Question

Pulmonology Consultation Report Reason for Consultation: Evaluation of increasingly severe asthma.

History of Present Illness: Patient is a 10-year-old male who first presented to the Emergency Dept. with dyspnea, coughing, and wheezing at 7 years of age. Paroxysmal attacks are increasing in frequency and there do not appear to be any precipitating factors such as exercise. No other family members are asthmatics.

Results of Physical Exam: Patient is currently in the ED with a paroxysmal attack with a marked dyspnea, cyanosis around the lips, prolonged expiration and a hacking cough producing thick, nonpurulent phlegm. Thoracic auscultation with a stethoscope revealed rhonchi throughout bilateral lung fields. Chest x-ray shows poor pulmonary expansion, with hypoxemia revealed by ABG. A STAT pulmonary function test reveals moderately severe airway obstruction during expiration. This patient responded to oxygen therapy, bronchodilators and IV steroids, and he is beginning to cough less and breath with less effort.

Assessment: Acute asthma attack with severe airway obstruction. There is no evidence of pulmonary infection. In view of increasing severity and frequency of attacks all his medications should be reevaluated for effectiveness and all attempts to identify precipitating factors should be made.

Recommendations: Patient is to continue to use Albuterol for relief of bronchospasms and steroids to reduce general inflammation. Instructions for taking medications and controlling severity of asthma attacks were carefully reviewed with the patient and his family. A referral to an allergist was made to evaluate this young man for presence of environmental allergies.

1. What important information regarding this young man’s asthma is unknown to the physician? What does this consulting physician recommend to address this problem?

2. Describe the characteristics related to this patient’s cough in your own words

3. Which of the following is not one of the symptoms seen in the Emergency Dept?

a. crackling lung sounds

b. bluish skin

c. difficulty breathing

d. extended breathing out time

Answer 1

1) The consulting physician is unknown about the presences or absences of environmental allergies to the young man asthma cause and so the consulting ohysicians has referred the patient to the allergist, 2)Characteristics related to this patients cough:t he patient is having a sudden recuurrent of difficult in breating and bluish discoloration aroud the lips and hanking cough and having thick nonpurulent phelgm and wheezing are also recorded etc, 3) the symptoms seen in the emergency department are dyspnea, coughing, wheezing , cyanosis around lips, prolonged expiration and hacking cough sounds but not the crackling lung sounds(it is the snapping sounds when airway opens and it is intermittent or discontinous )