%. on physical examination, his bp is 80/50 mmhg and his pulse is 124/min. he has distended neck veins and distant heart sounds. which of the following would also most likely be seen on this patient's physical examination? - absence of breath sounds in the right hemithorax- high amplitude carotid artery upstroke- a pleural friction rub- pulsus alternans- splenomegaly

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