A 23-Year-Old Man Is Brought to the Emergency Department by His

question 1090

Multiple Choice

A 23-year-old man is brought to the emergency department by his family due to a severe sore throat, persistent elevated fevers, pain and difficulty with swallowing, and shortness of breath.  His symptoms worsened over the past day.  Three days ago, he was seen at an urgent care center for pharyngitis and was prescribed azithromycin.  The patient's past medical history is otherwise insignificant.  He does not use tobacco, alcohol, or illicit drugs.  His temperature is 40 C (104 F) , blood pressure is 90/58 mm Hg, pulse is 115/min, and respirations are 24/min.  Pulse oximetry shows 94% on room air.  Physical examination is notable for a well-built man in moderate distress due to pain.  There is mild swelling and erythema of the oropharynx and tonsils without exudate.  Dentition is intact and shows good hygiene.  The neck is swollen and tender along the left sternocleidomastoid muscle.  Lung examination reveals basilar crackles.  There are no heart murmurs.  Leukocyte count is 17,400/mm³ with 93% neutrophils.  A duplex ultrasound shows left internal jugular vein thrombosis.  Chest x-ray reveals multiple peripheral lung nodules, some with cavitation.  Which of the following is the most likely causative organism?

• A)Clostridium perfringens
• B)Fusobacterium necrophorum
• C)Haemophilus influenzae serotype b
• D)Klebsiella pneumoniae
• E)Streptococcus pyogenes

Comprehend the significance of accurate diagnosis in clinical practice, including communication among professionals and insurance reimbursement.

Familiarize with the ordering of diagnoses in the DSM-5 and the rationale behind it.

Recognize the relationship between the DSM diagnostic codes and the International Classification of Diseases (ICD) coding system.

Understand informal diagnostic labels and their use in professional communication.

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Definitions:

Schizophrenia

A long-lasting and intense psychological condition marked by altered cognition, feeling, communication, identity, and conduct.

Hypochondriasis

A disorder characterized by an excessive preoccupation with and fear of having a serious illness, despite medical evaluation and reassurances.

Excessively

To a degree or extent that exceeds what is normal or permissible.

Doctors

Medical professionals who are licensed to diagnose and treat illnesses, perform surgery, and prescribe medication to patients.