A 24-Year-Old Man Comes to the Emergency Department in January

question 215

Multiple Choice

A 24-year-old man comes to the emergency department in January due to fever and shortness of breath.  A week ago, he developed fever, malaise, muscle aches, and rhinorrhea.  The symptoms largely resolved 2 days ago, but this morning the patient began having productive cough of green-yellow sputum, shortness of breath, and pleuritic chest pain.  He has had no recent travel or other significant illness.  The patient has not received the influenza vaccine.  He has a history of type 1 diabetes mellitus and takes insulin.
Temperature is 39.1 C (102.4 F) , blood pressure is 135/67 mm Hg, pulse is 104/min, and respirations are 22/min.  Pulse oximetry shows 90% on room air.  The patient is ill-appearing and in mild respiratory distress.  He coughs frequently during the examination.  Lung examination shows bronchial breath sounds and crackles in the right lower lung field.
Leukocyte count is 14,000/mm³ with 82% neutrophils.  Chest x-ray shows a dense right lower-lobe consolidation with a small area of lucency and small right-sided pleural effusion.  Rapid influenza test is positive.
Which of the following empiric treatments is most appropriate for this patient?

• A)Antimycobacterial therapy
• B)Azithromycin and ceftriaxone
• C)Azithromycin and piperacillin/tazobactam
• D)Azithromycin, ceftriaxone, and vancomycin
• E)Supportive care only

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Definitions:

Self-control Problems

Difficulties individuals face in resisting temptation or impulsivity, often impacting long-term goals for instant gratification.

Poor Information

Refers to scenarios where the data available for decision making is inadequate, inaccurate, or misleading.

Overall Set

The complete or total collection of elements, items, or objects under consideration.

Anchoring

The tendency people have to unconsciously base, or “anchor,” the valuation of an item they are currently thinking about on recently considered but logically irrelevant information.