bax
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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
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| dr.wad
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B
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| kpmle2
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B. Perform a chest x-ray film
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| Ivonne
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Will go with x-ray
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| neurom
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B
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| bax
Forum Senior
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a/c to uw ans sh'd be B....i also ticked B
but
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.
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| Ivonne
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Good one
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| hero
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i wonder would somebody really do this - pt with complains on cough affecting his sleep and dayly activity - sent home with no treatment.
E might be correct if you know microbiology (probably only microbiology  ), and have that nerve to say that everything ok without Dx and Tx, but..
at least send him home with follow up in a few days or something
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| mildus
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I agree with hero
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