SIMPLE QUESTION??

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SIMPLE QUESTION??

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10 Posts

sfk
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04/18/08 - 04:13 PM

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

B Sputum Gram's stain

C Chest CT scan

D Pulmonary function test

E Peak expiratory flow rate measurement

Edited by sfk on 04/18/08 - 04:18 PM

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aspire
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04/18/08 - 04:31 PM

cxr

sfk
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04/18/08 - 09:47 PM

Apparently not so simple!! disapproval

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patpelletier
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04/18/08 - 09:57 PM

Gram stain

caza
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04/19/08 - 01:30 PM

Answer is A
Defeneatly answers

caza
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04/19/08 - 01:30 PM

Answer is A

Justice
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04/19/08 - 01:37 PM

A Chest x-ray

This issue was discussed here several times at different times...

The only answer is A and not B, as some sources suggest... Does your source say B, SFK? It is wrong...

The only pneumonia requiring immediate sputum analysis for diagnosis is PC-pneumonia in AIDS patients...

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grechita12
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04/19/08 - 02:21 PM

sfk
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04/19/08 - 09:46 PM

Justice wrote:
A Chest x-ray

This issue was discussed here several times at different times...

The only answer is A and not B, as some sources suggest... Does your source say B, SFK? It is wrong...

The only pneumonia requiring immediate sputum analysis for diagnosis is PC-pneumonia in AIDS patients...

I agree with you, but yes, the answer does say sputum exam instead of a CXR!! Thats why i posted this question here.

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sfk
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04/19/08 - 09:50 PM

#10

This is the explanation given:
"The correct answer is B. This patient has a classic presentation of an acute community acquired bacterial pneumonia, as demonstrated by the findings of acute onset of fevers, rigors, and a productive sputum. His physical examination is consistent with a right lower lobe pneumonia and consolidation in this region. A sputum Gram's stain may demonstrate the organism responsible for this patient's pneumonia. The next step would then be a chest x-ray to confirm the presence of a pneumonia and identify its size and any associated parapneumonic effusions.
A chest x-ray film (choice A) is also indicated, but may take an hour or more to actually be obtained. For this reason, collecting sputum for a Gram's stain, before the x-ray, may shorten the time to definitive therapy."

So should we consider this answer wrong????

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