03-30-2007, 05:24 AM
After a hard day of holding retractors on the Orthopedic Surgery service, you are called to admit an 80-year-old woman who fell out of bed at a local nursing home and broke her hip. She has a history of stroke and does not talk. Her nursing home chart reveals that she has a history of chronic congestive heart failure and borderline renal insufficiency. She has a productive cough.
Her physical examination is as follows:
Vitals: BP 80/50, Heart rate 120, respirations 32, temperature 94.5 F.
Head/neck: normal
Chest: bilateral crackles and percussion dullness at right base
Heart: S3 gallop present
Abdomen: soft, bowel sounds normal in character
Extremities: 2+ pitting edema bilaterally
Other data include:
BUN 40, Hgb 12.5, WBC 16,000, platelets 50,000
ABG: (room air) PaO2 50, PaCO2 32, pH 7.48, HCO3 24
CXR: "consolidation of the right middle and lower lobes, with some airspace disease in the left lower lobe as well."
Sputum and blood cultures - pending
The most important determinant of her prognosis is:
A. Her advanced age
B. The bacteria causing her pneumonia
C. Her comorbid illness(es)
D. The time interval between diagnosis and institution of antibiotic therapy
Her physical examination is as follows:
Vitals: BP 80/50, Heart rate 120, respirations 32, temperature 94.5 F.
Head/neck: normal
Chest: bilateral crackles and percussion dullness at right base
Heart: S3 gallop present
Abdomen: soft, bowel sounds normal in character
Extremities: 2+ pitting edema bilaterally
Other data include:
BUN 40, Hgb 12.5, WBC 16,000, platelets 50,000
ABG: (room air) PaO2 50, PaCO2 32, pH 7.48, HCO3 24
CXR: "consolidation of the right middle and lower lobes, with some airspace disease in the left lower lobe as well."
Sputum and blood cultures - pending
The most important determinant of her prognosis is:
A. Her advanced age
B. The bacteria causing her pneumonia
C. Her comorbid illness(es)
D. The time interval between diagnosis and institution of antibiotic therapy