A 44-year-old male staying in a homeless shelter is alert and complaining of shortness of breath. He has a two-week history of cough with hemoptysis, fever, chills, and night sweats. Physical examination reveals skin to be warm and moist and lung sounds decreased in the right upper lobe with rhonchi. HR = 100, BP = 142/100, RR = 20, SaO₂ = 95%. You should assume this patient has a high likelihood of having:

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The patient's history and physical exam findings are indicative of tuberculosis, including cough with hemoptysis, fever, chills, night sweats, decreased lung sounds in a specific lobe, and rhonchi. The patient's age and being in a homeless shelter also increase the likelihood of tuberculosis. Hantavirus pulmonary syndrome typically presents with fever, muscle aches, and shortness of breath without cough, and RSV typically affects infants and young children. Pneumonia is a possible diagnosis, but the specific findings in this patient make tuberculosis more likely.

A 44-Year-Old Male Staying in a Homeless Shelter Is Alert