12-09-2013, 14:08
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#1
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Quiet Professional
Join Date: May 2004
Location: Pineland
Posts: 168
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PFC with a Cough
I have a final exam on friday, so thinking through these case studies is actually fairly helpful for me in studying.
Situation: You are deployed to Afghanistan and your team is co-located with a NG infantry company on a fairly remote FOB, and you are the highest level provider on site. You are running sick call one morning, and a young PFC shows up complaining of a cough and "generally feeling like shit."
You have a reasonably well-stocked aid station at your disposal, but you didn't bring your lab kit with you this time. No fancy schmancy labs, no imaging.
Vitals: T100.5, P72, BP 110/70, R12
What do you want to know? Lets flesh out the history, and then move onto physical exam.
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Medicina Bona Locis Malis
Last edited by ender18d; 12-09-2013 at 14:18.
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ender18d is offline
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12-09-2013, 14:44
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#2
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Area Commander
Join Date: Oct 2009
Location: Northeast Utah
Posts: 1,712
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Duration of cough? Getting worse/better?
Is the cough productive or not?
Hemoptysis?
Shortness of breath?
Any recent sick contacts with similar symptoms?
Any recent inhalation exposures (intentional or otherwise)?
Any recent choking while eating?
What exactly does he mean by "feel like shit"? Achiness, fatigue, etc.
Any nausea/vomiting (post-tussive or otherwise), diarrhea?
__________________
"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
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PedOncoDoc is offline
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12-09-2013, 14:56
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#3
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Quiet Professional
Join Date: May 2004
Location: Pineland
Posts: 168
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Duration of cough? Getting worse/better?
Started last night, so its new enough that its getting worse by defininition.
Is the cough productive or not?
He thinks he's getting a little of the "gunk" up, but he's not really sure.
Hemoptysis?
Negative
Shortness of breath?
Negative
Any recent sick contacts with similar symptoms?
Not that he knows of.
Any recent inhalation exposures (intentional or otherwise)?
Not that he knows of
Any recent choking while eating?
No.
What exactly does he mean by "feel like shit"? Achiness, fatigue, etc.
He feels fatigued and feverish.
Any nausea/vomiting (post-tussive or otherwise), diarrhea?
Negative.
__________________
Medicina Bona Locis Malis
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ender18d is offline
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12-09-2013, 15:14
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#4
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Quiet Professional
Join Date: May 2004
Location: Pineland
Posts: 168
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Any pain?
The cough is uncomfortable, but not much in the way of pain.
any SOB?
No
Lung sounds?
That is physical exam... we'll get to that... but lets say he has faint bilateral rales.
Anything making it better or worse?
He thinks it would help if he could get out of his patrol today and take a rest. Otherwise, no.
Blood in stools?
No.
Blood in urine?
No.
Pain when urinate?
No.
What color is urine?
Straw colored.
Past Medical history?
Appendicitis 4 years ago treated surgically. He admits he's "had the clap a few times."
On any meds? If so what?
Malaria Prophylaxis. (Doxy)
Are you taking your malaria meds?
Most of the time.
What does his skin look and feel like?
Lets give you the benefit of the doubt and assume you're doing a thorough skin exam even though he's just presenting with cold symptoms.  When you examine his skin, you notice a rash that looks like this on the pressure points where his body armor sits. How would you describe this?
http://img834.imageshack.us/img834/3794/o276.jpg
Abd tenderness or pain?
No.
Diarrhea or constipation?
No.
What does nose, ears and throat look like?
Throat is mildly erythemetous, but no petichiae, no lesions, no exudate, and you're not seeing significant swelling of lymphatic tissues. Nose and ears unremarkable.
Has he been bitten by anything? (ie infected beaver)
Does the sorority girl on mid-tour leave count?
Any rash or sores?
See above.
Swelling anywhere?
No.
How has his appetite been?
He hasn't had much appetite today.
Has he eaten any local food or drank from unclean water source (streams rivers etc)
Just that one time when he was really thirsty.
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Medicina Bona Locis Malis
Last edited by ender18d; 12-09-2013 at 15:21.
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ender18d is offline
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12-09-2013, 15:26
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#5
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Area Commander
Join Date: Oct 2009
Location: Northeast Utah
Posts: 1,712
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Rash is consistent with petechiae - typically from platelet defect (either quantity of function).
Has he noticed any jaundice or yellowing of the eyes?
Any ankle/extremity swelling?
Feeling bloated? Abdominal pain?
__________________
"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
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PedOncoDoc is offline
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12-09-2013, 15:28
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#6
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Quiet Professional
Join Date: May 2004
Location: Pineland
Posts: 168
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Has he noticed any jaundice or yellowing of the eyes?
Negative.
Any ankle/extremity swelling?
Negative.
Feeling bloated? Abdominal pain?
Negative.
__________________
Medicina Bona Locis Malis
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ender18d is offline
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12-09-2013, 15:36
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#7
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Area Commander
Join Date: Oct 2009
Location: Northeast Utah
Posts: 1,712
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Any headache?
has he ever had a similar rash in the past?
Family history of autoimmune/rheumatologic conditions?
History of pneumonia or recurrent infections?
Any limb/back pain?
__________________
"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
Last edited by PedOncoDoc; 12-09-2013 at 15:50.
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PedOncoDoc is offline
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12-09-2013, 15:57
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#8
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Quiet Professional
Join Date: Nov 2011
Location: Location, Location
Posts: 4,076
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First things first... Is he a leg?
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The two most powerful warriors are patience and time - Leo Tolstoy
It's Never Crowded Along the Extra Mile - Wayne Dyer
WOKE = Willfully Overlooking Known Evil
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MR2 is offline
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12-09-2013, 16:00
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#9
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Quiet Professional
Join Date: Nov 2012
Location: Harrisburg, PA
Posts: 3,836
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How long has the PFC been in country? Where before his deployment?
Headache?
Radiating peticheal hemorrhaging? Rings a bell in the ol' noggin. Need to search on that one, may be important diagnostic clue?
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Honor Above All Else
Last edited by Trapper John; 12-09-2013 at 16:10.
Reason: Added Question
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Trapper John is offline
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12-09-2013, 16:08
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#10
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Quiet Professional
Join Date: May 2004
Location: Pineland
Posts: 168
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First things first... Is he a leg?
Yes.
Any headache?
Not really.
has he ever had a similar rash in the past?
"I've had some chafing from my kit before, but it didn't really look the same."
Family history of autoimmune/rheumatologic conditions?
"Mom has some kind of arthritis, but I'm not sure what kind."
History of pneumonia or recurrent infections?
I had pneumonia once when I was a kid I think. I don't seem to get sick more than most other people I know.
Any limb/back pain?
No, not really.
How long has the PFC been in country? Where before his deployment?
Returned from mid-tour leave in the US one week ago. Layover in Germany.
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Medicina Bona Locis Malis
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