Cough/Shortness of Breath Flashcards
What key history would you obtain from a patient with a complaint of cough or shortness of breath?
Acute vs. chronic Presence/description of sputum Associated symptoms (URI, postnasal drip, dyspnea, wheezing, chest pain, heartburn) Exacerbating and alleviating factors Exposures, travel history Smoking history History of lung disease Allergies Medicines (ex. ACE inhibitors)
What key physical exam would you perform on a patient who has a complain of cough or shortness of breath?
Vital signs Pulse oximetry Exam of nasal mucosa Oropharynx Heart exam Lung exam Lymph noes Extremities (clubbin, cyanosis, edema)
30 yo M presents with shortness of breath, cough, and wheezing that worsen in cold air. He has had several such episodes over the past four months. Differentials?
Asthma (cold-induced) GERD Bronchitis Pneumonitis Foreign body
30 yo M presents with shortness of breath, cough, and wheezing that worsen in cold air. He has had several such episodes over the past four months. Differentials: asthma, GERD, bronchitis, pneumonitis, foreign body. Work up?
CBC CXR Peak flow measurement PFT's Methacholine challenge test
56 yo F presents with shortness of breath as well as productive cough that has occurred over the past two years for at least three months each year. She is a heavy smoker. Differentials?
COPD - chronic bronchitis
Bronchiectasis
Lung cancer
Tuberculosis
56 yo F presents with shortness of breath as well as productive cough that has occurred over the past two years for at least three months each year. She is a heavy smoker. Differentials: COPD (chronic bronchitis), bronchiectasis, lung cancer, tuberculosis. Workup?
CBC Sputum gram stain and culture CXR PFTs CT - chest PPD
58 yo M presents with pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD. Differentials?
Pneumonia Bronchitis Lung abscess Lung cancer Tuberculosis Pericarditis
58 yo M presents with pleuritic chest pain, fever, chills, and cough with purulent yellow sputum. He is a heavy smoker with COPD. Differentials: pneumonia, bronchitis, lung abscess, lung cancer, tuberculosis, pericarditis. Workup?
CBC Sputum Gram stain and culture CXR CT - chest ECG PPD
25 yo F presents with two weeks of a nonproductive cough. Three weeks ago she had a sore throat and runny nose. Differentials?
Atypical pneumonia Reactive airway disease URI-associated (post-infectious) Postnasal drip GERD
25 yo F presents with two weeks of a nonproductive cough. Three weeks ago she had a sore throat and runny nose. Differentials: atypical pneumonia, reactive airway disease, URI-associated, postnasal drip, GERD. Workup?
CBC Induced sputum Gram stain and culture CXR IgM detection for Mycoplasma pneumoniae Urine Legionella antigen
65 yo M presents with worsening cough over the past six months together with hemoptysis, dyspnea, weakness and weight loss. He is a heavy smoker. Differentials?
Lung cancer Tuberculosis Lung abscess COPD Vasculitis (i.e. Wegeners) Interstitial lung disease CHF
65 yo M presents with worsening cough over the past six months together with hemoptysis, dyspnea, weakness and weight loss. He is a heavy smoker. Differentials: lung cancer, tuberculosis, lung abscess, COPD, Vasculitis (i.e. Wegener’s), interstitial lung disease, CHF. Workup?
CBC Sputum gram stain, culture and cytology CXR CT- chest PPD Bronchoscopy
55 yo M presents with increased dyspnea and sputum production over the past three days. He has COPD and stopped using his inhalers last week. He also stopped smoking two days ago. Differentials?
COPD exacerbation (bronchitis) Lung cancer Pneumonia URI CHF
55 yo M presents with increased dyspnea and sputum production over the past three days. He has COPD and stopped using his inhalers last week. He also stopped smoking two days ago. Differentials: COPD exacerbation (bronchitis), lung cancer, pneumonia, URI, CHF. Workup?
CBC CXR PFTs Sputum gram stain and culture CT - chest
34 yo F nurse presents with worsening cough of six weeks duration together with weight loss, fatigue, night sweats and fever. She has a history of contact with tuberculosis patients at work. Differentials?
Tuberculosis Pneumonia Lung abscess Vasculitis Lymphoma Metastatic cancer HIV/AIDS
