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Question: a 55 year old woman who was previously well presents...

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A 55 year old woman who was previously well presents with shortness of breath, fever, and cough productive of sputum. She is a regular smoker and has not travelled abroad recently. Clinical examination reveals that her pulse is 104, her blood pressure 100/60 mmHg and her respiratory rate 32 breaths/ minute. A chest X-ray shows extensive consolidation at her lower left base and a small effusion.

1. What is your differential diagnosis?

2. What is the influence of smoking ?

3. What further investigations would be helpful?

4. A diagnosis of community- acquired pneumonia has been made, but what is the most likely pathogen ?

MORE INFO: the patient is treated with Ceftriaxone and clarithromycin and there is an initial response to this prescription: her temperature, pulse, and realities rate fall and she begins to feel better. After 6 days the patient complains that’s she is feeling worse and that she is more breathless. The nurses report that her temperature has come back.

5. What complication may have developed?

6. How would you make the diagnosis?

7. What additional procedure may be required?

8. What microbiological examination should be performed now ?

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