A 38-year-old man was admitted 3 days ago with community-acquired pneumonia and started on ceftriaxone and azithromycin. He still has a fever of 39°C. On reassessment there is new dullness to percussion and absent breath sounds over the left hemithorax. What is the next step in management?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: D. Chest X-ray
A patient with CAP still febrile on day 3 who develops new stony dullness and absent breath sounds most likely has a complication such as a parapneumonic effusion/empyema. Non-response by day 3 should prompt a search for complications (empyema, effusion, abscess) before blindly escalating antibiotics, and the chest X-ray is the standard initial imaging for pleural effusion. Changing antibiotics (B) or just waiting (A) misses a collection that may need drainage.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Persistent fever with new signs is delayed improvement, which means complications, wrong diagnosis, wrong treatment or local pathology; the cause has to be looked for, not just waited on for another 24 hours.
✓ (Y4)-(M B) Pneumonia and pleural effusion - Resident.pdf · p. 39 -
B
ليش غلط
A resistant organism (wrong treatment) is only one cause of non-response. New dullness and absent breath sounds point to a complication (effusion/empyema) to confirm first.
✓ (Y4)-(M B) Pneumonia and pleural effusion - Resident.pdf · p. 38 -
D
ليش صح
Dullness and absent breath sounds suggest a pleural effusion, and a chest X-ray is the standard initial imaging for it (blunted costophrenic angle, meniscus sign).
✓ Pleural effusion.pdf · p. 3
- المصدر
- (Y4)-(M B) Pneumonia and pleural effusion - Resident.pdf · p. 38
Pleural effusion.pdf · p. 3 - المحاضرة
- Pneumonia · Pulmonology · Module B
- ظهر في
- MED42 Compre B