cough and congestion pearls

Question 1

ck/ pneumonia of any cause/

fever why?

Answer 1

=>maybe; virus or bact in the lungs=> get to blood=> systemic => (can get really bad)sx= fever/

=>bronchitis; stays locally => no fever

Question 2

pneumonia/

PE+CXR tips

Answer 2

PE:

=>beginning of the pneumonia /

u he_{ar i}t be_fore ^{u ca}n s^{ee it} on CXR/

=>end of the pneumonia /

No PE sx but u mi_{ght sti}ll se_{e infil}trate in the CXR

hint: there is alw a delay bet the sound and the pix; first sound and then pic, sound gone, pix still there

Question 3

cough + congestion/

+high fever (> 38°C) suggest…

Answer 3

pn_eumonⁱa!!!

Question 4

cough + congestion/

Influenza +++ likely to occur in which months

Answer 4

December to May in the northern hemisphere/

Question 5

cough + congestion/

Elderly patients w pneumonia/

fever present?

Answer 5

NO fe^ver.

obta_{in a C}XR in

elde^{rly pa}tients or

in pts _{w CO}PD w coug_{h o}r w men_{tal sta}tus cha^nges

Question 6

cough + congestion/

A normal lung exam=> no pneumonia?

Answer 6

n_{l lu}ng exa_{m do}es n^{ot ru}le o_{ut p}ne_umonia!!!!

Hint: u hear it before you see it

Question 7

cough + congestion/pneumonia/

best CXR orientation?

Answer 7

Pos_teroanter^ior+later_{al c}hest fil^{m vie}ws

Question 8

cough + congestion/

CAP prefers the … lobes

while TB+aspiration pneumonia prefer the… lobes

Answer 8

C_{AP l}ow^{er lo}bes; /

T_{B o}r as^pirati_{on pne}umon_{ia = u}pp_{er lo}be (TB is aerobic)

Question 9

cough + congestion/

patients w respiratory distress/
what test is required?/

what EZ test should be discounted?

Answer 9

=>requred: A^BG PaCO₂/

=>n_ormal SaO₂ on puls^{e ox}imetry does no^{t exc}lude hyp_ercarbia+res_pirator^{y fai}lure

Question 10

cough + congestion/

acute bronchitis. + Purulent sputum/

Abx order?

Answer 10

Pur_{ulent spu}tum is NOT an indicat^{ion for} ant_ibiotic thera_{py i}n pati^{ents w} acut^{e bro}nchitis/

Discoloration:

can co^{me fro}m trach^eobronch_{ial ep}ithelium cells+WBCs+

is no^{t dia}gnostic o^{f bac}ter^{ial infe}ction

Question 11

cough + congestion/

pneumonia is suspected/

no crackles= no pneumonia

Answer 11

up to 25–50% of patients ^{w pn}eumo_{nia = no c}rackles ^{on au}scultation./

Chest fil_{m is} requir^{ed whe}n pneumon^{ia is s}uspected.

Question 12

cough + congestion/

pneumonia FU/

test to do

Answer 12

FU CX_{R is} indicat^{ed in p}atients _{w pn}eumon^{ia to} exclu_{de an} unde^rlying obstruc^{ting ma}ss.

Question 13

cough + congestion/

subacute onset+ diffuse bilateral CXR/

suspects..

Answer 13

P^CP/

oft_{en the} presenti^{ng man}ifestati^{on o}f AIDS.

Question 14

cough + congestion/

dyspneic patients w HIV+ low CD4 counts/ suspect

Answer 14

P^CP/

even when the che_{st e}xam+che^{st rad}iograph a^{re n}ormal

Question 15

cough + congestion/

Patients w a_ctive or la^tent TB/ test for…

hint: latent= usual sx are not yet manifested

Answer 15

H_IV!!!

Question 16

cough + congestion/

pulmonaryTB/ ++ common complaints

Answer 16

prima_{rily o}f wei^{ght lo}ss or nig_{ht sw}eats+hav^{e a} norm^{al lu}ng ^exam. /

F_ever+hem^optysis may be absent.

Pulmonary TB still needs to be considered in such patients.

Question 17

*cough + congestion/

TB/ CXR/ consider TB

Answer 17

a_pical;

c_avitary^{; o}r

ret_iculo_nodula^{r p}atterns on CXR

Question 18

cough + congestion/

A negative PPD/ rule out TB?

Answer 18

NO!!!

Question 19

cough + congestion/

H_ig^{h fe}ver w/in 12–24 hours of sx onset/ typical of

Answer 19

i_nfluen^za

Question 20

cough + congestion/

w influenza+shortness of breath/ test to do ?

Answer 20

CXR to rule out i_nflue^nza pn^eumon^ia.

Question 21

cough + congestion/

patients w pr_oductiv^{e co}ughs/

pertussis likely??

Answer 21

NO!!!