34-year-old man is brought to the emergency department due to several hours of confusion. His wife reports
that he has had fever, malaise, and cough for the past 2 days. A year ago, the patient required prolonged
hospitalization and extensive surgery for multiple gunshot wounds to the abdomen. He takes no medications
regularly and has no other medical problems. The patient does not use tobacco, alcohol, or illicit drugs. He has no
history of recent travel. Temperature is 40.5 C (104.9 F), blood pressure is 80/50 mm Hg, pulse is 110/min, and
respirations are 32/min. Mucous membranes are moist and no cervical lymphadenopathy is present. Dullness to
percussion and crackles over the left lower chest are present. Cardiovascular examination reveals normal first and
second heart sounds and bounding peripheral pulses. The abdomen has several well-healed surgical scars.
Intravenous fluids and broad-spectrum antibiotics are initiated. The next day, blood cultures show gram-positive
cocci. Which of the following is the most likely underlying mechanism leading to this patient’ s clinical presentation?
- 0 A. Complement deficiency
- 0 B. Destruction of CD4+ cells
- O C. lmmunoglobulin A deficiency
- O D. Impaired antibody-facilitated phagocytosis
- 0 E. Impaired B cell isotype switching
- 0 F. Impaired chemotaxis
- 0 G. Impaired oxidative burst
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