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183016 Medicine

A 40-year-old man without a significant medical history comes to the emergency room with a 3-day history of fever and shaking chills, and a 15-minute episode of rigor. He also reports a cough productive of yellow-green sputum, anorexia, and the development of right-sided pleuritic chest pain. Shortness of breath has been present for the past 12 hours. Chest x-ray reveals a consolidated right middle lobe infiltrate, and CBC shows an elevated neutrophil count with many band forms present. Which feature would most strongly support inpatient admission and IV antibiotic treatment for this patient?

ARecent exposure to a family member with influenza
BRespiratory rate of 36/min
CRecent sexual exposure to an HIV-positive patient
DPurulent sputum with gram-positive diplococci on Gram stain
Medicine
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