USMLE Forum Archives - USMLE Step 2 CK - IM 16
IM 16
TheOne - 12-03-06 17:01
A 60-year-old man is admitted to the hospital for fever and a productive cough. The patient reports that, over the past few days, he has had a worsening cough that has become productive of greenish sputum. The patient reports temperatures to 39.5 C (103 F) over the past day. The patient has had nothing to eat or drink for the past 2 days. On further questioning, the man describes a period of 7 days prior to the onset of the cough that was remarkable for rhinorrhea and general malaise. On physical examination, he appears acutely ill. His blood pressure is 120/80 mm Hg, and his pulse is 120/min. Examination is remarkable for diminished breath sounds on the right lung-base with "a to e" egophony and whispered pectoriloquy. Which of the following is required for the
diagnosis of pneumonia?
A. Hypoxemia on pulse oximetry
B. Infiltrates present on chest radiograph
C. Sputum Gram's stain showing gram-positive diplococci
D. Sputum Gram's stain showing neutrophils
E. Temperature to 38.6 (101.4 F)
TheOne - 12-03-06 17:01
A 60-year-old man is admitted to the hospital for fever and a productive cough. The patient reports that, over the past few days, he has had a worsening cough that has become productive of greenish sputum. The patient reports temperatures to 39.5 C (103 F) over the past day. The patient has had nothing to eat or drink for the past 2 days. On further questioning, the man describes a period of 7 days prior to the onset of the cough that was remarkable for rhinorrhea and general malaise. On physical examination, he appears acutely ill. His blood pressure is 120/80 mm Hg, and his pulse is 120/min. Examination is remarkable for diminished breath sounds on the right lung-base with "a to e" egophony and whispered pectoriloquy. Which of the following is required for the
diagnosis of pneumonia?
A. Hypoxemia on pulse oximetry
B. Infiltrates present on chest radiograph
C. Sputum Gram's stain showing gram-positive diplococci
D. Sputum Gram's stain showing neutrophils
E. Temperature to 38.6 (101.4 F)
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#3
Re: IM 16 drs_kh - 12-04-06 06:39 B is correct, sputum Gram stain and sputum culture will be done after CXR.
#4
correct
TheOne - 12-06-06 11:10 The correct answer is B. The diagnosis of pneumonia absolutely requires that an infiltrate of some sort (whether interstitial or parenchymal, lobar or diffuse) be present on a chest radiograph.
Hypoxemia on pulse oximetry (choice A) is one possible physical manifestation of severe pneumonia but is certainly not required for the diagnosis.
A sputum Gram's stain showing gram-positive diplococci (choice C) is suggestive of a pneumonia, but it could also easily be explained by pharyngeal colonization with this organism.
A sputum Gram's stain showing neutrophils (choice D) is also highly suggestive of some pulmonary inflammatory process, although not necessarily pneumonia.
A temperature to 38.6 (101.4 F) (choice E) is clearly a nonspecific sign and can be associated with a multitude of possible etiologies.
#6
Re: IM 16 bingousmle - 07-18-10 06:25 the only choice which will be specific for pneumonia is finding infiltrates on the chest x ray.. others can be foind in other conditions as well
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