Case #1

Diagnostic Work-up

Select from the following menu the diagnostic test(s) you think are appropriate, and list the test you ordered in the e-mail window.

(You should order these diagnostic studies necessary to evaluate your working diagnosis/diagnoses. Each test should be ordered with a specific question in mind. [i.e. avoid a "shotgun" approach].)

Lab Test

Cost
Acid Phosphatase 27.00
Amylase 13.00
Blood Culture 56.00
BUN and Creatinine 39.00
CBC with Differential 47.00
Chest X-Ray PA & LAT 143.00
CT Scan of Abdomen (unenhanced) 753.00
CT Scan of Chest (unenhanced) 679.00
EKG 40.00
Erythrocyte Sedimentation rate 25.00
Fasting Glucose 19.00
GGT 11.00
Intradermal Tuberculin Skin Test 15.00
Liver Profile 57.00
Lumbar Spine Series (plain films) 200.00
Platelet Count 20.00
Prostate Specific Antigen 49.00
Psychiatry Consult 150.00
Renal Ultrasound 451.00
Serum Calcium and Phosphorus 38.00
Serum Electrolytes 68.00
Serum Protein Electrophoresis 59.00
Serum Total Protein and Albumin 36.00
Serum Uric Acid 19.00
Sinus X-Ray 170.00
Sputum C&S 41.00
Thyroid Profile (T-3) 29.00
TSH 39.00
Ultrasound of the Abdomen 413.00
Urinalysis (dip stick and microscopic) 32.00
  1. What are your working diagnoses now?
  2. What are the common pathogens causing community- acquired pneumonia?
  3. What features are important to keep in mind when considering pneumonia in the elderly?
  4. Does Mr. Smith need hospitalization? What factors influence the decision to hospitalize the patient?

Final Diagnosis

Mrs. Smith requests that the patient be hospitalized. His age of 70, significant fatigue, weight loss of 10 pounds, and high fever all support significant illness. With the suggestion of cyanosis of his lip, O2 saturation should be checked as the patient may need O2 supplementation. Mr. Smith was admitted to the hospital for further evaluation and treatment.

  • For outpatient treatment of community-acquired pneumonia, see Tutorial #1.
  • For Radiographic Findings of Pulmonary Infiltrates, see Tutorial #2.

Author: 

Shou Ling Leong, M.D.
Assistant Professor
Department of Family & Community Medicine
Penn State University College of Medicine
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This page was last updated on April 24, 2006
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