3: Acute Bronchitis

PATIENT PRESENTATION

Chief Complaint

“I can’t stop coughing.”

History of Present Illness

MT is a 35-year-old female who presents to her primary care physician with cough for the last 10 days. She explains that her 6-year-old son had fever, runny nose, and cough about 2 weeks ago but got better after a few days. She explains that she got sick shortly after him and developed nasal congestion, sore throat, and a productive cough. While her congestion has improved, she continues to cough and is concerned that her symptoms still persist. She denies any fever, chills, dyspnea, or hemoptysis.

Past Medical History

Hypothyroidism, insomnia

Surgical History

None

Family History

Father has HTN and hyperlipidemia, mother has history of breast cancer and is in remission. One younger sister (age 30), who is alive and well.

Social History

Married with two children (ages 6 and 8), works as a dental hygienist, denies smoking and illicit drug use

Allergies

NKDA

Home Medications

Levothyroxine 50 mcg orally once daily

Alprazolam 0.25 mg orally nightly as needed for insomnia

Physical Examination

Vital Signs

Temp 98.8°F, P 68, RR 16, BP 115/73 mm Hg, O₂ saturation 98%, Ht 5′9″, Wt 63 kg

General

Well-developed female in NAD

HEENT

PERRLA, EOMI, TMs intact, moist mucous membranes, mild pharyngeal erythema present

Neck/Lymph Nodes

Supple, no lymphadenopathy

Pulmonary

CTA, no crackles/wheezing, cough present

Cardiovascular

NSR, no m/r/g

Abdomen

Soft, non-tender, non-distended, bowel sounds present

Genitourinary

Deferred

Neurology

A&O ×3, CN intact

MS/Extremities

Deferred

Laboratory Findings

Rapid Influenza Test

Negative

QUESTIONS

1. Which of ...