A 73-Year-Old Man Comes to the Emergency Department with Fever

question 842

Multiple Choice

A 73-year-old man comes to the emergency department with fever and chest discomfort.  He was hospitalized with right lower-lobe pneumonia 3 months ago and improved with antibiotics.  He has since had an intermittent cough and a 4.5-kg (10-lb) weight loss.  The patient is a life-long nonsmoker.  He has a long history of Parkinson's disease with gait instability along with hypertension and acid-reflux disease.  His temperature is 38.3 C (101 F) , blood pressure is 122/70 mm Hg, heart rate is 105/min, and respirations are 24/min.  Examination shows upper-extremity rigidity, resting tremor, mild dysarthria, and frequent drooling.  Lung examination shows crackles and dullness at the right base.  Extremities are warm to the touch.  The white blood cell count is 13,500/µL.  Chest x-ray shows a right middle-lobe infiltrate.  Intravenous antibiotics are started.  Which of the following tests is most helpful in evaluating this patient?

• A)Flexible bronchoscopy
• B)High-resolution computed tomography scan of the chest
• C)Quantitative immunoglobulin testing
• D)Tuberculin skin testing
• E)Videofluoroscopic swallowing study

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Definitions:

DLC

Acronym for "Data Link Connector," an interface found in vehicles that allows access to the onboard diagnostics (OBD) system.

J1939 Data Bus

A communication protocol based on CAN (Controller Area Network) used in the heavy-duty trucking industry for electronic control units (ECUs) to communicate.

Smart Switch

A smart switch is an advanced electrical switch that can be controlled remotely through an app or a home automation system, allowing for smarter energy usage and convenience.