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Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months.  She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms.  Her past medical history includes stroke 6 months ago.  She also smokes 20 cigarettes per day.  On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left.  She is obviously short of breath and presents with 4-word dyspnea.  Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9

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