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Discussion Question 1

JT is a fifty-five-year-old man with a three-day history of worsening shortness of breath, fever, chills, right-sided chest pain, and productive cough. He states that the initial symptoms started approximately one week ago. He has been taking over-the-counter (OTC) medications to control the fever and the cough. He comes in today because he feels that he is getting worse. He is coughing up rust-colored mucus, and the chest pain has started to make breathing even more difficult. His physical exam is normal, with the exception of tachypnea, labored breathing, coarse rhonchi through the right lung field, and decreased breath sounds on the right. Answer the following questions:

• What additional laboratory or radiological tests would be indicated and why? What would you expect to find?
• What is your diagnosis?
• What medication would be given and for what period of time?

Discussion Question 2

LN is a twenty-six-year-old married woman who presents at the clinic with symptoms of dysuria, frequency, and urgency. Further history yields two days of these symptoms but no fever, chills, or flank pain. She describes a burning discomfort during and immediately following urination and feeling the need to void every half hour. There is no vaginal discharge, itching, or odor. She is not using birth control at this time. She requests “a urine culture and some sulfa pills.” When asked to explain, she says she has had many “bladder infections” over the past three years and “sulfa pills usually work.” She was evaluated approximately five years ago with an IV pyelography and cystogram, and “nothing was wrong.” All her vital signs are normal. Answer the following questions:

• What additional information would you like to collect?
• What is your working diagnosis?
• What are the contributing factors to this potential diagnosis?
• What treatment would you implement and why?
• What type of follow-up would you recommend?