A 75-year-old man lives at home with his wife and is in
relatively good health aside from hypertension and mild
diabetes mellitus type 2. Through medications and lifestyle,
the man is able to keep both of his medical conditions
under control. He has never used tobacco, but his wife
was a smoker for 35 years. She quit approximately
20 years ago. She always smoked in the house and in
the car with other family members present, including her
husband.
The man presented with a 3-day history of fatigue, chills,
and lack of appetite. He has no acute respiratory complaints
other than mild dyspnea and a fever of 101°F. On an almost
daily basis he coughs up yellow sputum (Figure 14-8) in the
morning and has for several years. He has attributed this
to his “old age” and has never discussed this with his
physician.
Laboratory Results
Patient was found to have an elevated white blood count
of 16,000 with more than 10 bands per high power field (hpf)
(SEE PICTURE)
Questions
1. What risk factors are associated with this individual’s condition that predispose him to bacterial infections?
2. Review the laboratory results provided. Identify the abnormal
results, and provide an explanation for recommended
follow-up laboratory tests and any other recommended
diagnostics.
3. Review the Gram stain provided from the patient’s sputum.
Is it stain consistent with the patient’s condition? What, if
any, additional tests would be recommended?
A 75-year-old man lives at home with his wife and is in
relatively good health aside from hypertension and mild
diabetes mellitus type 2. Through medications and lifestyle,
the man is able to keep both of his medical conditions
under control. He has never used tobacco, but his wife
was a smoker for 35 years. She quit approximately
20 years ago. She always smoked in the house and in
the car with other family members present, including her
husband.
The man presented with a 3-day history of fatigue, chills,
and lack of appetite. He has no acute respiratory complaints
other than mild dyspnea and a fever of 101°F. On an almost
daily basis he coughs up yellow sputum (Figure 14-8) in the
morning and has for several years. He has attributed this
to his “old age” and has never discussed this with his
physician.
Laboratory Results
Patient was found to have an elevated white blood count
of 16,000 with more than 10 bands per high power field (hpf)
(SEE PICTURE)
Questions
1. What risk factors are associated with this individual’s condition that predispose him to bacterial infections?
2. Review the laboratory results provided. Identify the abnormal
results, and provide an explanation for recommended
follow-up laboratory tests and any other recommended
diagnostics.
3. Review the Gram stain provided from the patient’s sputum.
Is it stain consistent with the patient’s condition? What, if
any, additional tests would be recommended?
