Signs and symptoms support on the diagnosis

What clinically relevant signs and symptoms support the diagnosis and What laboratory findings support the diagnosis?

CASE STUDY 15.2

An 80-year-old man presents to the emergency department (ED) complaining of right-sided chest pain when he breathes and a productive cough. A sputum sample collected from the patient revealed rust-colored sputum. He also states that his symptoms began abruptly with chills the day before this visit to the ED; he had previously been healthy. Examination by the physician identifies coarse breathing sounds in the right anterior chest. A chest radiograph shows a right-upper-lobe infiltration. The patient currently has a fever of 102°F. Blood is drawn for a CBC. The sputum sample is Gram-stained and cultured.

Laboratory data follows:

Complete Blood Count

Hemoglobin: 14.5 g/dL (normal)

White blood count: Elevated

Differential: 90% neutrophils (normal range 25% to 60%)

Sputum

Gram stain: Gram-positive lancet-shaped diplococci (cocci in pairs)

Culture report: Streptococcus pneumoniae

The diagnosis is pneumonia caused by S. pneumoniae.

Multiple Choice Questions

1. The observation of which cells on the Gram-stained smear will assure the laboratory that a sputum specimen has been collected and tested?

a. Greater than 10 squamous epithelial cells per low-power field (10x)

b. Fewer than 10 squamous epithelial cells per low-power field (10x)

c. Greater than 10 columnar epithelial cells per low-power field (10x)

d. Greater than 10 gram-positive diplococci per low-power field (10x)

ANS: b. Fewer than 10 squamous epithelial cells per low-power field (10x)

2. What characteristics of this patient would coincide with pneumonia caused by this organism?

a. The patient is otherwise healthy.

b. The patient is most likely a smoker.

c. The patient is an older adult.

d. The patient is likely not providing all the details.

ANS: c. The patient is an older adult.

Critical Thinking Discussion Questions

1. What clinically relevant signs and symptoms support the diagnosis and What laboratory findings support the diagnosis?