Minicase - Cough/SOB Flashcards Preview

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Flashcards in Minicase - Cough/SOB Deck (12)
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1

Cough/SOB Hx components

OPQRST
- acute v chronic
- worsening
- sputum
- blood
- associated symptoms (post-nasal drip, heartburn, chest pain, etc)
- environmental factors, allergies
- previous episodes
- hx lung disease, HF
- posttussive emesis
- medications

2

Cough SOB exam (7)

1. pulse ox
2. nasal mucosa
3. oropharynx
4. heart
5. lungs
6. lymph nodes
7. extremities (clubbing, cyanosis, edema)

3

Main ddx for Cough/SOB (9)

1. asthma
2. COPD- chronic bronchitis
3. PNA
4. atypical PNA
5. lung cancer
6. COPD exacerbation (bronchitis)
7. TB
8. CHF
9. Pulmonary edema
(Other: GERD, postnasal drip, URI, GPA)

4

W/u for asthma (4) - SOB, cough, wheezing that worsen with cold air, multiple past episodes

1. CBC
2. CXR
3. Peak flow measurements
4. PFTs

5

W/u for COPD (chronic bronchitis) (6) - SOB and productive cough that lasted for at least 3mo each year over past 2 years, hx of smoking

1. CBC
2. Sputum gram stain/culture
3. CXR
4. PFTs
5. CT chest
6. quantiferon TB-gold

6

W/u for PNA (6) - 1 wk pleuritic CP, fever, hills, cough with purulent yellow sputum, hx of smoking and COPD

1. CBC
2. sputum gram stain and culture
3. CXR
4. CT chest
5. EKG
6. quantiferon TB-gold

7

W/u for atypical PNA (5) - young pt w/ 2 wks nonproductive cough and prior hx of URI

1. CBC
2. induced sputum gram stain and culture
3. CXR
4. IgM detection for mycoplasma penumoniae
5. Urine Legionella Ag

8

W/u for lung cancer (9) - 6 months worsening cough, hemoptysis, dyspnea, weakness and wt loss with smoking hx

1. CBC
2. sputum gram stain, culture, and cytology
3. CXR
4. CT chet
5. quantiferon-TB gold
6. ANCA (GPA)
7. bronchoscopy
9. ECHO (CHF)

9

W/u for COPD exacerbation (7) - increased dyspnea and sputum production for past 3 days after stopping inhalers last week w/ hx of COPD

1. CBC
2. CXR (PNA, lung cancer, URI rule-out)
3. ABG
4. PFTs
5. sputum gram stain and culture
6. CT chest
7. ECHO (CHF)
(8. respiratory viral panel PCR)

10

W/u for TB (8) - cough, wt loss, fatigue, night sweats, fever, exposure history

1. CBC
2. PPD/Quantiferon-TB Gold
3. Sputum Grain stain, acid fast stain and culture
4, CXR (PNA, lung abscess)
5. CT chest
6. bronchoscopy
7. HIV antibody
8. Lymph node biopsy (sarcoidosis, metastatic cancer, lymphoma)

11

W/u for CHF (7) - cough exacerbated by lying down at night and improved by sitting up, exertional dyspnea

1. CBC
2. CXR (CHF, COPD)
3. EKG
4. ECHO (CHF, cardiac valvular disease)
5. PFTs
6. BNP
7. CT chest
(ddx includes GERD - PPI trial, postnasal drip)

12

W/u for pulmonary edema (6) - worsening dyspnea of 6 hours duration and a cough that is accompanied by pink, frothy sputum

1. CXR (PNA_
2. EKG (CHF, arrythmia)
3. CBC (PNA)
4. ABG
5. PFTs
6. BNP (CHF)