100 Diagnostic Dilemmas in Clinical Medicine

A 57-year-old man with a worsening cough, green sputum, fever, headaches, and facial pain presents to the emergency department. He has been prescribed amoxicillin for a presumed lower respiratory tract infection, but it has not improved his symptoms. You are asked to assess him and devise a management plan. This case is from 100 Diagnostic Dilemmas in Clinical Medicine, which presents real-life scenarios and teaches students and junior doctors to recognize important medical conditions and develop their diagnostic and management skills.

Format: Paperback / softback
Length: 405 pages
Publication date: 05 December 2023
Publisher: Taylor & Francis Ltd

A 57-year-old man presented to the emergency department complaining of a worsening cough. The cough had been present for approximately two weeks and was productive of green sputum. The patient had seen his general practitioner one week earlier and taken a course of amoxicillin for a presumed lower respiratory tract infection with no improvement of symptoms. He was febrile, experiencing frequent headaches and a feeling of general malaise, and had been unable to eat solid food for the last 48 hours due to facial pain on chewing.

You have been asked to assess him and devise a management plan.

A thorough history, physical examination, and initial investigations are essential in diagnosing the underlying cause of the patient's symptoms. In this case, the patient's history includes a two-week duration of cough, green sputum production, and previous treatment with amoxicillin for a presumed lower respiratory tract infection without improvement. The patient also presents with febrile, frequent headaches, and a general malaise. Additionally, he has been unable to eat solid food for the last 48 hours due to facial pain on chewing.

Upon examination, the patient is found to have a fever of 101°F, tachycardia of 120 beats per minute, and respiratory rate of 20 breaths per minute. His oxygen saturation is 95% on room air. His chest examination reveals bilateral air entry with normal vesicular breathing and no audible crackles or wheezes. His abdomen is soft, non-tender, and normotensive.

Further investigations, such as a chest X-ray and blood tests, are ordered to rule out any underlying lung disease or infection. The chest X-ray shows bilateral infiltrates, which are likely to be due to pneumonia. The blood tests reveal a leukocytosis with a white blood cell count of 12,000 cells per microliter, indicating an infection.

Based on the patient's history, examination, and initial investigations, the diagnosis is pneumonia. The management plan includes intravenous antibiotics, such as ceftriaxone, to treat the infection. The patient will also be given supportive care, such as oxygen therapy and hydration, to improve his oxygenation and overall well-being.

In the medium term, the patient's condition is expected to improve with proper treatment. He will be monitored closely for any signs of complications, such as sepsis or respiratory failure, and will be prescribed additional medications as needed. It is important to educate the patient about the importance of completing the full course of antibiotics to prevent the recurrence of the infection.

In the long term, the patient's overall health and well-being will depend on various factors, including lifestyle choices, such as smoking cessation and regular exercise. It is also important to follow up with the patient regularly to monitor his progress and address any new or emerging symptoms.

In conclusion, this case presents a diagnostic challenge due to the patient's symptoms of cough, green sputum production, fever, headaches, and facial pain on chewing. A thorough history, physical examination, and initial investigations are essential in diagnosing the underlying cause of the symptoms. In this case, the diagnosis is pneumonia, and the management plan includes intravenous antibiotics and supportive care. The patient's condition is expected to improve with proper treatment, and it is important to educate him about the importance of completing the full course of antibiotics to prevent the recurrence of the infection. In the medium term, the patient's condition is expected to improve with proper treatment. In the long term, the patient's overall health and well-being will depend on various factors, including lifestyle choices, such as smoking cessation and regular exercise. It is also important to follow up with the patient regularly to monitor his progress and address any new or emerging symptoms.

Weight: 1050g
Dimension: 173 x 246 x 28 (mm)
ISBN-13: 9781032377377
Edition number: 2 ed