A 26 Year Old Man With Fever, Cough And Breathlessness for 1 Week

MCPS Family Medicine (Sample Question)

A 26 year old gentle man presents with fever, cough and breathlessness for 1 week. He has no known co morbids. On examination temp is 39 C and respiratory rate is 23/min. Chest examination reveals crepitations in the right mid zone.

1. What further points would you like to explore in history?
2. What investigations should be ordered in this patient?
3. Write 5 points in the management plan?

Question Solved:




1. What further points would you like to explore in history?

Answer: The following questions are to be asked in the history:

• The pattern and grade of fever.
• Is the fever associated with chills
• Is the cough productive in nature (if yes then ask..)
• the amount, frequency and appearance of sputum
• is there any blood in the sputum
• Any associated chest pain ( pleuritic chest pain)
• Is the patient taking any medicines 
• History of smoking
• History of recent travel or exposure to sick contacts

 2. What investigations should be ordered in this patient?

Answer: Investigation to be ordered in a patient with a suspected case of pneumonia include:

• Chest X Ray PA View (expected to show opacity in the right mid zone).
• Complete blood count (increased WBC count and increased neutrophils indicate and acute infection)
• Sputum for Culture and sensitivity ( helps in identifying the organism and the choice of antibiotic).

3. Write 5 points in the management plan?

Answer:

Management Plan:

1. Get plenty of rest.

2. Stay hydrated and drink lots of fluids. 

3. Simple analgesic and antipyretic like acetaminophen (1000 mg up to 4 times daily) is given for relief of pain and fever. 

4. Give oral antibiotic Amoxicillin 500 mg 3 times daily for 7 days.

5. Followup with culture reports and if needed antibiotics can be changed according to sensitivity results. Rule out any complications of pneumonia during the followup visit.