A 70-Year-Old Man Is Brought to the Emergency Department by His

question 808

Multiple Choice

A 70-year-old man is brought to the emergency department by his daughter due to 2 days of fever, chills, shortness of breath, and cough productive of yellow-green sputum.  According to the daughter, the patient appeared lethargic and mildly confused this morning and refused to eat breakfast as he wanted to stay in bed.  He regularly sees a physician and is up to date on vaccinations, including the annual flu vaccine.  The patient has a history of hypertension and type 2 diabetes mellitus.  He currently takes hydrochlorothiazide, lisinopril, and metformin.  He smokes a pack of cigarettes a day and drinks alcohol occasionally.  The patient lives alone but his daughter lives nearby.  Temperature is 39.4 C (103 F) , blood pressure is 104/62 mm Hg, pulse is 118/min, and respirations are 28/min.  Pulse oximetry shows 86% on room air but improves to 93% on 2 L of oxygen.  He appears mildly lethargic.  Bronchial breath sounds and crackles are heard over the right middle and lower chest fields.  Heart sounds are normal.  Neurological examination shows no focal deficits.  Complete blood count shows a leukocyte count of 17,000/mm³ with 80% neutrophils.  Blood glucose is 100 mg/dL.  Chest x-ray reveals consolidation in the right middle and lower lobes.  Blood cultures are obtained.  Which of the following is the best next step in management of this patient?

• A)Hospitalization and cefotaxime plus gentamicin
• B)Hospitalization and ceftriaxone plus azithromycin
• C)Hospitalization and piperacillin-tazobactam plus levofloxacin
• D)Hospitalization and vancomycin plus ceftriaxone
• E)Outpatient oral levofloxacin and close follow-up

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Definitions:

Person Perception

The process of forming impressions and making judgments about the traits and characteristics of others.

Attribution

The process by which individuals explain the causes of behavior and events, attributing them to internal dispositions or external situations.

Logical Assumption

A basic premise or belief that is accepted as true without proof and used as the basis for reasoning or argument.

Ingroup Vs Outgroup

Ingroup vs outgroup refers to the social categorization of people into groups based on perceived similarities or differences, where "ingroup" represents those similar to oneself and "outgroup" those who are not.