How to Answer What Clinically Relevant Questions (Complete Guide)
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Key Explanation
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Original Question
What clinically relevant signs and symptoms support the diagnosis and What laboratory findings support the diagnosis? CASE STUDY 15.2 An 80-year-old man presents to the emergency department (ED) complaining of right-sided chest pain when he breathes and a productive cough. A sputum sample collected from the patient revealed rust-colored sputum. He also states that his symptoms began abruptly with chills the day before this visit to the ED; he had previously been healthy. Examination by the physician identifies coarse breathing sounds in the right anterior chest. A chest radiograph shows a right-upper-lobe infiltration. The patient currently has a fever of 102°F. Blood is drawn for a CBC. The sputum sample is Gram-stained and cultured. Laboratory data follows: Complete Blood Count Hemoglobin: 14.5 g/dL (normal) White blood count: Elevated Differential: 90% neutrophils (normal range 25% to 60%) Sputum Gram stain: Gram-positive lancet-shaped diplococci (cocci in pairs) Culture report: Streptococcus pneumoniae The diagnosis is pneumonia caused by S. pneumoniae. Multiple Choice Questions 1. The observation of which cells on the Gram-stained smear will assure the laboratory that a sputum specimen has been collected and tested? a. Greater than 10 squamous epithelial cells per low-power field (10x) b. Fewer than 10 squamous epithelial cells per low-power field (10x) c. Greater than 10 columnar epithelial cells per low-power field (10x) d. Greater than 10 gram-positive diplococci per low-power field (10x) ANS: b. Fewer than 10 squamous epithelial cells per low-power field (10x) 2. What characteristics of this patient would coincide with pneumonia caused by this organism? a. The patient is otherwise healthy. b. The patient is most likely a smoker. c. The patient is an older adult. d. The patient is likely not providing all the details. ANS: c. The patient is an older adult. Critical Thinking Discussion Questions 1. What clinically relevant signs and symptoms support the diagnosis and What laboratory findings support the diagnosis?
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