105) A 66 year old man presents to your office with complaints of productive cough and low grade fever for past two days. He denies any sick contacts. On physical examination, his temperature is 100F, breath sounds are reduced in left lower lobe. A chest x-ray reveals left lower lobe infiltrate. Laboratory investigations reveal WBC count of 12,ooo/µl with 80% neutrophils. Sputum gram stain and cultures are sent for. Blood cultures have been obtained and are pending. He received a Flu vaccine about one month ago but never received a pneumococcal vaccine. The next important step in managing this patient:
A) Oral Azithromycin
B) Oral Levofloxacin
C) Admit the patient
D) Swallowing evaluation
E) PPD skin test
A
Classic
a
bbb
A but I’m not certain..Exposure to influenza virus can cause pneumonia with fevers for 3-8 days with prostration, but this looks like community acquired pneumonia. begins outside hospital or within 48 hrs of admissinon if not longterm care facility patient. Pneumonia pts typically admitted if severe systemic conditions – like PORT risks CMDT2007, p. 254 – CHF, liver or renal diseases, this patient is 66 and not too severe so have as outpt. No electrolytes or vitals. Old recs were use macrolides firstline and keep fluroquinolones as alternatives…but this may be changing due to resistance….any critical care or ID feedback? I’m a generalist IMG intending to help.
Answer: C , CURB65/ pt. needs to be admitted
patient with curb65 with 1 criteria can be treated as op
The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:
Confusion of new onset (defined as an AMT of 8 or less)
Urea greater than 7 mmol/l (19 mg/dL)
Respiratory rate of 30 breaths per minute or greater
Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less
age 65 or older
Patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases[2]:
0 to 1 <5% mortality
2 to 3 < 10% mortality
4 to 5 15-30% mortality