USMLE Forum Archives - USMLE Step 2 CK - IM 15
IM 15
TheOne - 11-26-06 18:49
A previously healthy 26-year-old man comes to the physician complaining of a cough with sputum production for the past 4 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 135/75, pulse is 80/min, and respirations are 17/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
TheOne - 11-26-06 18:49
A previously healthy 26-year-old man comes to the physician complaining of a cough with sputum production for the past 4 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 135/75, pulse is 80/min, and respirations are 17/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
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#5
Re: IM 15
TheOne - 12-03-06 16:26 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 acute bronchitis in an elderly patient with chronic disease. A macrolide is the treatment of choice.
#6
Re: IM 15 Brainlab - 12-13-06 11:59 A chest x-ray film (choice B) has no role in the diagnosis of acute bronchitis in a healthy patient.
If the patient has bronchitis he is already not healthy ;-)
#8
Re: IM 15 babbu5508 - 07-08-10 01:21 B. Perform a chest x-ray film...to rule out a respiratory tract pathology...and treat appropriately...correct me if i'm wrong......
#9
Re: IM 15 bingousmle - 07-09-10 01:39 the patient is stable and all his vitals are WNL as well as the physical exam does not show any signssuggestive of infectious pathology i would put him on a trial of PPI..
#10
Re: IM 15 babbu5508 - 07-09-10 03:51 ofcourse that could definitely be a thought but since it is not given in the options we should think about other alternatives...........
#11
Re: IM 15 bingousmle - 07-09-10 04:02 yeah in that case i will want to give him a course of antibiotics since he has complaints of cough and sputum production and see if he improves
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