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PROCEDURE ead the case sections and perform the analyses as structed At the Patient s Bedside A 68 year old man is brought to the emergency department ED of the hospital where you work He reports a severe stabbing pain in his lower back nausea without vomiting and blood in his urine CT scan imaging revealed two kidney stones renal calculi in the left kidney as well as one stone lodged in the urethra and another stuck in the distal portion of the left ureter He is running a fever and has underlying health conditions such as diabetes and heart disease The ED doctor orders urine and blood samples to be collected for microbiological analysis as well as for other tests Once the samples are collected the doctor starts the patient on a broad spectrum intravenous antibacterial drug and admits him for inpatient hospital care In the Clinical Microbiology Lab Day Same Day as Sample Collection You are responsible for analyzing the patient s urine sample and detecting the pathogen of interest You start with a Gram stain of the centrifuged urine sample You observe the following via light microscopy Fig 47 3 FIGURE 47 3 Gram Stain of Centrifuged Urine Sample gram Negative Tod s 1 Gram property 2 Cell shape 3 Cellular arrangement Single 4 Assuming oil immersion microscopy with a 10x ocular and 100x objective what would the final magnification be for the image 1000 5 Based on the Gram stain and morphological information you can make an informed decision about your next steps For each of the following state if you would or would not perform the procedure and explain the reasoning behind your decision Remember performing unnecessary tests takes time and costs your lab money so you would only perform tests that would help you further narrow down the bacterium s identity a Inoculate the sample onto mannitol salt agar MSA b Test the bacteria for coagulase c Test the bacteria for oxidase d Perform an acid fast stain e Inoculate the sample onto eosin methylene blue agar EMB At the Patient s Bedside The infectious disease specialist familiarizes themselves with their newly admitted patient s case In the meantime the assigned urologist also visits the patient They consult on the care plan for their shared patient Their plan primarily centers on removing the lodged kidney stone within the next 12 hours while simultaneously managing the infection that has developed The infectious disease doctor states that the Gram stain data suggests a narrower spectrum drug might be a more desirable option as compared to the broad spectrum drug started in the ED

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