Four days after undergoing an open cholecystectomy, a 76-yea…
Four days after undergoing an open cholecystectomy, a 76-year-old man is evaluated for confusion and fever. He has hypertension, type 2 diabetes mellitus, and chronic obstructive pulmonary disease. He smoked 1 pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, and ipratropium. He appears acutely ill and lethargic. Vitals: Temp 103.1*F, pulse 108/min, respirations 22/min, blood pressure 110/84 mmHg. He is oriented to person but not to place and time. Examination demonstrates a 10-cm subcostal incision that appears dry, clean and mildly erythematous; there is no tenderness to palpation of the lower abdomen and there is no guarding or rebound. Pulmonary examination shows scattered wheezing throughout both lung fields and no crackles. The remainder of the physical examination shows no abnormalities. A urinary catheter is in place and urine output is normal. Which of the following is likely to establish the diagnosis?
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