49.A tall, thin 18-year-old man presents to the ED with acute onset of
dyspnea while at rest. The patient reports sitting at his desk when he felt a
sharp pain on the right side of his chest that worsened with inspiration. His
past medical history is significant for peptic ulcer disease. He reports taking
a 2-hour plane trip a month ago. His initial vitals include a HR of 100 beats
per minute, a BP of 120/60 mm Hg, an RR of 16 breaths per minute, and an
oxygen saturation of 97% on room air. On physical examination, you note
decreased breath sounds on the right side. Which of the following tests
should be performed next?
a. Electrocardiogram (ECG)
b. D-dimer
c. Ventilation perfusion scan (V/Q scan)
d. Upright abdominal radiograph
e. Chest radiograph
50.A 46-year-old alcoholic man presents to the ED with cough, fever, and
rigors for 2 days. He describes his sputum as rust-colored. His vital signs
are: temperature 101.1°F, HR 94, BP 125/75 mm Hg, RR 20, and pulse
oxygen of 97% on room air. Auscultation reveals crackles in the left-lower
lobe. Chest radiograph is significant for a left-lower lobar infiltrate. Which of
the following organism is the most common cause of community acquired
bacterial pneumonia?
a. Haemophilus influenza
b. Streptococcus pneumoniae
c. Klebsiella pneumonia
d. Group A streptococci
e. Pseudomonas aeruginosa
Shortness of Breath 51