Case (51)

[Mustafa]

A 34-year-old man presents for evaluation of a cough that has been persistent for the past 3 months. He recalls having an upper respiratory tract infection prior to the onset of cough with complaints of rhinitis, sore throat, and low-grade fever. After these symptoms resolved, he states that "the cold moved to my chest" about 10 days later. He reports severe coughing episodes that have been associated with posttussive emesis in the past, but these are less frequent now. His biggest complaint has been coughing that awakens him from sleep at night and ultimately has resulted in progressive fatigue. He denies wheezing. Specific triggers for his cough include eating cold foods, especially ice cream. He has no history of asthma or prior history of prolonged cough. He denies symptoms of gastroesophageal reflux disease. He breathes easily through his nose and does not have seasonal rhinitis. He has no past medical history. He works as an accountant in a new office building. He does not have any fume exposure. He does not smoke or drink alcohol. He has no pets. He does not recall his vaccination history, but thinks he has not had any vaccinations since graduating from high school. On physical examination, he appears well. He is speaking in full sentences. He is 190 cm tall and weighs 95.5 kg. His temperature is 37.5°C, respiratory rate of 14 breaths/min, heart rate of 64 beats/min, and blood pressure of 112/72 mmHg. His oxygen saturation is 97% on room air at rest. Head, eyes, ears, nose, and throat examination reveals no enlargement of the nasal turbinates, with open nasal passages. The airway is Mallampati class I without cobblestoning or erythema. The lung examination is clear to auscultation. No forced expiratory wheezes are present. The cardiac, gastrointestinal, extremity, and neurologic examinations are normal. His peak expiratory flow rate is 650 L/min. The forced expiratory volume in one second (FEV1) is 4.86 L (96% predicted) and forced vital capacity (FVC) is 6.26 (99% predicted). The FEV1/FVC ratio is 78%.

What is your next diagnostic procedure?
What is the most likely diagnosis?
what are the most frequent causes of the complication might occur in this age if left untreated?
What is the purpose of the the therapy?

[Diagnostic]

What is your next diagnostic procedure?
Culture of nasophryngeal specimen which is 90% of cases is positive.

What is the most likely diagnosis?
Whooping cough

what are the most frequent causes of the complication might occur in this age if left untreated?
Bronchopneumonia, Bronchiectasis & Atelectasis

What is the purpose of the the therapy?
Oraly erythromycin usually eradicate nasophryngeal carriage of the organism thsu diminishing infectivity to others & possibly aborting the infection in contacts
NB: cough supressants should not be used fro treatment of whooping cough.
Dose of erythromycin is 50mg/kg/Q/6hrs-14 days.

[Mustafa]

All the answers are correct. The 15 points goes to mr Diagnostic.