54 yr man with cough - kj72patel

[ArchivalUser]

A 54-year-old man presents to his physician with 2 days of cough and fever. His past medical history is significant for mild asthma and peripheral vascular disease (PVD). He takes albuterol metered dose inhalers as needed and has never been intubated for his asthma. His PVD manifests as calf claudication and has been stable over the past few years. His other medications include atenolol, lisinopril, and quinine. He has no drug allergies. He denies rigors, chills, nausea, vomiting, or any pleuritic chest pain. On physical examination, he appears well with an occasional cough. His temperature is 38.0 C (100.4 F), blood pressure is 150/84 mm Hg, pulse is 90/min and regular, and respirations are 22/min and somewhat labored. His lungs have bibasilar crackles and a questionable area of increased dullness near the right base. The rest of the examination is unremarkable. Which of the following is the most appropriate intervention at this time?
A. No intervention is indicated
B. Prescribe penicillin and send the patient home
C. Obtain a chest radiograph
D. Obtain an arterial blood gas
E. Refer the patient to the hospital for admission

[ArchivalUser]

chest radiograph

[ArchivalUser]

yes... C for me too...

[ArchivalUser]

E
I will admitt first, with RR of 22/m, scary history, needs some FIO2, some fluid prior to go for chest x ray

[ArchivalUser]

D. Obtain an arterial blood gas

[ArchivalUser]

patel are you in
Ans pls

[ArchivalUser]

The correct answer is
C. A patient such as this, who presents with signs and symptoms of a respiratory tract infection, requires only one major initial therapeutic decision: are antibiotics required? Antibiotics are indicated for cases of pneumonia. Many patients like this one actually have bronchitis. Therefore, to determine whether antibiotics are required, a chest radiograph is needed to detect any infiltrates.

Deciding that no intervention is indicated (choice A) is hasty since there are currently no data in his history and physical examination that allow a good decision to be made as to what this patient actually has.

Prescribing penicillin and sending the patient home (choice B) assumes that this patient has pneumonia. This has not yet been demonstrated.

An arterial blood gas (choice D) is not indicated for this patient. First, his physical examination does not suggest that severe respiratory compromise, and therefore a major acid-base abnormality, would be present. Second, this test in no way helps with management.

Referring the patient to the hospital for admission (choice E) is much too premature a decision. There is no indication that this patient fits the description for admission.