A 75-year-old patient with community-acquired pneumonia presents ...

[crobinson2013]

A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl.
 
  He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:
  A. Can be treated as an outpatient
  B. Requires hospitalization for treatment
  C. Requires a high dose of parenteral antibiotic
  D. Can be treated with oral antibiotics

Question 2

If on physical examination the clinician auscultates rhonchi, the clinician should ask the patient to take a deep breath and cough in order to:
 
  A. Mobilize secretions
  B. Diagnose pleural effusion
  C. Accurately distinguish lung sounds
  D. A & C

[IRincones]

Answer to Question 1

ANS: A
Decision Rule: CURB-65 provides framework for determining whether the patient diagnosed with community-acquired pneumonia can be safely monitored and treated at home. One point is awarded for each of the following factors present:
 Confusion of new onset
 BUN is greater than 20mg/dl
 Respiratory rate of 30 breaths/minute
 Blood pressure is less than 90 mmHg systolic or diastolic 60 mm Hg
 Age 65 or older
Patients scoring 3 to 5 typically require hospitalization for observation and therapy. Scores of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2 is inconclusive.

Answer to Question 2

ANS: D
Cough is the most common symptom of bronchitis and may persist for several weeks after the initial infection is resolved. During the acute phase, the cough may be productive. There may be associated symptoms, including fever, malaise, chest discomfort, chills, and headache. The chills and chest discomfort are mild in comparison to the symptoms of pneumonia. There may be wheezes and/or rhonchi on auscultation, which disappear or alter with cough effort.

[crobinson2013]

TYSM

[milbourne11]

Gracias!