CHIEF COMPLAINT: Cough and fever for four days

CHIEF COMPLAINT: Cough and fever for four days
•HISTORY: Mr. Alcot is a 68 year old male, married,  protestant, retired truck driver, height: 180 cm, weight: 70 kg, BMI. 22.9, who developed a harsh, productive cough four days prior to being seen by a physician. The sputum is thick and yellow with streaks of
blood. He developed a fever, shaking, chills and malaise along with the cough.One day ago he developed pain in his right chest that intensifies with inspiration. The patient lost 15 lbs. over the past few months but claims he did not lose his appetite. “I just thought I had the flu.”
•Past history reveals that he had a
chronic smoker’s cough for “10 or 15 years” which he describes as being mild, non-productive and occurring most often in the early morning. He smoked 2 packs of cigarettes per day for the past 50 years. The patient is a retired truck driver who has been treated for mild hypertension, bronchitis, appendicitis (as a young adult), hemorrhoids and a fractured femur and splenic injury (motorcycle accident)
•LABORATORY:
WBC
17,000/mm3 (n.v. 4,500
to 11,000 WBCs per microliter); neutrophils 70% (n.v. 55%
to 70%),
bands 15% (n.v. 0-5%),
lymphocytes 15% (20%
to 40%).