Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
IMG
A healthy 27-year-old man has a cough with sputum production for 2 days. The cough has been keeping him up at night and it is affecting his job performance. He has no history of respiratory disease. His temperature is
37 C (98.6 F), blood pressure is 130/80, pulse is 70/min, and respirations are 18/min. Physical examination is normal. Which of the following is the most appropriate next step in management?
A. Admit to the hospital for medical management
B. Perform a chest x-ray film
C. Perform a sputum culture
D. Send home with antibiotic therapy
E. Send home with no therapy
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Sunny
I think it is a A. bronchitis- mostly viral so
E. Send home with no therapy
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
TAC
I think B. It is worth doing a chest X ray because Mycoplasma's pneumonia is very common in this age group and can present in an atypical way, with no or mild fever, and just cough. If the X tay shows no infiltrates, then I would assume it is bronchitis and treat accordingly. Bronchitis can be treated with antibiotics if it is bothering the patient.
But I would surely do a chest X ray first.
My 2 cents. :o)
TAC
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
talli
i would go with the answer as being "B" also.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
river
I think this is from UW, I know the ans.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
abrar
I think E.
We have to think viral first with the presentation and if symptoms still persist then do a chest X-ray.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
TAC
The cough is keeping him up at night and affecting his job performance... Sending th guy home with no workup or treatment surely wouldnt help him sleep or work. That is why I think we should do an x ray. if we find a treatable cause for his cough (like atypical pneumonia), we could give him antibiotics (probably a macrolide) and help the poor guy sleep and work. LOL
A X ray is not expensive and totally reasonable approach for this patient.
Just my opinion anyways. That is what I would do if I had this patient in front of me. :o)
TAC
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
aditi
how abt sending the patient home on antibiotics?Agreed that mycoplasma pneumoniae is the most common cause and it would respond to erythromycin..if after a trial of antibiotics patient doesnt improve then may be go in for CXR
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
Sunny
TAC your approach could be OK in practice, but I think for board exam as the Q says- normal Phycsical, normal temp, and short duration of history( 2 days) all goes in favor of viral bronchitis- so we should send home at present if it persists beyod 5 dya or so get x-ray.
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
TAC
I still think it would be kinda mean to let the guy cough and wake up at night for 5 days before we do something to help him.. LOL But Sunny your explanation is reasonable, it may be right. I would still mark B in the exam anyways. I may be wrong but that´s what I would do. :o)
TAC
