Hotobhaga
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46) A healthy 27-year-old man has a cough with sputum production for 2 days. The cough has been keeping him up at night and it is affecting his job performance. He has no 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 normal. 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
Explanation:
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 2 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 acute bronchitis in an elderly patient with chronic disease. A macrolide is the treatment of choice.
Send home with no THERAPY/??… the guy is in distress!!!!
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| ssrpk
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its true that n therapy is required because most of the cases are indeed viral, but atleast chest X-ray is required, even kaplan notes says that....you can ony diagnose acute bronchitis with normal chest x-rays
answer should be B
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| Hotobhaga
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i found a lot of these discrepancies on the Kaplan Q-Bank that i have. I now have doubts on whether it is genuine. What do you all say?
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USMLE preparation is all about discovery. Discovery of your own capabilities....Julia Perch MD (iprep)
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| young_doc
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I think for the test (and also in real life) you should do a CXR first to r/o pneumonia.
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| prasannakumar
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if he presents with fever, CXR is the best next step
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