fox
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dunno if this has been discussed already.
39) A 64-year-old man presents to the physican's office complaining of fevers for the past 2 days. Over the past 24 hours, he has developed a productive cough. He also reports that he has frequent chills, and has been waking for the past 2 nights with drenching sweats. His past medical history is remarkable only for mild exertional angina. On physical examination, he does not appear chronically ill but appears moderately dyspneic. His temperature is 38.6 C (101.4 F), blood pressure is 136/94 mm Hg, and respirations are 26/min. There is no jugular venous distention. The lungs have coarse rhonchi at the right lung base with increased fremitus in the same area. He has a regular heart rhythm, with a 1/6 systolic murmur at the left sternal border. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate next step in diagnosis?
A. Chest x-ray film
B. Sputum Gram's stain
C. Chest CT scan
D. Pulmonary function test
E. Peak expiratory flow rate measurement
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| robin082006
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B
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| dr.wad
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yes ( b).
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| sarika
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why not CXR...they always tell you to do that first no matter what! now im confused
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| liwei
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X-ray tells you the diagnosis "pneumonia", sputum can't tell
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| Mamay
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Agree, this should be (a)...
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| fox
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Well the answer is B) gram stain....& I find this hard to believe. Kap says that gram stain is first step as a x ray may take more than an hour to be done & reported, whereas sputum gramstain can be done at arrival. 
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| Mamay
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With no microbiologist around it will take much longer than x-ray... Kaplan wants to be tough but sometimes it does not make sense...
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| sarika
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and specially after they hammer something so hard into your head CXR first CXR first... they are sounding more like john kerry each day!
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| prathapdoctor
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i will go for X ray only in the actual exam.
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