PCM Case II

Question 1

A 58 year old male arrives at the emergency dept. complaining of dyspnea fever and cough.

What symptom is most concerning?

Answer 1

Fever

Question 2

A 58 year old male arrives at the emergency dept. complaining of dyspnea fever and cough.

Symptoms began 8 days ago, with additional myalgia, headache and sore throat. Given the symptom complex and the presence of an influenza outbreak in the community his PCP diagnosed influenza and prescribed antiviral.

After initial improvement, his symptoms worsened.

Alcoholic cardiomyopathy four years

45 pack years

1L of gin per week

tax attorney

divorced

What are some likely DDX?

Answer 2

1. pneumonia
2. COPD
3. Lung Cancer

Question 3

At what O2% should you really start paying attention?

Answer 3

In colorado -under 90%. Lower altitudes - below 95%

Question 4

Why does a COPD patient develop a barrel chest?

Answer 4

The alveioli deteriorate, and to compensate the lungs hyperinflate, the ribs spread apart in front increasing the AP diameter

Question 5

Increased tactile fremitus equals?

Answer 5

Increased consolidation in the lung space

Question 6

How would you describe normal breath sounds?

Answer 6

Vesicular - leaves rustling

Question 7

What do harsh lung sounds mean?

Answer 7

You are not hearing the alveoli, you are hearing the bronchiols conducting air.

Question 8

What is a left shift in a CBC?

Answer 8

Indicative of an increased number of immature forms.

Question 9

What are the three most likely organisms behind pnuemonia?

Answer 9

1. Streptococcus pneumonia
2. H. Influenza
3. S. Aureus

Question 10

How do you determine wether or not to hospitalize a pnuemonia patient?

Answer 10

Use the PORT scoring criteria

Question 11

What do you do with a risk class I pneumonia patient?

Answer 11

May be sent home on oral antibiotics