【COPD英文PPT课件】Case Based ReviewPPT.ppt

Case Based Review- Lab 6 Robert Allan, MD Case #1 65 year old male with a past medical history of chronic obstructive pneumonia disease (COPD) presents with a one week history of worsening shortness of breath and fever. On physical examination he appears somewhat blue and he complains of constant sputum production- however now his sputum is more green than usual. He has diminished breath sounds over the left lower lung. He smokes 2 packs a day and has done so for the last 20 years. A chest x-ray shows a hyper-expanded “barrel like” chest with an infiltrate in the left lower lobe and an associated pleural effusion What is the most likely diagnosis? - COPD with superimposed PNEUMONIA, chronic bronchitis predominant (blue bloater) Case #1- COPD with fever What are the most likely organisms responsible? Streptococcus pneumoniae ?? Haemophilus influenzae ?? Moraxella catarrhalis ?? Staphylococcus aureus Influenza could be considered but the infiltrate is focal- same could be argued for mycoplasma (focality and presence of significant fever would argue against) ?? Case #1- COPD with fever Additional history may be of value. Below are additional questions that you could ask- think about how this may help you in the differential. Alcohol use/ abuse? - This could help identify risk factor for aspiration pneumonia due to impaired consciousness ?? Social history/ sick contacts/ exposures? Is he homeless and/ or exposed to possible M Tb? Have others had a similar illness What is his occupation? Exposure to water may be important for considering Legionella ?? Travel history? - Though perhaps not as relevant in this case- travel to regions with endemic fungal infections may suggest an etiology Case #1 COPD with fever On the subject of travel… Match up the endemic fungus with the geographic area mentioned… - Coccidiomycosis Southwestern US- California San Joaquin Valley Ohio and Mississippi river valley - A bit of a trick question here- Histoplasmosis and Blas