He feels a bit short of breath and also complains of malaise. Question 3: What other treatment does he need? Case 4ĥ5-year-old male comes to your office complaining of severe left-sided chest pain, fever, rigors, and cough productive of rusty colored sputum. Question 2: What significant comorbidity does this patient have? Question 1: What is this patient’s diagnosis? What are typical pathogens? Maxillary sinuses are tender to palpation bilaterally and poorly transilluminate. There is purulent discharge in both nares. The nasal mucosa is boggy, pale and edematous. On physical examination, his conjunctivae are bilaterally injected. He has a slight cough and some postnasal drip as well. His mother notes that he snores while asleep at night. He admits to being fatigued, but denies fevers. He has tried using OTC Sudafed without benefit. Question 4: What kind of counseling does he need? Case 3ġ8-year-old male presents complaining of 2 weeks of severe nasal stuffiness, bilateral facial pain and fatigue. Question 3: What treatment would you recommend? Lung examination reveals diffuse rhonchi and wheezes throughout both lung fields. On examination he is in no respiratory distress. He notes he had a similar illness about 6 months ago. He admits to smoking 1 ½ pack per day since age 18, although he has not smoked at all in the last 3 days. He has had some chills, but has not taken his temperature at home. He notes he has become increasingly dyspneic and short of breath. ![]() Symptoms initially started with nasal congestion and rhinorrhea, but those resolved after the first 7 days. Question 3: What can be done to manage her symptoms? Case 2Ī 37-year-old male complains of a 4-week history of cough productive of greenish sputum. Question 2: What workup (if any) needs to be done? Question 1: Does this patient need antibiotics? The tympanic membranes are clear posterior pharynx is mildly erythematous. ![]() There is a small amount of whitish discharge inside the left naris. On physical exam, the nasal mucosa is swollen and erythematous. She denies myalgias, shortness of breath, and ear pain, but does admit to mild headache. She notes that she had a sore throat the first 2 days, but that has now resolved. Case 1Ī 43-year-old female presents to your office with a 5 day history of low grade fever of 100.1 F, nasal discharge initially clear, but now turning yellow in color, nasal congestion and a minimally productive cough. Note: This is the required text for the FM Preceptorship. Philadelphia, PA: Lippincott, Williams and Wilkins, 2002, 259 – 276. ![]() Acute Respiratory Infections (Chapter 17), In: Sloan PD, Slatt LM, Ebell MH, Jacques LB, eds.
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