Mike is a 68-year-old construction foreman

Mike is a 68-year-old construction foreman. He comes to your clinic today complaining of a productive cough and some shortness of breath for the past four days. He has a fever of 101 °F. His O₂ sat is 93% on room air. His respiratory rate is 26/minute, his pulse is 102 and regular, and his BP is 158/78. He is married, a nonsmoker, and still works. He had his influenza vaccine but has not had his pneumonia 23 vaccine yet. He is alert and oriented × 3. A stat office set of labs demonstrate a white count of 18,000 with a left shift, K+ of 4.2, Na+ of 136, GFR of >60, creatinine of 1.1, and BUN of 14. His only medications are atorvastatin 10 mg for hyperlipidemia and valsartan 160 mg for hypertension.

1. What other questions would you ask Mike?

1. If you suspect left lower lobe pneumonia, what would you expect to hear when you percuss the thorax?

1. What would you expect to feel while performing tactile fremitus?

1. If you suspect pneumonia, what would you expect to hear on auscultation?

1. Calculate Mike’s CURB-65 score. What does this score indicate?

1. What  antibiotic  prescription would place Mike on today.

1. When would you recheck Mike?

1. What are some differential diagnoses you might consider with Mike’s presentation?

1. What is your role as a primary care provider in preventing CAP in this population?