resent illness. A 35-year-old male resident of Wayne, NJ presents

resent illness. A 35-year-old male resident of Wayne, NJ presents with fever and cough. He was well until 3 days earlier, when he suffered the onset of nasal stuffiness, mild sore throat, and a cough productive of small amounts of clear sputum. Today, he decided to seek physician assistance because of an increase in temperature to 38.3°C and spasms of coughing that produce purulent secretions. On one occasion, he noted a few flecks of bright-red blood in his sputum. Other pertinent history. It is March. He lives in a home in the city with his wife and 3 children, aged 7, 9, and 11 years. The children are fully immunized. The 11-year-old child is recovering from a “nagging” cough that has persisted for 10-14 days. The family has a pet parakeet who is 5 years old and appears to be well. The patient has not traveled outside the city in the past year. He is an office manager. Medical history. The patient has no history of familial illness, hospitalizations, or trauma. There are no drug allergies or intolerance. The only medication he takes is acetaminophen occasionally, for headaches. He drinks beer or wine in moderation. Physical examination. His body temperature is 38.9°C (100°F), his pulse is 110 beats/min and regular, and his respiratory rate is 18 breaths/min. His oxygen saturation is 93% while breathing room air. There is mild erythema of the mucosa of the nose and posterior oropharynx. Inspiratory “rales” are heard at the right lung base. Laboratory and radiographic findings. His hemoglobin level is 12.5 g/dL, with a hematocrit of 36%. His WBC count is 13,500 cells/μL, with 82% polymorphonuclear cells, 11% band forms, and 7% lymphocytes. His platelet count is 180,000 cells/μL. The results of a CMP screen are unremarkable. Chest radiography documents bilateral lower lobe infiltrates that are more pronounced on the right side. There are no pleural effusions. What is this patient’s most likely diagnosis? What is the significance of the patient’s oxygen saturation being 93% on room air? It indicates severe hypoxemia requiring immediate hospitalization. It is within normal limits and does not require intervention It suggests mild hypoxemia and the need for close monitoring It is indicative of hyperventilation syndrome When should a follow-up chest radiograph be considered for this patient? Within 24 hours of initial presentation After completion of antibiotic therapy Only if symptoms worsen despite treatment No follow-up radiograph is necessary What is the most appropriate antibiotic treatment for this patient? levofloxacin (Levaquin) Amoxicillin (Amoxil) oseltamivir (Tamiflu) amoxicillin/clavulanate (Augmentin) plus doxycycline (Vibramycin) 1 Point What would the CURB-65 score be for this patient based on the information provided? 0 1 2 3 1 Point Which of the following symptoms has the patient experienced that suggests a lower respiratory tract infection? Mild sore throat Nasal stuffiness Clear sputum production Purulent sputum production 1 Point Reasonable differentials to consider should include: (select all that apply) Acute bronchitis COVID-19 Allergic Rhinitis Influenza 1 Point Given the patient’s history and clinical findings, which pathogens should be considered? (select 2 that apply) Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydia psittaci Haemophilus influenzae 1 Point What is the likely significance of the flecks of bright-red blood in the patient’s sputum? Allergic reaction Pulmonary embolism Trauma to the respiratory tract Lung cancer What other information would be useful for the provider to gather to determine the cause of the patient’s illness? (select all that apply) Hygiene of the bird More details about sick child Whether the patient’s parents smoked What is the significance of the patient’s oxygen saturation being 93% on room air? It indicates severe hypoxemia requiring immediate hospitalization. It is within normal limits and does not require intervention It suggests mild hypoxemia and the need for close monitoring It is indicative of hyperventilation syndrome 1 Point When should a follow-up chest radiograph be considered for this patient? Within 24 hours of initial presentation After completion of antibiotic therapy Only if symptoms worsen despite treatment No follow-up radiograph is necessary 1 Point What is the most appropriate antibiotic treatment for this patient? levofloxacin (Levaquin) Amoxicillin (Amoxil) oseltamivir (Tamiflu) amoxicillin/clavulanate (Augmentin) plus doxycycline (Vibramycin) 1 Point What would the CURB-65 score be for this patient based on the information provided? 0 1 2 3 1 Point Which of the following symptoms has the patient experienced that suggests a lower respiratory tract infection? Mild sore throat Nasal stuffiness Clear sputum production Purulent sputum production 1 Point Reasonable differentials to consider should include: (select all that apply) Acute bronchitis COVID-19 Allergic Rhinitis Influenza 1 Point Given the patient’s history and clinical findings, which pathogens should be considered? (select 2 that apply) Streptococcus pneumoniae Mycoplasma pneumoniae Chlamydia psittaci Haemophilus influenzae 1 Point What is the likely significance of the flecks of bright-red blood in the patient’s sputum? Allergic reaction Pulmonary embolism Trauma to the respiratory tract Lung cancer What other information would be useful for the provider to gather to determine the cause of the patient’s illness? (select all that apply) Hygiene of the bird More details about sick child Whether the patient’s parents smoked When the patient last took antibiotics When the patient last took antibiotics

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