1.What do you suspect that Jimmy might have? Please list ALL the possibilities and rationale for each possibi?!

1. pneumococcal pneumonia
typical acute onset, high fever, rusty sputum, and pleuritic chest pain are the hallmarks. the chest pain is caused by irritation of the lung lining that rubs against the rib cage with each breath. it is classic for pneumoccus.

2. would also consider staphylococcal pneumonia -- if he had a presumed influenza infection first, for several days beforehand when he was feeling "ill". Influenza is a setup for staph pneumonia.

3. briefly consider pulmonary embolism. Can also cause hemoptysis and pleuritic chest pain. But would not cause the purulent sputum, and less likely to cause fever. Chest xray would be normal with PE, but will show pnemonia if present. Consider PE because of the smoking history and cardiovascular family history.

4. consider TB, but the onset would never be this quick - it has a much more insidious onset of low grade fever, weight loss and chronic cough. Very unlikely here.

5. consider aspergillosis - predisposed in patients with emphysema. But this would only be diagnosed with sputum culture.


#1 is the right answer, but you'd want a stat gram stain of the sputum to hopefully show gram positive cocci in pairs (pneumococcus), and not in clusters (staph). This will tell you how to direct your antibiotic therapy. also, you need to do blood cultures in this case - it's a good way to recover either organism in a man this severely ill.Health Question & Answer

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Pneumonia - the fever of 103, the cough came on suddenly although he was a smoker for 40 years. He coughed up the phlegm and the left side of his chest hurt whenever he coughed. I think it's pneumonia

or could be bronchitisHealth Question & Answer

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