A 13-year-old boy with a history of acute intermittent asthma is brought in by his family for cough and chest pain that started today. He tried his inhaler, which did not seem to help. His pain is intermittent, pleuritic, with no other alleviating or aggravating features; the rest of his history is unremarkable. His family is upset and concerned that this could be pneumonia, because his grandmother recently died from the same.
On exam, he is well appearing, but slightly anxious, has mild increased work of breathing, speaks effortlessly in full sentences with a normal tidal volume. He is afebrile, and his vital signs are normal. On auscultation his lungs are clear, if perhaps slightly diminished on the right.
Regarding his presentation, which of the following is the single BEST answer:
A. He has normal vital signs and is not hypoxic; he should receive oral steroids, no antibiotics, and close follow-up
B. He likely has a primary spontaneous pneumothorax and will need admission
C. He should receive a small gauge right chest tube now, based on your exam, in order to prevent his decompensating
D. His treatment and disposition should be based on signs, symptoms, and radiographic evidence
In the meantime, a quote -- "The medical profession is a noble and pleasant one, though laborious and often full of anxiety." --Andrew James Symington, 19th century Scottish author, who established a famous wine "empire" in Oporto, Portugal
On exam, he is well appearing, but slightly anxious, has mild increased work of breathing, speaks effortlessly in full sentences with a normal tidal volume. He is afebrile, and his vital signs are normal. On auscultation his lungs are clear, if perhaps slightly diminished on the right.
Regarding his presentation, which of the following is the single BEST answer:
A. He has normal vital signs and is not hypoxic; he should receive oral steroids, no antibiotics, and close follow-up
B. He likely has a primary spontaneous pneumothorax and will need admission
C. He should receive a small gauge right chest tube now, based on your exam, in order to prevent his decompensating
D. His treatment and disposition should be based on signs, symptoms, and radiographic evidence
In the meantime, a quote -- "The medical profession is a noble and pleasant one, though laborious and often full of anxiety." --Andrew James Symington, 19th century Scottish author, who established a famous wine "empire" in Oporto, Portugal
RSS Feed