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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify signs and symptoms of acute bronchitis and their duration, and evaluate relevant laboratory values to rule out more serious illness such as pneumonia.

  • Discuss why obtaining sputum cultures and Gram stains is not relevant in evaluation and treatment of patients with uncomplicated acute bronchitis.

  • Discuss why antibiotic treatment is not indicated for uncomplicated acute bronchitis.

  • Select nonpharmacologic and pharmacologic treatment alternatives for supportive care, incorporating data regarding efficacy.

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PATIENT PRESENTATION

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Chief Complaint

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“I can’t seem to stop coughing! It’s keeping me and my roommate awake at night, not to mention totally disrupting my classes. And now my throat is also really sore. I even tried my roommate’s asthma inhaler in hopes that my cough would stop, but it didn’t. I just want an antibiotic to make this all go away!”

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HPI

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Allie Comeaux, a 21-year-old college student, is being seen at her university’s Student Health Center for complaints of a productive, purulent cough and sore throat for the past 5 days. On questioning, Allie denies that she has had any fever, chills, or myalgias. She does express concern that a dorm mate was recently hospitalized with pneumonia. She admits to using her roommate’s asthma inhaler, which she recalls was albuterol, with no relief. While her throat is still sore, she is most concerned with her disruptive cough. “My history professor even asked me to leave the class when I couldn’t stop coughing!”

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PMH

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  • Mild acne × 5 years

  • Irregular menstrual cycle, ranging from 25 to 40 days in length

  • Current with age-appropriate vaccinations, with the exception of influenza and human papillomavirus

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FH

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Father, 51, has been diagnosed with hypertension and hyperlipidemia and has a distant history of alcohol abuse. Mother, 50, is menopausal. The patient also has two younger brothers, ages 16 and 18, with no health issues.

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SH

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Allie lives at University dorm with a suitemate. She smokes “socially” when out with friends but denies alcohol use due to her father’s history of alcohol abuse. She also denies any illicit drug use. She is currently a junior kinesiology major and hopes to attend physical therapy school on completion of her degree. She is also on the University Dance line. Allie states that she is sexually active with her boyfriend of 8 months. They use condoms as a method of birth control, although inconsistently.

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Meds

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  • Acetaminophen 650 mg PO PRN headache or menstrual cramps

  • Benzoyl peroxide 2.5% cream topically daily PRN acne

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All

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Penicillin—“all-over body rash”

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ROS

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No fever, chills, myalgia, chest pain, or shortness of breath; no ...

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