AccessMedicine's Case of the Week: Pulmonology Case 3.12

From: Graber and Wilbur’s Family Medicine Examination and Board Review, 5th Edition

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A 74-year-old male presents to your ED for weakness, cough, and fatigue. His wife relates an incomplete recovery since his myocardial infarction last year. He continues to have poor appetite and listlessness, and she thinks that he may be depressed. He is short of breath and confused. His wife says that yesterday he developed a fever, chills, and a new cough productive of white sputum. His past medical history is otherwise remarkable for a cholecystectomy. He is taking aspirin (secondary prevention, not primary!), metoprolol, and atorvastatin.

Vitals: temperature 39°C, respiratory rate 30, pulse 90 bpm, blood pressure 140/80 mm Hg. Oxygen saturation on room air is 90%. He is thin, pale, and oriented to person only. The lung examination is remarkable for rales in the left lower field, with dullness to percussion and increased tactile fremitus. The remainder of the examination is normal.

The chest x-ray shows a left lower lobe infiltrate. Other laboratory data currently available: hemoglobin 12.4 g/dL, WBC 14,100/mm3, platelets 340,000/mm3, creatinine 1.9 mg/dL, BUN 50 mg/dL, and normal electrolytes, troponin, and CK. An ECG shows normal sinus rhythm.

Question 1 of 6

What is your next step in managing this patient’s medical condition?

A - Place a chest tube on the left

B - Perform chest CT

C - Administer inhaled bronchodilators

D - Administer parenteral antibiotics

E - Perform intubation and mechanical ventilation 

Click HERE to answer the questions and complete the case!

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education