Pulmonary Department
Mayo Clinic Arizona
Scottsdale, AZ USA
History of Present Illness
A 78-year-old man presented to the Emergency Department on April 7 for shortness of breath and weakness over the last 2 weeks. He was in good health prior to an outside hospitalization March 29-April 3 for pneumonia and a possible non-ST-elevation myocardial infarction (elevated troponins). He had a bronchoscopy during his recent outside hospitalization without specific pathogen identified but was treated with antibiotics and discharged on levofloxacin. Since his hospital discharge 4 days previously he feels weaker and increasingly short of breath. He is short of breath even walking around his home. He denies fever or a productive cough.
Past Medical History, Family History and Social History
- Atrial fibrillation, s/p ablation. On Eliquis.
- Prior renal cell carcinoma, s/p resection, no recurrence
- DM Type 2
- GERD
- OSA
- Essential tremor
- Never smoked
Medications
- Apixaban
- Aspirin
- Atorvastatin
- Flecanide
- Insulin
- Levofloxacin
- Lisinopril
- Pantoprazole
- Tamsulosin
Physical Examination
- General: The patient looks comfortable and is in no distress
- Vital Signs: BP 110/62 O2 Sat 94% on room air
- CVS: Heart sounds are regular
- Lungs: Clear to auscultation
- Abdomen: Soft, nontender, bowel sounds present
- Extremities: No edema
- Neuro: Alert and oriented
- Skin: Warm and dry, no rashes
Chest X-ray
A portable chest X-ray was performed (Figure 1).
Figure 1. Portable chest X-ray obtained in the emergency department.
Which of the following should be done next? Click on the correct answer to be directed to the second of six pages)