40

40 CASE 40


A 24-year-old man presents to his primary care physician complaining of fever and chills that have persisted for 1 week.


During this time, the patient has had an unproductive cough and shortness of breath when he exerts himself. His chest now hurts when he coughs, and the sputum has a greenish tint. He has a general feeling of malaise and has noticed a decrease in appetite. He has been using an over-the-counter cold medicine for symptom relief, but symptoms return when the medication wears off. The patient has been working outside on a construction job this winter and is under a lot of stress with the recent move into a new apartment with his pregnant wife.



PHYSICAL EXAMINATION



VS: T 40°C, P 90/min, R 25/min, BP 112/70 mm Hg

PE: Physical appearance includes a pale sunken face. Breathing pattern is rapid and shallow, with some dyspnea during deep breaths. There are altered breath sounds and rales in the upper right lobe noted during chest auscultation. The upper right lobe is also dull to percussion. An increase in fremitus is evident. Cough produces green/yellow sputum.


LABORATORY STUDIES



Pulse oximetry: 90% saturation on room air

Chest radiograph: Segmented lobe infiltrate

Gram stain: Numerous gram-positive diplococci along with polymorphonuclear leukocytes suggesting infection with Streptococcus pneumoniae
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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 40

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