I&I lab case vignettes

Case #133 - Koskovich, Gregory

In January, 1 31 year-old man experienced a sudden onset of headache, myalgia, malaise, and dry cough. He had a temperature of 102oF and said he felt "lousy". A couple of days later he came to your office complaining of a sore throat and a worsening cough.

Physical exam revealed pharyngeal erythema and post-nasal drainage. Vital signs were normal.

Case 113 - Ernst, William

A 5 year-old child, William (Bill) Ernst, was brought to your office. Biss's father reported that Bill had a fever, cough and chest pain for the past four days.

Physical examination revealed a tire-appearing but well-developed child with signs of mild dehydration. He had a temperature of 37.4oC, blood pressure of 110/80 and a pulse rate of 140. Physical exam was normal except for his chest examination; breath sounds were decreased over the right lung base and crackles were heard over the right anterior chest.

Bill's immunizations are complete and up-to-date. He attend kindergarten; no one else in the family is ill. He has no known allergies and no history of lung disease including asthma. There is no history of unusual or recurrent infections.

Case 108 - Anderson, Hanna

A 25-year old woman, Hanna Anderson, came to your office complaining of fatigue, sore throat and a headache. Hanna related that she had been very tired for the previous week and had a fever.

Physical examination revealed a temperature of 102oF, normal pulse and blood pressure. In addition, Hanna had swollen cervical lymph nodes. The lungs were clear; the liver descended just below the costal margin and the edge was smooth and tender. The spleen was enlarged and palpable.

Hanna reported no associated rash or cough; she had no significant medical history.

Case 33- Johnson, Kevin

A previously healthy 12 year-old boy, Kevin Johnson, was admitted to O'Bleness Memorial Hospital following 3 days of illness and tactile fever. During the first two days of illness he had vomited, had been fatigued and had had a cough, runny nose, headache, and poor appetite.

Physical examination up admission revealed a temperature of 39oC and an increased respiratory rate. He appeared to be dehydrated and rales were heard at the base of his left lung.

Kevin had no significan medical history; his mother had had a cold the previous week.

Case 265 - Williams, Susy

Susy is a 3 year-old child and was brought to your office by her mother with a complaint of a runny nose, severe barking-like cough and a fever. Susy made a wheezing sound when agitated.

Susy was a well-developed child with height and weight appropriate for age and both values at the 60th percentile. Her pulse was elevated, temperature was 101.8oF. Breath sounds were normal. Lateral X-ray demonstrated a subglottal narrowing.

Case 257 - Storb, John

John Storb, a 62-year-old man with a history of chronic obstructive pulmonary disease presented at the Emergency Department with a temprerature of 102.2oF, chills, nausea, vomiting, and hypotention. John's sputum was tenacious and yellowish and had been increasing in amount over the past 3 days.

Respiration rate: 18
BP: 97/52
Chest X-ray: Extensive infiltrate in the left lower lung, involving both the lower lobe and the lingual.

Case 165 - Jamison, Annie

Annie is a 20-year old student who presented to the office with a complaint of tiredness, headache, cough, temperature of 101oF with night chills and sweats. Upon examination, she had a nonproductive cough and experienced dyspnea upon exertion.

Pulse: 95
Resp. Rate: 28

Pharynx was erythematous; scattered rhonchi and rales but no consolidation were noted by ascultation. A chest radiograph revealed patchy infiltrates.

Case 65 - Thomas, Brad

A 9-month-old boy presented to the Emergency Department in January with a fever, cough, and rapid respirations. He was well until 1 week earlier, when he developed rhinorrhea and cough. One day prior to admission, he developed an increased cough, anorexia, fever of 102oF rectally, and rapid breathing. Several family members have had colds.

Physical exam: Infant in moderate respiratory distress.

Temp: 101oF rectally
Pulse: 140
Resp. rate: 46
BP: 90/50

A clear nasal discharge was present. Tympanic membranes were normal. Neck was supple without adenopathy. Moderate subcostal and intercostals retractions and mild nasal flaring were present. Fine expiratory wheezes were heard bilaterally, and the expiratory phase was prolonged. No stridor was present. The cardiac exam was normal.

Chest x-ray: hyperinflated lungs with flat diaphragms and increased perhilar markings throughout both lung fields.

Case 13 - Jordan, Joseph

A 50-year-old cooling/heating service technician was seen in your office with a complaint of diarrhea, a sudden onset of chills, fever and cough. Joseph also appeared to be slightly confused. Joseph is a heavy smoker and social drinker.

Tem;: 39.5oC
Resp. Rate: 25
Pulse: 120
BP: 90/60

Rales were heard over the left posterior lung fields; chest X-ray demonstrated the presence of pneumonitis in the lower left lobe. Joseph was unable to produce sputum.

Case 16 - Bacon, Harvey

Harvey, a 9-year-old child, was brought to your office with a complaint of a sore throat and runny nose. The mother was also ill with similar symptoms.

Physical exam was normal except for a, red inflamed throat and palate.