You are working in the ED at Harborview Medical Center. You areseeing a 52-year-old male patient who reports cough, fever,sweating, pleuritic chest pain and general malaise. Yourexamination reveals a fever of 102F, respiration rate 24bpm,rhonchi and decreased breath sounds, tachycardia with pulse of116bpm, a tender one-inch mass on his right chest wall near hisshoulder and right eye injection with reported pain and normalvision.
Your history indicates that he returned from Hawaii yesterday wherehe participated in the Ironman competition. He was seen in the EDin Kona, Hawaii two days earlier for similar symptoms thatinitiated 12 hours prior to that visit. He had an appendectomy andshoulder surgery in the past and reports episodic rashes over thepast few months. He is married with adult children and works at theFred Hutchinson Cancer Research Center in a molecular geneticslaboratory with no patient care responsibilities. List twoquestions that you would ask the patient. For each, note yourrationale (i.e. note why you think that question will help youdiagnose this patients disease).
