Case 20 - 26 yo M with cough

Question 1

Gathering information

Answer 1

CC
Onset
Preceding symptoms
Fever, chills, sweats
Sputum production and description
Hemoptysis
CP, SOB, wheezing
Exacerbating and alleviating factors
Location of chest pain, radiation of pain and severity
Exposure to TB, pets/animals
Last PPD
Weight loss
N/V/D/C
PMHx
PSHx
FHx
Social Hx (occupation, tobacco, alcohol and drug use, diet, exercise, and sexual activity and use of condoms)
Sick contacts
Travel Hx
Health maintenance (including vaccinations)
Current medications
Drug allergies

Question 2

Physical examination

Answer 2

Head and neck exam (examined mouth for thrush, throat, lymph nodes)
CV exam
Pulmonary exam (auscultation for rhonchi, rales, wheezing, diminished breath sounds, palpation, percussion, fremitus)
Extremities (cyanosis and edema)

Question 3

Closure

Answer 3

Antibiotics can help if the infection is bacterial, but not viral. We will determine whether antibiotics may be appropriate or not.
Safe sex practices (using condoms to prevent HIV transmission and unwanted pregnancies)
HIV testing (and discussed consent)
Do you have any questions for me?

Question 4

Differential diagnosis

Answer 4

PNA (increased tactile fremitus, decreased BS, low-grade fever)
URI-associated (post-infectious) cough
Acute bronchitis (white sputum, increased tactile fremiuts)

Question 5

Diagnostic work-up

Answer 5

CXR
CBC with differential
Sputum Gram stain and culture
Urine Legionella antigen, serum Mycoplasma PCR, cold agglutinin measurement
Bronchoscopy with bronchoalveolar lavage
Pulse oximetry or ABG
HIV antibody testing

Question 6

Remember to offer the patient a tissue or cup of water when they have a coughing fit!

Answer 6

Remember to offer the patient a tissue or cup of water when they have a coughing fit!