PLEASE ANSWER questions with information below ???

PLEASE ANSWER questions with information below ??? What is the CC in the case studies? What are important questions to ask the patients to formulate the history of present illness and what did the patients tell you? What components of the physical exams are important to review in the cases? What are pertinent positive and negative physical exam findings to help you formulate your diagnosis? Which differential diagnosis is to be considered with each case study? What was your final diagnosis? It is September and you are working with Dr. Erin Griffin in her outpatient general medicine clinic. She asks you to see Mr. Fadil Taleb, a 50-year-old male with respiratory symptoms. Dr. Griffin tells you he is relatively new to the practice and has been seen only once in the past for a general physical. In addition, she points out that when he initially called to schedule an appointment he was directed to get SARS-CoV-2 testing—this was negative. Internal Medicine 15: 50-year-old male with cough and nasal congestion HISTORY Note: This case was created prior to the COVID-19 pandemic. We acknowledge that the photos do not reflect current standards regarding the use of personal protective equipment (PPE). HISTORY It is September and you are working with Dr. Erin Griffin in her outpatient general medicine clinic. She asks you to see Mr. Fadil Taleb, a 50-year-old male with respiratory symptoms. Dr. Griffin tells you he is relatively new to the practice and has been seen only once in the past for a general physical. In addition, she points out that when he initially called to schedule an appointment he was directed to get SARS-CoV-2 testing—this was negative. “What brings you to the office today?” “I have been sick for the past three or four days. It started with my throat being scratchy and lots of sneezing. Now my nose is all stopped up, and I’m blowing it constantly. I’m also coughing a lot. Initially I was worried I could have COVID, but I’ve been vaccinated and I got a test a couple days ago—it was negative.” “Have you had a fever?” “I felt warm the first day but now I just have the chills occasionally. I am also really tired.” “Is anyone else you know ill?” “My kids were sick at the end of last week; we also had them tested for COVID and thankfully they were negative, too. One of them is still coughing but the others seem better. During the school year it seems like one of them picks up something at school almost every other week. I ride the bus to and from work, and there are always people coughing there.” “Do you smoke?” “Yeah, doc, I know it’s not good for my health, but I do smoke. Usually it’s about a half pack per day, but since I have been sick, I have been smoking only one or two cigarettes a day.” “Tell me more about your cough. Do you bring anything up?” “No, it’s a dry cough, but it wakes me up at night several times.” “Do you feel short of breath?” “No, not really.” “Does your chest hurt?” “No. Can’t say that it does.” “Have you tried any medicine to help?” “My face has felt full, so I took some Actifed Cold and Allergy tablets, but they didn’t seem to do much. I’ve also taken some Cold-EEZE, vitamin C, and Waltussin DM, but nothing is helping.” “Have you had problems like this before?” “I had this same thing last fall and it lasted a couple of weeks. I hate to bother you doctors with this, but I don’t want to get any worse.” You review Mr. Taleb’s chart and confirm the following: Past Medical History: Hyperlipidemia Medications: None except over-the-counter medications OTC Cold and Allergy medication (phenylephrine and chlorpheniramine) OTC cold preparation (zinc gluconate) Vitamin C OTC cough medication (guaifenesin and dextromethorphan) Allergies: None Family History: Mother: Alive and well. Father: High cholesterol, HTN. Three sisters: Alive and well. Social History: Married and monogamous. Works as a computer specialist for the help desk at the hospital. Three children ages 12, 15, and 18 years old. Has smoked half a pack per day for the past 25 years. Quit with each of his wife’s pregnancies, then resumed a year or so later. He rarely drinks alcohol and has never used IV drugs. Review of Systems: No headache, myalgias, hemoptysis, weight loss, or night sweats. Differential of Acute Respiratory Symptoms in Middle-Aged Male with Tobacco History (excluding COVID-19) Allergic rhinitis The cardinal symptoms include sneezing, watery rhinorrhea, and nasal congestion, often accompanied by cough, postnasal drip, and itching and tearing of the eyes. Some individuals also experience itching of the inner ear and palate and may clear their throat frequently. Allergic rhinitis can cause sleep-disordered breathing leading to generalized fatigue and malaise, but is not associated with fever, chills, or other signs of systemic illness. Symptoms may be seasonal or perennial depending on the allergens triggering the allergic response in an individual and generally last for weeks during exposure to the environmental allergens; thus, a short duration of symptoms would argue against this diagnosis. Causes of seasonal rhinitis include pollen from trees, grasses, and weeds. Common indoor allergens that cause perennial rhinitis include dust mites, cockroaches, mold spores, and animal dander. Acute bronchitis A self-limited inflammation of the large airways in the lung which is characterized by acute onset of cough. It leads to excessive tracheobronchial mucus production sufficient to cause purulent sputum in half of patients. Initial symptoms may be hard to distinguish from those of a URI. However, the cough of acute bronchitis persists for more than five days, typically lasting one to three weeks. Viruses account for the majority of cases with bacterial causes such as Bordetella pertussis, Mycoplasma pneumonia, and Chlamydia pneumoniae accounting for less than 6% of cases in a single series evaluating adults hospitalized with acute bronchitis. The viral induced inflammation may lead to a secondary bacterial infection. Viral upper respiratory infection Initial symptoms include rhinorrhea, nasal congestion, and dry, scratchy throat, with cough often developing later and persisting after the nasal and throat symptoms have resolved. Individuals may also experience low grade fever, sneezing, malaise, headache, sinus pressure, and ear discomfort. Associated with over 200 subtypes of viruses, but rhinoviruses are the most common cause Acute bacterial sinusitis Occurs when an initial viral nasopharyngeal infection converts to a secondary bacterial infection of the paranasal sinuses. Viral rhinosinusitis is diagnosed when symptoms or signs of acute rhinosinusitis (nasal congestion, facial pain/pressure, purulent nasal discharge) are present less than 10 days, and the symptoms are not worsening. Acute bacterial rhinosinusitis (ABRS) should be diagnosed when symptoms or signs of acute rhinosinusitis fail to improve within 10 days, or when symptoms or signs worsen in the first 10 days after an initial improvement (double worsening). Asthma Often presents with a chronic, nocturnal cough—or cough, dyspnea, and/or wheezing associated with exertion. Symptoms do not include rhinorrhea, sore throat, sneezing, and chills. These are suggestive of an infectious etiology rather than asthma. Bacterial pneumonia Characterized by persistent fever, cough with purulent sputum, dyspnea, and occasionally pleuritic chest pain. Exam often reveals focal lung findings and chest x-ray may demonstrate an opacity in one or more lobes. Influenza Characterized by upper and lower respiratory tract symptoms accompanied by systemic symptoms. High fever of 102 to 104 F and chills are very common along with severe myalgias and headache. Stuffy and runny nose can be present in influenza but are more characteristic of the common cold. Onset is so abrupt that patients can often identify the precise time their symptoms began. Outbreaks typically occur during winter months. Streptococcal pharyngitis Typically presents with abrupt onset of sore throat, painful swallowing, and fever. Tender anterior cervical adenopathy is common. Cough, nasal congestion, rhinorrhea, and coryza are not characteristic symptoms. Tuberculosis Chronic illness with weight loss, night sweats, and hemoptysis. Inquiry about travel to developing countries, exposure to TB, and HIV risk factors would be indicated if TB was a serious consideration. Infectious mononucleosis Characterized by sore throat, fatigue, and lymphadenopathy. Cough is not a typical feature. Pertussis (whooping cough) Had been uncommon in the U.S. due to near universal vaccination. However, in the past few years the incidence has increased and outbreaks in schools have occurred in many states. This is likely due to decreasing use of vaccination, waning immunity in those previously vaccinated, or just better testing and reporting. The Centers for Disease Control and Prevention (CDC) recommends that all adults receive a one-time booster, which is accomplished with a Tdap vaccine. Adolescents are also receiving an additional booster. Pertussis has three phases: Catarrhal: seven to ten days of symptoms indistinguishable from a URI, with rhinorrhea, malaise, low-grade fever, and mild cough Paroxysmal: one to six weeks of paroxysms of rapid coughing associated with a high-pitched whoop that is frequent and often worse at night; this whoop is not common in adults Convalescent: one to three weeks of lessening cough The catarrhal phase is unlikely without a known exposure. PHYSICAL EXAM You proceed with the physical examination and note the following: Vital signs: Temperature is 37.2 C (98.9 F) Pulse is 76 beats/minute Respiratory rate is 14 breaths/minute Blood pressure is 125/76 mmHg Weight is 91 kg (200 lbs) Height is 178 cm (70 in) Body mass index is 28.7 kg/m2 General: Well-developed, well nourished male. No acute distress. Eyes: Clear conjunctiva, no discharge, anicteric sclera. Ears: Canals are clear. TMs are clear. No redness or bulging. Nose: No maxillary or frontal sinus tenderness on palpation. No dullness on transillumination. Throat: Slightly reddened posterior pharynx but no exudates or tonsillar enlargement. There is no cobblestoning. Neck: No cervical or supraclavicular lymphadenopathy. Chest: Good excursion. No dullness to percussion. Rhonchi throughout all lung fields. There are no wheezes or crackles. CV: RRR normal S1 and S2. No murmurs, rubs, or gallops. Dr. Griffin joins you to review what you have covered with Mr. Taleb up to this point. She asks what you found on the nasal examination. You confess you didn’t look up his nose, but will now. You examine Mr. Taleb’s nose and find clear discharge with slight erythema of the nasal mucosa With some help from Dr. Griffin, you explain to Mr. Taleb that you believe he has a common cold. You go on to explain that colds are caused by viruses and not bacteria and that antibiotics treat bacterial infections only. You end by telling him that viral infections are self-limited, and treatment is supportive. You discuss how to prevent spreading the cold and inform Mr. Taleb when he can expect to feel better. You then ask if he has any questions. “Are you sure it is not the flu? Should I get a flu shot?” “Yes, I am sure it is not the flu. With the flu you would have a high fever that started all of a sudden, a lot of muscle aches, a headache, as well as a bad cough. And yes, you’re right, as a smoker you should receive a flu shot. We start administering it as soon as it is available; ideally you should have it before October 1st.” “My last doctor always gave me antibiotics. Are you sure I don’t need them?” “Yes. Antibiotics will not work for your viral infection and they can cause problems, such as diarrhea. Furthermore, using antibiotics unnecessarily can cause bacteria to become resistant to them, so the antibiotic won’t work when you do need it. There is a tiny chance you could develop bacterial sinusitis, but this happens less than 2% of the time. If you develop a toothache in your upper teeth, or a fever, you should give us a call.” SCIENCE HEALTH SCIENCE NURSING ADVANCED NURSING PRACTICE NSG6420

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