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Approach to a Patient with Productive Cough and Fever

Approach to a Patient with Productive Cough and Fever. B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon , Gaspar, Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo Geronimo , Go, Go, Go, Go, Go, Go December 7, 2009. Objectives.

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Approach to a Patient with Productive Cough and Fever

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  1. Approach to a Patient with Productive Cough and Fever B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon, Gaspar, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo Geronimo, Go, Go, Go, Go, Go, Go December 7, 2009

  2. Objectives • To present a case of a patient with productive cough and fever • To account for the pathogenesis of the signs and symptoms • To provide laboratory and ancillary procedures appropriate for a patient with productive cough and fever • To formulate an effective management plan for a patient with productive cough and fever

  3. General Data • Name: RM • Age: 60 • Sex: Male • Status: Married • Address: Quiapo, Manila • Religion: Roman Catholic • Race: Filipino • Occupation: Vendor

  4. History of Present Illness • CC: Productive Cough

  5. Past Medical History • HPN (2005) - Highest BP 200/160; Usual BP – 120/80 • Nifedipine, - unrecalled dosage; “Amcor” from a Chinese store • Non-compliant • LVH (2005) • “ Food poisoning” (unrecalled cause) – UST Hospital (2005) • External Hemorrhoids (2005) - resolved • Claims to have complete childhood immunizations • No history of surgery • (-) DM • (-) Bronchial asthma • (-) PTB • (-) Blood transfusion • (-) Allergies • (-) Trauma/ accident

  6. Family History • (+) HPN – parents and siblings • (+) Heart disease – parents and siblings • (+) DM - sister • (-) Cancer • (-) Allergy • (-) Asthma • (-) PTB • (-) Thyroid diseases

  7. Personal/Social History • Drinks a lot of soft drinks (approximately 1L/ meal) • (+) Smoking - 25 years (1969-1994); 2 pack/year) • Occasional alcohol drinker • Mixed diet, preference to salty foods • Used to work for customs as a “checker” for 2O years and retired in 2009 • Currently sells candles in Quiapo church with his wife. • Married with 8 kids • Currently lives with his 20-year old son in a small apartment located in Abad Santos - no ventilation and sunlight coming in • Joined a marathon as his form of exercise

  8. Review of Systems • (-) anorexia, (+) weight loss (2 inches in waistline in the past month) • (-) itchiness • (-) headache, (-) blurring of vision • (+) dizziness • (-) colds • (-) chest pain, (-) palpitations • (-) abdominal pain • (-) vomiting, (-) diarrhea, (-) constipation • (-) dysuria, (-) hematuria, (-)flank pain

  9. Review of Systems • (-) bleeding, (-) easy bruisability • (-) dysuria, (+) paroxysmal nocturia every 2 hours, 4 times a night for the past 2-3 months, (+) polydipsia (1.5 L a night) • (-) heat / cold intolerance • (-) muscle pain • (-) edema

  10. Physical Examination

  11. Physical Examination

  12. Physical Examination

  13. Physical Examination

  14. Salient Subjective Features

  15. Salient Objective Features

  16. Acute Cough with Fever

  17. Differential Diagnosis • Weight loss (+) • Productive cough • Fever • Dyspnea • Unremarkable lung findings • AFB not performed • Fever • Cough • Dyspnea • (-) colds • Septum midline • (-) nasoaural discharge • (-) palpable cervical lymphadenopathy

  18. Differential Diagnosis • (-) Immunocompromised • (-) Extrapulmonary manifestations

  19. Clinical Impression • Community-Acquired Pneumonia CRB-65 Group 2, PSI (?) • Tuberculosis suspect • Hypertensive Cardiovascular Disease • Left Ventricular Hypertrophy, NYHA Functional Class I Stage B • DM suspect

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