question archive A 65 year old man is admitted with left lobar pneumonia
A 65 year old man is admitted with left lobar pneumonia
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A 65 year old man is admitted with left lobar pneumonia. His symptoms on admission included productive cough, fever, dyspnea, confusion, nausea vomiting, constipation, and weakness. He has a 45 pack year history of smoking. He admits to losing 35 pounds over the past 4 months but his wife says he thought that was because of his poor appetite, feeling bad, and no energy.
Medications include Advair, an albuterol rescue inhaler, Lisinopril, and HCTZ. The physical examination shows a somewhat emaciated man with a blood pressure of 123/72. There are decreased breath sound throughout the left lung field and normal cardiovascular, abdominal, and extremity examinations. His sputum is green with some blood streaks. Review of his chest x-ray shows lower lobe consolidation. There are also some white spots in the lower lobe which are concerning.
He has been started on antibiotics and seems better but is still confused, weak, and complaining of nausea. His repeat labs from today show:
-Sodium 133
-Potassium 4.4
-Chloride 98
-Bicarbonate 31
-BUN 15
-Creatinine 1.0
-Glucose 112
-Calcium 17.7
-What is the most likely diagnosis and how would you treat it?
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Answer:
*The most likely diagnosis is lung consolidation.
Step-by-step explanation
*The most likely diagnosis is lung consolidation.
*In a person with lung consolidation when chest X-ray is done the consolidated parts appear white which is observed in this case.
*The symptoms of lung consolidation are cough with thick green or bloody sputum, chest pain,noisy breathing, fever and fatigue and which are seen in this case.
*The causes of Lung consolidation can be pneumonia,pulmomary edema, aspiration and cancer.
*In this case the cause of lung consolidation is pneumonia.
*So the treatment is to treat pneumonia based on the organism causing pneumonia whether it is bacterial, viral or fungal.Few treatment choices include levofloxacin, azithromycin and clarithromycin etc.
