BOF: 2.22
Your junior calls you up to ask advice regarding a
50-year-old male who has been admitted with a history of cough and
breathlessness. He has had an upper respiratory infection for a few days prior
to presentation. On the day of presentation he developed a single shaking
chill followed by fever. He also complained of cough productive of purulent
sputum, right-sided pleuritic chest pain and breathlessness. On examination he looked unwell, was febrile, had a
tachycardia and tachypnoea. On
palpation the trachea was in the midline, respiratory movements were
diminished at the right base. There were fine crepitations at the right base.
Chest x-ray did not show any abnormality.
Your advice to your junior
would be:
a)
Arrange a right lateral chest x-ray
b)
Repeat the chest x-ray
c)
Arrange a ventilation perfusion scan
d)
Arrange a CT pulmonary angiogram
e)
Arrange a high resolution CT scan
Answer:
b)
The clinical features are suggestive of pneumococcal
pneumonia
. In patients with pneumococcal pneumonia, the chest x-ray findings may be
minimal or undetectable during the first several hours.
Pneumonia
