Question 2 of 36

A 35-year-old woman who is generally healthy complains of fever and cough with sputum production. Vital signs: heart rate 115/min; respiratory rate 24/min; blood pressure 126/88 mm Hg; pulse oximetry, 97% on room air. You initially hear wheezing, but she improves with nebulized albuterol. Chest x-ray shows a right lower lobe infiltrate with effusion. The most appropriate next step is to:

Obtain decubitus films and begin intravenous ceftriaxone for possible empyema.

Obtain CBC and sputum and blood cultures and begin intravenous ceftriaxone and intravenous azithromycin.

Obtain urgent echocardiography to determine ejection fraction and evidence of pericardial effusion.

Begin oral azithromycin and discharge home.

Begin oral penicillin VK and discharge home.

Criteria for hospital admission in healthy young patients include respiratory distress, hypoxemia, and dehydration as evidenced by BUN > 25. The treatment of choice is an oral macrolide.

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