10-25-2008, 08:43 PM
68-year-old male is seen in the clinic for evaluation
of chronic cough that has lasted 4 months. He reports
that the cough is dry and occurs at any time of the
day. He denies hemoptysis or associated constitutional
symptoms. Further, there is no wheezing, acid reflux
symptoms, or postnasal drip. Past medical history is notable
for a well-compensated ischemic cardiomyopathy
that was diagnosed 6 months ago. His current medications
include aspirin, carvedilol, furosemide, ramipril,
amlodipine, and digoxin. He has no history of tobacco or
alcohol abuse and denies occupational exposure. Physical
examination shows a normal upper airway, clear lungs,
and a normal cardiac examination with the exception of
an enlarged point of maximal impulse. Plain radiography
of the chest is normal with the exception of cardiomegaly.
Which of the following is the most appropriate next step
in his management?
A. Bronchoscopy
B. Changing furosemide to bumetanide
C. Discontinuing digoxin
D. Changing ramipril to valsartan
E. Giving azithromycin for 5 days
of chronic cough that has lasted 4 months. He reports
that the cough is dry and occurs at any time of the
day. He denies hemoptysis or associated constitutional
symptoms. Further, there is no wheezing, acid reflux
symptoms, or postnasal drip. Past medical history is notable
for a well-compensated ischemic cardiomyopathy
that was diagnosed 6 months ago. His current medications
include aspirin, carvedilol, furosemide, ramipril,
amlodipine, and digoxin. He has no history of tobacco or
alcohol abuse and denies occupational exposure. Physical
examination shows a normal upper airway, clear lungs,
and a normal cardiac examination with the exception of
an enlarged point of maximal impulse. Plain radiography
of the chest is normal with the exception of cardiomegaly.
Which of the following is the most appropriate next step
in his management?
A. Bronchoscopy
B. Changing furosemide to bumetanide
C. Discontinuing digoxin
D. Changing ramipril to valsartan
E. Giving azithromycin for 5 days