Question

A 55 year old woman has had four days of a cough productive of dark yellow sputum. She has also experienced occasional shaking chills and has sharp chest pain that is worst on inspiration. She denies recent travel history, known sick contacts, or recent hospitalization. Past medical history is significant for osteoarthritis and hypertension. Temperature is 38.0 C (100.4 F), pulse 85, blood pressure 132/80, respirations 22/min, oxygen saturation 97% on room air. The patient is alert, oriented, and interactive. Heartbeat is regular with normal S1 and S2. There is no JVD. There are decreased breath sounds as well as egophony and positive tactile fremitus at the right lung base. Abdomen is obese, nondistended, and nontender. There are no petechiae or rashes noted on skin exam. Chest x-ray is shown. Which of the following is the most appropriate therapy for this patient?

A. Enoxaparin
B. Vanc and meropenem
C. Cefepime and gentamicin
D. Azithromycin
E. Immediate needle thoracostomy

Answer 1

Cefepime and gentamicin is the most appropriate therapy for this patient with possible pneumonia.

Step-by-step explanation:

The most appropriate therapy for this patient is Cefepime and gentamicin (Choice C). The patient's symptoms, including cough productive of dark yellow sputum, shaking chills, and sharp chest pain worst on inspiration, along with the physical examination findings of decreased breath sounds, egophony, and positive tactile fremitus suggest a possible diagnosis of pneumonia. The choice of therapy should cover Gram-negative organisms and Pseudomonas, as well as atypical pathogens, which Cefepime and gentamicin can accomplish.