Cough and dyspnoea

Chapter 24 Cough and dyspnoea



Case 24.1


A 25-year-old woman presents with rhinorrhoea, a sore throat, runny eyes and a dry cough. She has no other symptoms. On examination, there is erythema of the oropharynx and discharge from her nose.




Questions



1. What is the most likely cause of this patient’s symptoms?

2. Name other disorders which may present with this type of symptomatology.

3. What is the relationship between the colour of the nasal discharge and the aetiological agent?


Case 24.2


A 53-year-old male presents with a fever, malaise, headaches, and a cough with green sputum. The symptoms commenced 3 days ago. He has had a recurrent cough for years, productive of white sputum. Relevant examination findings are: temperature 38.8°C, pulse 100/minute, blood pressure 130/85 mm Hg, some dullness to percussion and decreased vesicular breath sounds at both lung bases, plus bilateral basal crackles.




Questions



1. What is the most likely cause of this patient’s current presentation?

2. What is his underlying chronic condition?

3. Name some of the possible predisposing factors which can make an individual more susceptible to this disease.


Case 24.3


A 57-year-old male presents with a cough, productive of a yellow-green sputum, plus dyspnoea. He has a very long history of a persistent cough, usually accompanied by white sputum. He is a heavy smoker. On examination, there are no abnormalities except some scattered expiratory wheezes.




Questions



1. What is the most likely underlying, chronic condition?

2. What is the most likely cause of this patient’s current presentation?

3. Can you determine from this information the most likely aetiological agent for his problem?

4. In a patient with no underlying lung disease would this disorder generally cause dyspnoea?


Case 24.4


A 26-year-old female presents with a gradual onset of dyspnoea, which has developed over approximately the last 3 months. She states that it is not severe, but it concerns her as she is usually very fit and healthy. She also states that she feels very tired, and has occasional palpitations. There are no other symptoms. She is a non-smoker, drinks alcohol only occasionally and has a balanced diet. She is on no medications.




Questions



1. With no other information, what is your differential diagnosis?

On examination, her pulse rate is 98, with a high volume. Blood pressure is 125/70. She is afebrile. The only other physical abnormality detected is pallor of her conjunctiva.


2. Based on this additional information, can you now narrow your diagnosis?

3. What do you need to do now?


Case 24.5



History


John is a 61-year-old male who presents with a noticeable alteration in his usual cough. He has a 25-year history of a chronic cough, usually productive of white sputum. He has been a heavy smoker since the age of 20. He describes the change in his cough in terms of duration (now lasting all day rather than mornings only), intensity (deeper), and altered sputum colour (now yellow–green). He also complains of mild dyspnoea, something quite new to him. These changes have been occurring over the last week. In the last few hours, he has noticed some sharp, left-sided chest pain, which is worse on inspiration and when he coughs. He had a similar experience about a year ago, but there was no chest pain, and minimal dyspnoea.



Questions



1. What is the most likely cause of John’s 25-year history of cough and sputum?

2. What extra questions do you need to ask John?

3. What is your differential diagnosis for his current presentation? Why?

4. What do you need to examine in this patient?


Physical examination




































Vitals •Pulse rate/min 98
•Respiratory rate/min 22, shallow
•Blood pressure mm Hg 140/90
•BMI 28
•Temperature (degrees C) 39.2
HEENT Unremarkable
Neck Carotid pulse strong, no bruits
Chest
• Decrease in movement on left side

• Dullness to percussion at left base

• Decrease in vesicular breath sounds at left base

• Presence of bronchial breath sounds at left base

• Increased vocal fremitus and resonance at left base

• No cardiomegaly

• No murmurs
Abdomen Soft, non-tender, no organomegaly or masses
Limbs All pulses L = R = 2+; no evidence of digital clubbing


Questions



5. What information can you obtain from these findings? Can you narrow your differential diagnosis?

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Cough and dyspnoea

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