Persistent Cough after URI! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-01-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106
Lungs Persistent Cough after URI!

A 42-year-old man has a 15-day history of a cough that was initially associated with rhinorrhea, nasal congestion, and a sore throat. All symptoms have resolved except the cough, which is productive of purulent sputum. The patient has not had fever, malaise, dyspnea, pleuritic chest pain, myalgia, paroxysms of coughing, or posttussive vomiting. Medical history is unremarkable, and he takes no medications. On physical examination, vital signs, including temperature, are normal. There is no pharyngeal erythema or exudate and no lymphadenopathy. The lungs are clear to auscultation. Which of the following is the best initial management?

A Albuterol inhaler
B Azithromycin
C Chest radiograph
D Nasopharyngeal swab for influenza virus culture
E Symptomatic treatment
Reply With Quote Quick reply to this message
The above post was thanked by:
step1an (06-04-2012)



  #2  
Old 06-01-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

Quote:
Originally Posted by Novobiocin View Post
A 42-year-old man has a 15-day history of a cough that was initially associated with rhinorrhea, nasal congestion, and a sore throat. All symptoms have resolved except the cough, which is productive of purulent sputum. The patient has not had fever, malaise, dyspnea, pleuritic chest pain, myalgia, paroxysms of coughing, or posttussive vomiting. Medical history is unremarkable, and he takes no medications. On physical examination, vital signs, including temperature, are normal. There is no pharyngeal erythema or exudate and no lymphadenopathy. The lungs are clear to auscultation. Which of the following is the best initial management?

A Albuterol inhaler
B Azithromycin
C Chest radiograph
D Nasopharyngeal swab for influenza virus culture
E Symptomatic treatment
E.........
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #3  
Old 06-02-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106
Default

Whether a cough is due to acute bronchitis or an upper respiratory tract infection is difficult to determine during the first few days. However, a cough caused by bronchial infection typically persists for 10 to 20 days. Since this patient has been coughing for 15 days, he most likely has acute bronchitis. Approximately 50% of patients with acute bronchitis have purulent sputum, but this is not a reliable predictor of bacterial infection.

Treatment of acute bronchitis is usually symptomatic. There is no evidence to support the use of most over-the-counter and prescription antitussive medications. However, some studies have shown that NSAIDs, with or without an antihistamine, decrease cough severity. A trial of ibuprofen may be reasonable for this patient, provided there are no contraindications.

Albuterol in a metered-dose inhaler may help to decrease cough severity and duration in adults with acute bronchitis when there is evidence of wheezing. However, β-agonist inhalers have not been shown to be helpful in the absence of wheezing and, therefore, probably would not benefit this patient.

Most studies fail to show that antibiotic administration significantly improves outcomes in patients with acute bronchitis, including symptom resolution and early return to work. In patients with an acute exacerbation of chronic obstructive pulmonary disease, antibiotic therapy is most likely to be helpful in those with at least two of the following: increased sputum purulence (change in sputum color), increased sputum volume, or increased dyspnea. Antibiotics are appropriate for patients with pertussis in order to decrease disease transmission, although these agents have a limited effect on symptoms. Pertussis should be suspected when a community outbreak has been reported. Symptoms may include coughing paroxysms and posttussive vomiting, but are not reliable indicators of infection.

A chest radiograph is not indicated in a patient with acute bronchitis who does not have signs or symptoms of pneumonia, such as fever, dyspnea, and pleuritic chest pain. Cough that persists for more than 3 weeks is atypical for acute bronchitis, and a chest radiograph is generally indicated as the initial diagnostic test. Influenza virus culture is not needed in a patient without fever, myalgia, or malaise because the probability of influenza virus infection would be very low.
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (06-02-2012), step_enhancer (06-29-2012), step1an (06-04-2012)



Reply

Tags
Infectious-Diseases, Internal-Medicine-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Different Types of Cough! chienpolska USMLE Step 1 Buzzwords 2 04-06-2012 09:56 AM
cough with expectoration ricko335 USMLE Step 1 Forum 3 08-19-2011 06:58 AM
persistent urethritis earthpole USMLE Step 1 Forum 4 06-28-2011 02:22 PM
Fever and Cough Sarah-cali USMLE Step 1 Forum 7 03-07-2010 05:01 PM
Heart Failure + Cough Farazdaq USMLE Step 2 CK Forum 3 03-02-2010 06:49 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)