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Answer :
The most likely diagnosis for this patient is community-acquired pneumonia (CAP) with a suspected bacterial etiology, possibly caused by Streptococcus pneumoniae.
A) The most likely diagnosis for this patient is community-acquired pneumonia (CAP) with a suspected bacterial etiology.
The potential pathogen causing this disorder could be Streptococcus pneumoniae, given the typical presentation of cough with thick yellow sputum, fever, chills, and chest pain. S. pneumoniae is a common cause of CAP in adults.
B) The mode of transmission for S. pneumoniae is typically through respiratory droplets. It can spread from person to person through close contact with respiratory secretions from infected individuals, such as coughing or sneezing.
C) The data supporting this decision include the patient's symptoms of productive cough with thick yellow sputum, fever, and chest pain, which are consistent with pneumonia. The crackles and dullness to percussion on the lung exam indicate consolidation and infection in the right lower lobe, further supporting the diagnosis.
D) A diagnostic test that should be performed is a chest X-ray to confirm the presence of infiltrates or consolidation in the lungs, which is characteristic of pneumonia. Additionally, a sputum culture can be obtained to identify the specific pathogen causing the infection.
E) The treatment plan for this patient with suspected community-acquired pneumonia would typically involve empirical antibiotic therapy. In this case, a suitable choice would be a respiratory fluoroquinolone or a combination of a beta-lactam antibiotic plus a macrolide.
However, the patient's history of smoking and working as a landscaper may increase the risk of resistant pathogens. Therefore, a broader-spectrum antibiotic such as levofloxacin or moxifloxacin may be considered.
Treatment duration is typically 7-10 days, and close monitoring of symptoms and response to therapy is essential. Additionally, smoking cessation counseling should be provided to the patient.
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