usmle CS FA minicase7
Terms
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COUGH/SHORTNESS OF BREATH
Key History -
Key History
Acute vs. chronic; presence/description of sputum, associated symptoms (constitutional, URI, postnasal
drip, dyspnea, wheezing, chest pain, heartburn, other), exacerbating and alleviating factors; exposures;
smoking history; history of lung disease; allergies; medicines (especially ACE inhibitors). -
COUGH/SHORTNESS OF BREATH
Key Physical Exam -
Key Physical Exam
Vital signs ± pulse oximetry; exam of nasal mucosa, oropharynx, heart, lungs, lymph nodes, and extremities
(clubbing, cyanosis, edema). -
30 yo M presents with shortness of
breath, cough, and wheezing that worsen
in cold air. He has had several such
episodes over the past four months. -
Asthma
GERD
Bronchitis
Pneumonitis
Foreign body
W/O:
CBC
CXR
Peak flow measurement
PFTs
Methacholine challenge test -
56 yo F presents with shortness of breath,
as well as productive cough that has
occurred over the past two years for at
least three months each year. She is a
heavy smoker. -
D/D:
COPD—chronic bronchitis
Bronchiectasis
Lung cancer
Tuberculosis
CBC
W/O:
Sputum Gram stain and culture
CXR
PFTs
CT—chest
Purified protein derivative
(PPD) -
58 yo M presents with pleuritic chest
pain, fever, chills, and cough with
purulent yellow sputum. He is a heavy
smoker with COPD. -
D/D:
Pneumonia
Bronchitis
Lung abscess
Lung cancer
Tuberculosis
Pericarditis
W/O:
CBC
Sputum Gram stain and culture
CXR
CT—chest
ECG
PPD -
25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose. -
D/D:
Atypical pneumonia
Reactive airway disease
URI-associated
(“postinfectiousâ€)
Postnasal drip
GERD
W/O:
CBC
Induced sputum Gram stain
and culture
CXR
IgM detection for Mycoplasma
pneumoniae
Urine Legionella antigen -
65 yo M presents with worsening cough
over the past six months together with
hemoptysis, dyspnea, weakness, and
weight loss. He is a heavy smoker. -
D/D:
Lung cancer
Tuberculosis
Lung abscess
COPD
Vasculitis (i.e., Wegener’s)
Interstitial lung disease
CHF
w/o:
CBC
Sputum Gram stain, culture,
and cytology
CXR
CT—chest
PPD
Bronchoscopy -
55 yo M presents with increased dyspnea
and sputum production over the past
three days. He has COPD and stopped
using his inhalers last week. He also
stopped smoking two days ago. -
d/d:
COPD exacerbation
(bronchitis)
Lung cancer
Pneumonia
URI
CHF
W/O:
CBC
CXR
PFTs
Sputum Gram stain and culture
CT—chest -
34 yo F nurse presents with worsening
cough of six weeks’ duration together
with weight loss, fatigue, night sweats,
and fever. She has a history of contact
with tuberculosis patients at work. -
D/D:
Tuberculosis
Pneumonia
Lung abscess
Vasculitis
Lymphoma
Metastatic cancer
HIV/AIDS
W/O:
CBC
PPD
Sputum Gram stain, acid-fast
stain, and culture
CXR
CT—chest
Bronchoscopy
HIV antibody -
35 yo M presents with shortness of breath
and cough. He has had unprotected sex
with multiple sexual partners and was
recently exposed to a patient with active
tuberculosis. -
D/D:
Tuberculosis
Pneumonia (including PCP)
Bronchitis
CHF (cardiomyopathy)
Asthma
W/O:
CBC
PPD
Sputum Gram stain, acid-fast
stain, silver stain, and culture
CXR
HIV antibody -
50 yo M presents with cough that is
exacerbated by lying down at night and
improved by propping up on three
pillows. He also reports exertional
dyspnea. -
D/D:
CHF
Cardiac valvular disease
GERD
Pulmonary fibrosis
COPD
Postnasal drip
W/O:
CBC
CXR
ECG
Echocardiography
PFTs
BNP