This 53-years-old man with a past medical history of non-insulin dependent diabe

Question

This 53-years-old man with a past medical history of non-insulin dependent diabetes mellitus and hypertension was in his usual state of health until 4 days prior to admission, when he developed fatigue, fever, chills and a cough occasionally productive of green sputum. Over the two days prior to admission, he had drenching sweats, increasing dyspnea, and left-sided pleuritic chest pain. The patient had smoked two packs of cigarettes a day for 40 years. His physical examination was notable for an increased respiratory rate of 22 per minute, and crackles were heard over the right middle, left middle, and lower lung fields. A chest radiograph demonstrated right lower lobe, left lingular, and left lower lobe infiltrations. The blood sample cultured on blood agar is on your bench

Explanation / Answer

Although a blood culture would be highly informative and beneficial in this case, it can be avoided if other useful tests are performed. According to the information, it seems that the patient is suffering from chronic diabetes and due to poor healthy habits, he is a patient of hypertension as well. It seems that the patient is suffering from pulmonary bronchitis and blockage of pulmonary alveoli due to over-smoking. This resulted in local inflammation and sputum formation. Secondary infections might also have emerged leading to further deterioration in health.

Here, a pulmonary function test along with a complete hematocrit analysis and sputum culture should be performed if the type of blood culture is required to be avoided. These battery of tests would be able to provide the maximum picture of the pathology in this patient.

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