A 45-Year-Old Man Comes to the Emergency Department Due to 3

question 310

Multiple Choice

A 45-year-old man comes to the emergency department due to 3 weeks of fever, malaise, and cough productive of foul-smelling, purulent sputum.  Six weeks ago, the patient was hospitalized after sustaining a head injury during a motor vehicle collision; he briefly required intubation and was discharged from the hospital 4 weeks ago.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 39.1 C (102.3 F) , blood pressure is 120/74 mm Hg, pulse is 110/min, and respirations are 14/min.  Laboratory studies reveal a hemoglobin of 12.5 g/dL and leukocyte count of 18,000/mm³.  X-ray of the chest is shown in the exhibit.  Sputum cultures are obtained.  Which of the following is the most appropriate next step in management of this patient?

• A)Ampicillin-sulbactam empiric therapy
• B)Bronchoscopy and biopsy
• C)Metronidazole empiric therapy
• D)Observation until culture results are available
• E)Surgical resection

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