100 Diagnostic Dilemmas in Clinical Medicine

A 57-year-old man with a worsening cough, febrile, 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: Hardback
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 fever, frequent headaches, and a general feeling of malaise. Additionally, he has been unable to eat solid food for the last 48 hours due to facial pain on chewing.

Based on the patient's presentation, several possible diagnoses can be considered. These include pneumonia, bronchiectasis, chronic obstructive pulmonary disease (COPD), and tuberculosis (TB). Pneumonia is a common respiratory infection that can cause fever, cough, and chest pain. Bronchiectasis is a chronic condition characterized by abnormal expansion of the airways, leading to recurrent infections and inflammation. COPD is a chronic respiratory disease that includes emphysema and chronic bronchitis, and is often associated with smoking. TB is a bacterial infection that can affect the lungs and other organs, and is particularly common in individuals with weakened immune systems.

To determine the most appropriate management plan, further diagnostic tests may be necessary. These may include chest X-rays, sputum culture, and blood tests to rule out other respiratory infections, assess lung function, and detect the presence of TB. In addition, a CT scan or bronchoscopy may be necessary to visualize the lungs and assess the extent of any underlying abnormalities.

Once the diagnosis is confirmed, the management plan can be tailored to the specific condition. In the case of pneumonia, antibiotics such as amoxicillin or cephalosporins may be prescribed to treat the infection. Additional supportive care may include rest, hydration, and over-the-counter pain relievers to alleviate symptoms. Bronchiectasis may require medications to reduce inflammation, such as bronchodilators, and regular follow-up with a respiratory specialist to manage symptoms and prevent complications. COPD may require medications to improve lung function, such as bronchodilators and inhaled corticosteroids, as well as lifestyle modifications such as quitting smoking and regular exercise. TB may require a combination of antibiotics, such as isoniazid, rifampin, and pyrazinamide, and supportive care to manage symptoms and prevent the spread of the infection.

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 these symptoms. Further diagnostic tests may be necessary to confirm the diagnosis and determine the most appropriate management plan. Treatment for each condition may vary depending on the severity of the symptoms and the underlying cause, and may include antibiotics, bronchodilators, corticosteroids, and lifestyle modifications.

Dimension: 246 x 174 (mm)
ISBN-13: 9781032382333
Edition number: 2 ed