Machiavelli
Forum Senior
Topics: 49
Posts: 65
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Do you have any idea why are they so sure that it is Ac. bronchitis without r/o aypical pneumonia (with cxr) ?
A previously healthy 27-year-old man comes to the physician complaining of a cough with sputum production for the past 3 days. The cough has been keeping him up at night and it is affecting his job performance. He has no prior 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 unremarkable. 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
The correct answer is E. This patient most likely has acute bronchitis. Acute bronchitis in a healthy patient with no other medical conditions is often due to a viral infection that is usually self-limited. Given that this patient has only had 3 days of symptoms, an antibiotic is not necessary and is inappropriate. If the symptoms persist for longer than 1 week, a macrolide antibiotic may be given. A chest x-ray film and a sputum culture are not indicated.
Admission to the hospital for medical management (choice A) is inappropriate for a healthy patient with acute bronchitis.
A chest x-ray film (choice B) has no role in the diagnosis of acute bronchitis in a healthy patient.
A sputum culture (choice C) is used to identify organisms, but should only be used in elderly patients with chronic disease that fail antibiotic therapy.
Sending the patient home with antibiotic therapy (choice D) is appropriate management for Ac Bronchitis in an elderly man with chronic disease.
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| drvic
Forum Elite
Topics: 10
Posts: 181
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cough with sputum of only 3 days' duration in a previously healthy young man with normal vitals and temperature and physical exam findings - viral infection is definitely the first possibility. atypical pneumonia has a more indolent onset and presents with longer duration of symptoms. unnecessarily treating with macrolides will be overtreatment with such a short history.
what is not mentioned is whether the patient is a smoker or not. this could be a pointer towards acute bronchitis.
next issue is that of getting a chest x-ray done? well, for every stable patient with short duration symptoms getting a chest x-ray done is not only uneconomical but also gives unnecessary radiation exposure. the yield of cxr in this scenario is likely to be very very low.
unless the patient is toxic looking, has tachypnoea, significant fever or chest signs, or has some underlying chronic pathology i would not get a chest x-ray done.
however there is the issue of cough keeping him up at night and affecting his job performance - that needs some looking into. but there's nothing like that in the options presented.
maybe others have some bright ideas? :idea:
regards
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| ELM
Forum Guru
Topics: 28
Posts: 936
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E is a perfectly legitimate answer for this q with the given information about the patient. Explanations for the options are enough to understand the diffirences of practices in diffirent stages of acute respiratory condition like this one, ABronchitis.
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ELM
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