Answer this weeks USMLE-style questions correctly to win a free month of Firecracker! Answers MUST include your reasoning and be submitted before we post the correct answers the following mornings. Day 4: Step 2 question A 68-year-old female comes into the Emergency Department complaining of a cough productive of thick yellow sputum. She denies fevers or myalgias. A diagnosis of community acquired pneumonia is made, and she is sent home on a 5-day course of azithromycin. She returns in two weeks because her symptoms have not improved. Vitals this time are temperature 38.5 C, HR 115, BP 112/80, RR 32, and oxygen saturation is 92% on room air. Physical exam is notable for labored breathing with use of the sternocleidomastoid muscles, as well as dullness to percussion over the lower right lung. A basic metabolic panel is ordered with the following results: Sodium: 139 mEq/L Potassium: 4.2 mEq/L Chloride: 104 mEq/L Bicarbonate: 24 mmol/L BUN: 24 mg/dL Creatinine: 1.3 mg/dL Which of the following is the best next step in the management of this patient? A) Hospital admission, begin levofloxacin B) Hospital admission, begin clarithromycin C) ICU admission, ceftriaxone plus levofloxacin D) Outpatient treatment with a 5-day course of doxycycline E) Outpatient treatment with levofloxacin F) Outpatient treatment with oseltamivir
Posted on: Thu, 15 May 2014 19:19:08 +0000
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