Cough/shortness of breath Flashcards Preview

Step 2 CS - Minicases > Cough/shortness of breath > Flashcards

Flashcards in Cough/shortness of breath Deck (12):
1

Key history in cough/shortness of breath

Acute/subacute vs. chronic
Progression
Timing
Presence and description of sputum
Hemoptysis
Other symptoms (constitutional, URI, dyspnea, wheezing, chest pain, heartburn)
Exacerbating and alleviating factors
Exposures
Smoking history
History of lung disease, heart failure
Medications (e.g. ACEis)

2

Key physical exam in cough/shortness of breath

Vitals with pulse oximetry
HEENT exam
Heart, lungs, lymph nodes
Extremities (clubbing, cyanosis, edema)

3

30 yo M with SOB, cough, wheezing worse in cold air
+ several such episodes over last four months

Asthma
GERD
Bronchitis

CBC, CXR, peak flow measurement, PFTs, methacholine challenge

4

56 yo F with SOB, productive cough lasting at least three months each year over the last two years
+ heavy smoker

COPD - chronic bronchitis
Bronchiectasis
Lung cancer

Sputum Gram stain and culture, PFTs, CBC, CXR, CT - chest

5

58 yo M with one week of pleuritic chest pain, fever, chills, cough with purulent yellow sputum
+ heavy smoker with COPD

Pneumonia
COPD exacerbation (bronchitis)
Lung abscess

CBC, CXR, Sputum Gram stain and culture, CT - chest, PPD, ECG

6

25 yo F with two weeks of nonproductive cough
+ sore throat and runny nose three weeks ago

Atypical pneumonia
Reactive airway disease
URI-associated cough ("post-infectious")
Postnasal drip

CBC, induced sputum Gram stain and culture, CXR, IgM detection for Mycoplasma pneumoniae, urine Legionella antigen

7

65 yo M with worsening cough over past six months
+ hemoptysis
+ dyspnea
+ weakness
+ weight loss
+ heavy smoker

Lung cancer
Tuberculosis
COPD

CBC, CXR, CT - chest, PPD, PFTs, sputum Gram stain, culture and cytology, bronchoscopy, echocardiography

8

55 yo M with increased dyspnea and sputum production over last 3 days
+ COPD and stopped using inhalers last week
+ stopped smoking two days ago

COPD exacerbation (bronchitis)
Lung cancer
Pneumonia
URI

CBC, CXR, ABG, PFTs, sputum Gram stain and culture, CT - chest, echocardiography

9

34 yo F with worsening cough over last six weeks
+ weight loss, night sweats and fever
+ Hx of contact with tuberculosis patients at work

Tuberculosis
Pneumonia
Lung abscess
Lymphoma

CBC, PPD/QuantiFERON Gold, sputum Gram stain, acid-fast stain and culture, CXR, CT - chest, bronchoscopy, HIV antibody, lymph node biopsy

10

35 yo M with SOB and cough
+ unprotected sex with multiple partners
+ recently exposed to patient with active tuberculosis

Tuberculosis
Pneumonia (including Pneumocystis jiroveci)
Bronchitis
Acute retroviral syndrome
Asthma

CBC, PPD/QuantiFERON Gold, sputum Gram stain, acid-fast stain, silver stain and culture, CXR, CT - chest, HIV antibody, echocardiography

11

50 yo M with cough exacerbated by lying down at night
+ improved by propping head up on three pillows
+ exertional dyspnea

Congestive heart failure
Cardiac valvular disease
GERD
COPD
Postnasal drip

CBC, CXR, echocardiography, ECG, PFTs, BNP, CT - chest

12

60 yo M with worsening dyspnea over last six hours and cough with pink, frothy sputum

Pulmonary edema
Congestive heart failure
Mitral valve stenosis
Arrhythmia

ECG, CXR, CBC, ABG, BNP, PFTs