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66.A 52-year-old nursing home worker presents with a four-week history of non-productive cough and night-time sweating. She also reports having unintentionally lost five pounds over the last month. Hermedical history is significant for a mastectomy for left-sided breast cancer five years ago and hepatitisC for which she does not take treatment. She says she was last tested for HIV 6 months ago and the test was negative. She takes no medications currently. She emigrated from Mexico two years ago. Shesmokes one pack of cigarettes daily and consumes two bottles of beer every weekend. Chest x-ray
shows a right upper lobe cavity with surrounding infiltration. Which of the following is the mostimportant epidemiologic clue to the etiology of this patient's disease?67.A 44-year-old obese Asian immigrant presents to the ER complaining of a persistent cough for about 3 months. He denies any fever, chills, runny nose or sputum production. He does complain of dyspnea on exertion, which also has been of a short duration. He says that over the last year, he has become progressively short of breath and is unable to sleep lying down. He denies any chest pain or diaphoresis, but has had palpitations in the past. He does not smoke or drink alcohol. On examination,he is alert and in mild distress. He has a BP of 110/70 mmHg, pulse 100/min and is afebrile. Auscultation is difficult. The chest-x ray reveals an enlarged cardiac silhouette. It appears that the leftmain stem bronchus is elevated. There is no other lung pathology visible. The ECG shows irregularly irregular rhythm. The pathophysiology of this condition is related to which of the following?68.A 72-year-old white male with a past medical history of hypertension, hypothyroidism, and coronaryartery disease presented to the physician's office because of fever, malaise, nonproductive cough, andshortness of breath. His temperature was 38.3C (101 F). His chest x-ray showed a patchy right lower lobe infiltrate. He was sent home on oral amoxicillin. Four days later, the patient was brought to the emergency room because he was having continuous fevers, headache, pleuritic chest pain, and abdominal pain. He appears confused. His blood pressure is 120/70 mmHg, pulse rate is 100 per minute, respiratory rate is 24 per minute, and temperature is 38.9C (102 F). His chest x-ray showed consolidation of the right lower lobe. Which of the following is the most likely cause of this patient'spneumonia?