Question

NURS-60506: Comprehensive Study

A 78 year old male presents to your office with c/o 1 week of "cold" symptoms with cough. 2 days ago he noticed bloody sputum. He tried taking an OTC cough medication with little effect. This morning he noticed some CP when he exerted himself that lasted for about 30 seconds. He has had similar pains in the past. He admits to having bloody stool with diarrhea as well for the past month but thought it would go away on its own. He has no abdominal pain, N/V, dizziness, or HA. No recent travel. He has been visiting his wife regularly in the Nursing Home 2-3x/week.

Physical exam findings are as follows:

VS-BP—90/54, P-130 irregular, Temp-101.2 F , Resp—32

Neck: Mildly elevated JVD

Lungs: Expiratory wheezing bilaterally

CV: Irregular, S1 and S2 with a III/VI systolic ejection murmur

Abdomen: Tender to LLQ, BS +X4, soft, non-distended

Ext: Trace pedal edema, +2PPP bilaterally

Skin: Pale, cool, clammy

Guaiac positive

No recent labs

PMH: HTN, CAD w/CABG x 2 (5 years ago), COPD, Hyperlipidemia

PSH: Appendectomy in 1980

Meds: Lisinopril 10mg daily, Metoprolol 25mg BID, ASA 325mg daily, Simvastatin 80mg daily, Albuterol PRN, Spiriva 18mcg daily

Social: No alcohol or drug use. He is an ex-smoker for last 5 years, prior was a pack a day smoker x 50yrs

What are your differential diagnoses and why you choose each one? Please list at least 5 differentials. (10 points)

2. What lab and diagnostic tests would you order and why? (12 points)

3. What is your follow up going to include with this patient? (8 points)

Answer 1

Answer:

1. A. Acute bronchitis : It is the inflammation of bronchial tubes. One of the symptoms of acute bronchitis is blood in the sputum.

B. Lung cancer : Neoplasms of the lungs manifested with bloody sputum in smokers.

C. Pneumonia: Inflammation of lung air sac due to infection is called pneumonia. One of it classical symptom is coughing up sputum.

D. Tuberculosis: Bacterial infection of the lungs which is manifested with bloody sputum

E. Pulmonary edema: Bloody sputum also present in pulmonary edema.

2. * Differential counts and white blood cells count - white blood cells elevated in lung infections.

* D- dimmer - elevated in pulmonary embolism

* sputum cytology - To detect lung cancer

  * High resolution CT scan - To evaluate the cause of hemoptysis

* Fiberoptic bronchoscopy - To identify the site of bleeding

*Chest X ray - To identify chest infection

3. * Instruct the patient to avoid contact with other patients

* Instruct the patient to drink plenty of water

* Instruct the patient to avoid indoor pollutants

* Advice the patient to take medication as prescribed

. * Advice the patient to monitor the sputum for the presence of blood

* Instruct the patient to clean the respiratory equipments using at home

* Advice the patient to take adequate rest