A different cause of cough session 2

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A different cause of cough session 2 Door Mind Map: A different cause of cough session 2

1. Step 6

1.1. Review session 1

1.1.1. Summary of step 5

1.2. Report new knowledge

1.2.1. cystic fibrosis epidemiology mechanism risk factors presentation diagnosis

1.2.2. bronchiactesis causes mechanism

1.2.3. why infections are common in winters

1.3. 40 minutes

2. Step 8

2.1. Diagnostic decision

2.1.1. cystic fibrosis

2.1.2. bronchiactesis

2.1.3. pseudomonas aeurgenosa infection

2.2. Mechanism

2.2.1. mutations lead to gene abnormality lead to cystic fibrosis then recurrent infections and bronchiactesis after that

2.3. Presentation

2.3.1. chronic persistent cough with sputum during winters and green sputum since last year, along with history of asthma (wheezing and dysnea) and weight loss

2.4. Supporting data

2.4.1. cyanosis, clubbing, + sweat cl test, CT and x-ray, vitA deficiency, elevated liver enzymes and the presence of pseudomonas auregenosa

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain chronic persistent cough and half a cup green sputum with smell previously and no hemoptysis occasional fever during the attaks wheezing and dysnea during exacerbations weight loss

3.1.2. Previous medical / surgical history clean surgical history no diabetes or hypertension no nasal polyps or sinusitis no vit deficiency history of ashma when 2 y o negative chloride sweat test when 6 months old

3.1.3. Drug history / allergy oral prednisolone, ventolin and antibiotics during exacerbations no allergies

3.1.4. Family history clean family history of respiratory diseases

3.1.5. Social / occupational history not a smoker, step father is a smoker living with his family no pits no alcohol consumption high school degree

3.1.6. Systemic review normal thrive clean other systems history

3.1.7. Physical examination 37 temp 120 pulse rate 120\60 bp 18 rr 18.6 bmi 86% O sat marked clubbing no tremors and no muscle wasting not raised JVP cebtral cyanosis mucopurulent discharge in the nasopharyns and crusted secretions in the nostrils no burrel chest and no enlarged lymph nodes normal percussion occasional crepitations (crackles) in both lungs at the bases polyphoning expiratory wheezing in forced normal apex beat and not elevated pulmonary valve normal heart sound (1st and 2nd) normal liver and spleen spans normal bowel movement and no rectal prolapse normal genitourinary, neorological systems

3.1.8. tests results patchy peripheral ling inflitrates ring-like arrowheads (dilated bronchi) elevated liver enzymes elevated ESR pseudomonas auregenosa detection with mucopurulent sputum vitA difeciency spirometry no results + sweat chloride test )61) D508 mutation (1 copy) nasal potential difference no results elevated protein and alk phosph

3.2. 40 minutes