Case presentation of acute cough

1. 2. Presentation/Theme:
Acute Cough
Prototype Case: Pneumonia

3. Rationale:
• Pneumonia is a serious clinical problem with associated high mortality
and morbidity. It can be potentially life threatening in the elderly and
in patients with other comorbid diseases. Its clinical spectrum ranges
from rapid resolution of symptoms to severe medical complications
and death.
• Pneumonia remains a leading cause of death from infectious
diseases.

4. Case: Pneumonia
• A 67-year-old man with a history of alcoholism presents with a 2-day
history of fevers, chills, rigors, shortness of breath, and a cough
productive of dark yellow sputum. He had a recent binge of alcohol
use that ended 2 days before admission, and he woke up with these
symptoms. On physical examination, his temperature is 39.5°C, his
respiratory rate is 30/min, and he is in moderate respiratory distress.
His lower right lung field has inspiratory crackles on auscultation.
Laboratory testing reveals a white blood cell count of 16,000/µL. A
chest radiograph shows focal consolidation in the right middle and
lower lobes.

5. Essentials of Diagnosis:
• Fever or hypothermia, tachypnea, cough with or without sputum,
dyspnoea, chest discomfort, sweats, or rigors (or both)
• Bronchial breath sounds or inspiratory crackles on chest auscultation
• Leucocytosis
• Purulent sputum
• Parenchymal opacity on chest radiograph

6. Symptoms and Signs:
• Acute or subacute onset of fever, cough with or without sputum,
and dyspnoea
• Rigors, sweats, chills, pleurisy, chest discomfort, and haemoptysis are
common
• Fatigue, anorexia, headache, myalgias, and abdominal pain can be
present
• Physical findings include — Fever or hypothermia — Tachypnea —
Tachycardia — Arterial oxygen desaturation
• Altered breath sounds are common

7. Laboratory Tests
• Sputum Gram stain and culture & sensitivity
• Urinary antigen assays for Legionella pneumophila and
Streptococcus pneumoniae
• All hospitalized patients should have the following tests
• — Complete blood count with differential
• — Chemistry panel (including serum glucose, electrolytes, urea
nitrogen, creatinine, bilirubin, and liver enzymes)
• — Arterial blood gases to assess severity of illness

8. Imaging Studies
• Chest radiograph can confirm the diagnosis and detect associated
lung diseases
• Findings range from patchy airspace opacities to lobar consolidation
with air bronchograms to diffuse alveolar or interstitial opacities
• Clearing of opacities can take 6 weeks or longer

9. LEARNING OBJECTIVES:
1. Explain how blood gases and pH influence Ventilation
2. Differentiate between acute and chronic pneumonias.
3. Interpret different patterns of pulmonary infiltrate and
consolidations types.
4. Choose the laboratory methods required in the process of
diagnosing pneumonias.
5. Distinguish community-acquired from hospital-acquired pneumonia
6. Understand the factors that predispose to pneumonia and the ways
to prevent the disease

10. 7. Identify drugs used in treatment of pneumonias.
8. Describe the mechanism of action of these antibiotics.
9. Describe the pharmacokinetics of these antibiotics
10. Describe the spectrum of action of these antibiotics.
11. Identify the adverse effects of these drugs

11. QUESTIONS:
1. What are the chemical and neural mechanism that control breathing?
2. What are the key features, including essentials of diagnosis and general
considerations, of pneumonia?
3. What are the symptoms and signs of pneumonia?
4. What is the differential diagnosis of pneumonia?
5. What are laboratory, imaging, and procedural findings in pneumonia?
6. What are the treatments of pneumonia?
7. When should patients with pneumonia be referred to a specialist or
admitted to the hospital?
8. What are the drugs used for lung infections ?