Case 1: A 40-year old female smoker with a chest infection

Question 1

Mrs Audrey Cartwright, 40, is a sheltered housing warden,
and comes to see you with a cough which she has had for 2
weeks. You know she is a smoker, of 20/day for 20 years.
There is no record of recent smoking cessation advice being
given. It appears that she came in last winter with a cough.

What other questions do you want
to ask?

Answer 1

• Duration of the cough?
  • Is the cough productive, if so of what?
  • Any reduced exercise tolerance?
  • Any shortness of breath?
  • Has she experienced chest pain, on coughing or
  inspiration?
  • Any symptoms?

Question 2

She confi rms that she has had the cough for 2 weeks, it is
productive in nature, of green and yellow foul-tasting
sputum. She does not feel able run up the stairs as well as
she did. She says she begins coughing and then becomes
short of breath. She occasionally feels pain on coughing and
this is sharp in nature. It is in her back and this is not
associated with breathing in. She has not noticed any
blood in her sputum. She feels tired because the cough does
tend to wake her during the night. She had no symptoms
until 2 weeks previously and thinks of herself as generally fi t
and healthy.

What is your differential diagnosis?

Answer 2

• Lower respiratory tract infection (LRTI) – viral
• LRTI – bacterial
• Pneumonia
• Underlying lung disease