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Approach to a P atient w ith C ough

Approach to a P atient w ith C ough. B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon , Gaspar, Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo Geronimo , Go, Go, Go, Go, Go, Go December 4, 2009. Objectives. Case Presentation of a Patient with Cough

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Approach to a P atient w ith C ough

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  1. Approach to aPatient with Cough B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon, Gaspar, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo Geronimo, Go, Go, Go, Go, Go, Go December 4, 2009

  2. Objectives • Case Presentation of a Patient with Cough • Management of patient with Community-Acquired Pneumonia

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

  4. History of Present Illness • CC: Productive Cough

  5. Past Medical History • HTN (2005) - Highest BP 200/160; Usual BP – 120/80 • Nifedipine, Metoprolol, and Aspirin - unrecalled dosage • Non-complaint (?) • LVH, possible MI (2005) • “ Food poisoning” – UST Hospital (2005) • External Hemorrhoids (2005) • Claims to have complete immunizations • No history of surgery • (-) DM • (-) Bronchial asthma • (-) PTB • (-) Blood transfusion • (-) Allergies • (-) Trauma/ accident

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

  7. Personal/Social History • Drinks a lot of soft drinks (each meals) • (+) Smoking pack/year • Occasional alcohol drinker amt • 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 • Joined a marathon as his form of exercise

  8. Review of Systems • (-) anorexia, (+) weight loss (8kg loss in a 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 • (-) polyuria, (-) polydipsia, (-) polyphagia • (-) heat / cold intolerance • (-) muscle pain • (-) edema • (+) asterixis

  10. Physical Examination

  11. Physical Examination

  12. Physical Examination

  13. Physical Examination

  14. Salient Subjective Features

  15. Salient Objective Features

  16. Etiology of Cough

  17. Differential Diagnosis • (-) orthopnea, PND • JVP 3cm at 30 angle • AB at 6th LICS AAL • S3 at apex • (-) hepatojugularreflux • (-) edema • Dyspnea • 8 cm liver span MCL • Weight loss • Dyspnea, • (-) chest pain • (-) syncope • (-) tachycardia • (-) cyanosis • (-) hypotension • Fever • Cough • Dyspnea • (-) colds • Septum midline • (-) nasoaural discharge • (-) palpable cervical lymphadenopathy

  18. Clinical Impression • Community-Acquired Pneumonia

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