Case 36 - 32 yo M for pre-employment physical Flashcards
1
Q
Information gathering
A
Any health concerns? HAs, vision changes, hearing loss Seizures or LOC Difficulty swallowing CP, palpitations, slow heart rate SOB, wheezing, coughing Abdominal pain N/V/D/C Changes in stool color Fever, chills, sweats Weight or appetite changes Swelling in legs Pain in joints Numbness, tingling or weakness anywhere PMHx PSHx FHx Social Hx (occupation, tobacco, alcohol, drug use, diet, exercise, sexual activity) Health maintenance (immunizations, PPD/QuantiFERON Gold) Current medications Drug allergies
2
Q
If a patient has a cough, what should you ask them?
A
When did it start? How has it progressed? Do you have SOB or wheezing? Sputum production How much sputum, what color Hemoptysis Fevers, chills, sweats Does the cough change throughout the day? Do you cough at night Exposure to TB Last PPD/QuantiFERON Gold Recent travels
3
Q
Physical examination
A
Head and neck exam (mouth, throat, lymph nodes, JVD)
CV exam (auscultation)
Pulmonary exam (auscultation, palpation, percussion, fremitus)
Abdominal exam (auscultation, palpation)
Extremities (inspection)
Neurologic exam (CNS, motor exam, DTRs, gait)
4
Q
Closure
A
We need to R/O TB because of your time in Africa, not only because it is harmful for you, but it can also be transmitted to your coworkers
I urge you to quit smoking
Do you have any questions for me?
5
Q
Differential diagnosis
A
COPD (chronic cough with sputum production, smoking, worked as a coal miner)
Pneumoconiosis (worked as a coal miner, chronic cough)
Pulmonary TB (Africa, chronic cough)
6
Q
Diagnostic work-up
A
CXR - PA and lateral PPD/QuantiFERON Gold CBC Sputum culture, AFB smear, Gram stain PFTs
