Fever, Infection, Lung

Question 1

18 month old presenting with fever. 1. What questions important things to ask? 2. DDx? 3. Test?

Answer 1

1. OLDCARTSRash and describe Rash, Sick Contacts, Daycare, Day care sick contacts, Irritable, Eating, Sleeping, Last check and immunizations, Normal height, weight and development. 2. Otitis Media, Meningitis, Scarlet fever, 5th disease, Varicella. 3. Pneumatic Otoscopy, Tympanometry, CSF, Platelets, PT/PTT, D-dimer, Fibrinogen, CBC with diff, UA, Urine Culture, Blood Culture, Parovius B 19 IgM antibody, Skin lesion scrapings to test for Varicella, Varicella Antibody Titer

Question 2

26 yo with cough. 1. What questions to ask? 2. What to ask when he states he drinks a lot and has sex a lot? 3. DDx? 4. Test?

Answer 2

1. OLDCARTS, Previous symtoms before uncontrollable cough, Fevers, Chills, Night sweats, Weight loss, Smoking, Last PPD, pet animal, Recent Travel, Exposure to TB. 2. CAGE questions and Condom use then counsel. 3. URI, Acute Bronchitis, Pneumonia, Pleurodynia, Aspiration 4. CBC with diff, Sputum culture and gram stain, Urine Legionella, Serum Mycoplasma PCR, Cold agglutinin - r/o Atypical PNA, Bronchoscopy with BAL, Pulse Ox or ABG- to determine need for hospitlization, HIV Antibody.

Question 3

54 yo female complains of persistent cough + sputum production. 1. What questions to ask? 2. DDx? 3. Test?

Answer 3

1. OLDCARTS, Changes of cough during day?, Progression of the cough during the past month?, Cough at night?, Sputum production (Amount, Color, Consistency, Blood?), Sick previously?, Exposure to TB?, Last PPD 2. Pulmonary TB, Lung cancer, Atypical PNA, Typical PNA, COPD exacerbation, Granulomatosis with Polyangiotis. 3. PPD, CBC with diff, Sputum Culture, AFB stain x 3, Blood Cultures, CXR, CT-Chest, c-ANCA, Bronchoscopy, Lung Biopsy.

Question 4

25 yo male comes to ED following MVC and has trouble breathing and clenches chest when breaths in. 1. What questions to ask? 2. DDx? 3. Test?

Answer 4

1. OLDCARTS, Cough, Sputum, Fevers/Chills, Other injuries, Head Truama, Discharge ears/nose/mouth, Convulsions, HA, Change in vision, LOC, Confusion/memory loss, change in personality, NWT, Heart, GI, Pain or blood with urination, Last meal/drink able to keep down, under the influence. 2. Pnemothorax, Hemothorax, Pneumonia, Rib Fracture, Splenic Fracture, Pleuritis. 3. CXR, XR/CT-abdomen, Pulse Ox, Urine Tox, BAC, Sputum and blood Gram stain and culture.

Question 5

Mother calls complaining 2 yo has noisy breathing. 1. What questions to ask? 2. DDx? 3. Test?

Answer 5

1. OLCARTS, Description of breathing, Description of sound, Consistency, Heard on inhalation or expiration, Can identify anything that caused it/Eating/playing with toys, Fever, Chills, N/V Barking cough, Production, Blood in sputum, crying, active, hoarseness, snoring at night, positional, Vaccinations/immunizations, last check up, Eating, Sleeping, Birth hx, Weight/Height/Lang development. 2. Foreign body aspiration, Croup, Laryngitis, Epiglottis, Retropharyngeal abcess, Angioedema, Peritonsilar abscess, Laryngeal papilloma. 3. ABG, CXR- PA and Lateral, XR-neck, AP and lateral, CBC with diff, Direct laryngoscopy, Bronchoscopy.

Question 6

32 yo male comes to office for premployement medical checkup as requested by prospective employer. 1. What questions to ask? 2.DDx? 3. Test?

Answer 6

1. Medical Complaints or problems, Heart, Pulmonary, Swelling in legs, GI, Neuro, TB exposure, Recent travel 2. Pulmonary TB, COPD/Chronic Bronchitis, Pulmonary silicosis, Asthma, GERD 3. CBC, CXR- PA and lateral, AFB stain and culture X3, Suptum cytology, PPD test.