Correct!
5. All of the above

There appears to be diffuse consolidation on portable chest x-ray. This was confirmed by thoracic CT scanning (Figure 4).

Figure 4. Movie of representative images from the thoracic CT scan showing diffuse consolidation and small bilateral pleural effusions.

At this juncture, the cause of the clinical deterioration and diffuse consolidation is not apparent. Pneumonia is certainly a possibility. Despite a negative sputum Gram stain and culture she was begun on empiric broad-spectrum antibiotic coverage. Coccidiomycosis is so common in Arizona that fluconazole was also empirically added. She had received considerable crystalloid and colloid for her gastrointestinal bleeding raising a concern of pulmonary edema from fluid overload.

Which of the following are appropriate at this time?

1. Repeat sputum Gram stain and culture
2. Change the empiric antibiotic coverage
3. Insert a pulmonary artery catheter
4. Bronchoscopy with bronchoalveolar lavage
5. All of the above

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