Diagnostic testing
Based on Ms. Peters' symptoms and physical exam, you decide to get a chest xray. You have a very skilled technician in your office, and she returns to you with the results in minutes. The images are below:
You diagnose Ms. Peters with pneumonia based on the plain films above.
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Out of the pathogens listed, please select the microbe that is most likely cause lobar pneumonia:
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While you know labs are not routinely collected in all case of community-acquired pneumonia, you have a speedy lab in your office, and you want to make sure that you are treating Kathy appropriately. You decide to collect a comprehensive metabolic panel. Her results are listed below:
Comprehensive Metabolic Panel:
Gluc: 93 mg/dL
BUN: 18 mg/dL
Creatinine: 1.05 mg/dL
eGFR: >60 mL/min
eGFR-AfAm: >60 mL/min
Na+: 139 mmol/L
K+: 4.4 mmol/L
Cl-: 107mmol/L
CO2: 33 mmol/L
Ca++: 9.2 mmol/L
Gap: 12
Osmo: 281 mOsm/kg
ALT: 33 IU/L
AST: 17 IU/L
ALK PH: 77 IU/L
In order to determine how you are going to treat Ms. Peters, you need to figure out if her pneumonia can be safely managed in the outpatient setting. Being the diligent clinician that you are, you determine her risk according to both the PSI and the CURB-65.
You access the PSI through the following government website:
http://pda.ahrq.gov/clinic/psi/psicalc.asp
(please note: you did not test a hematocrit, so assume that K.P.'s hct is normal)
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The CURB-65 scale is listed below.
- C onfusion
- Blood U rea Nitrogen (BUN) >20 mg/dL
- R R >/= 30
- B P (systolic <90 mmHg or diastolic </= 60 mmHg)
- >/= 65 y.o.
Mrs. Peters' CURB-65 score is: 0
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You feel safe treating Ms. Peters on a outpatient basis. The next step is to determine appropriate antibiotic treatment. You ask Kathy is she has been treated with antibiotics in the last 3-6 months and she says no. She has no known allergies to antiobiotics. You also check her past medical history for co-morbidities.
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