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Week 17

 

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Quiz 17 Context:

A 68-year-old male presents with the onset of productive cough, gastrointestinal symptoms, and fevers. The patient is a heavy smoker and is known to suffer from chronic obstructive pulmonary disease for which he receives aerosolized steroids and occasional oral steroid therapy. He had recently returned from a week long camping and fishing trip when he noted the onset of fevers 2 days ago. Subsequently the fevers intensified and he began to develop a productive cough, nausea, vomiting, and diarrhea.

Physical examination reveals an uncomfortable appearing male patient. He is lethargic. He is presently tachypnic. Rigors are evident. Vital signs reveal a temperature of 40.5 degrees Celsius, heart rate 55 bpm, blood pressure 88/50. The exam is notable for pulmonary rales and dullness to percussion at the base of the lung fields. The abdominal exam is normal. Examination of the neurological system is notable for lethargy; reflexes are preserved, cranial nerve exam is normal, and there are no meningeal signs.

A chest radiograph is obtained and shown above.

The history, examination, and chest film are most consistent with which of the following?

  1. Pneumonia, community-acquired
  2. Viral upper respiratory tract infection
  3. Non- small cell lung cancer with humoral hypercalcemia of malignancy
  4. Rheumatic fever
  5. Small-cell lung cancer with SIADH

 

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Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195