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shalu

A 48-year-old man with alcoholism and a long history of cigarette smoking is admitted to the hospital with pneumonia. The chest radiograph shows a right lower lobe infiltrate with blunting of the right costophrenic angle. The leukocyte count is 16,100/µL with 82% neutrophils and 10% band forms. Sputum specimen reveals gram-negative coccobacilli. Antibiotic therapy is begun.

Twenty-four hours later, the patient?s temperature is 40 °C (104 °F), and breath sounds are diminished over the right base. The leukocyte count is 20,300/µL, and the chest radiograph shows significantly increased haziness and complete loss of the costophrenic angle at the right base.

Which of the following is the most appropriate management option?

( A ) A chest CT scan
( B ) Inhaled β-agonist
( C ) Decubitus radiographs of the chest
( D ) Postural drainage and percussion
( E ) Endotracheal intubation

lp

answer: A

shalu

no !

abc

is it postural drainage with percussion for lung abcess??... shalu.. pls give the answer at the end..

mnhakeem

answer is D

shalu

right answer as per source is ............
Correct Answer = C


The sputum smear shows gram-negative coccobacilli consistent with Haemophilus influenzae. Although the correlation between sputum Gram stain results and pathogens present within the alveoli is still the subject of some debate, the clinical setting (acute febrile illness in a patient with a history of cigarette and alcohol abuse) and sputum smear both suggest that the initial antibiotic should include coverage for H. influenzae. Although this acute presentation would be most common for type b strains of H. influenzae, a large proportion of both typeable and nontypeable strains produce β-lactamase and must be treated with agents resistant to that enzyme. However, within 24 hours of initiating therapy, the patient still appears to be toxic and now has findings consistent with development of a right pleural effusion. Extension of pneumonia to involve the pleural space is a relatively common complication of infection with H. influenzae, as are bacteremia and intrapulmonary or extrapulmonary abscess formation. Assessment of the pleural space with decubitus views or other imaging procedures is appropriate. If an effusion is confirmed, a diagnostic thoracentesis should be performed to exclude empyema. If an empyema (that is, purulent fluid, positive Gram stain or culture) is present or if the pH is less than 7.1, it should be drained. There is no reason to change antibiotic therapy at this time, nor is there any indication that bronchial hygiene would be facilitated by either intubation or percussion and drainage. CT scan of the chest would yield similar information but is significantly more costly; lateral decubitus films are sufficient to do this. Inhaled β-agonists may transiently improve respiratory status but will not alter the course of a complicated parapneumonic effusion.

abc

thanks shalu for that explanation..

docespy - docespy

very nice explanation "it has to make sense" this makes complete sense.

lp

shalu - - 12/16/04 13:08

"right answer as per source is ............"
What source???Are these Kaplan q?

carlos canova - teresacanova

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