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Worsening Productive Cough in a 25-Year-Old Male

A 25-year-old male presents with gradually worsening productive cough. Levofloxacin has provided minimal improvement. CXR reveals coarse breath sounds in the right lung. Leukocytosis and mild bandemia are present. Explore the diagnostic possibilities and proposed management for this case.

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Worsening Productive Cough in a 25-Year-Old Male

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  1. These are actual cases to • Stimulate your reading • Test your knowledge of the material • Look for the sound icon

  2. 25 year old male 2 to 3 weeks of gradually worsening productive cough minimal improvement with Levofloxacin went to ER nonsmoker PMHx unremarkable Physical Exam: VSS, no adenopathy. Resp – coarse breath sounds right lung, no clubbing. Cardiac, neurologic, abdominal exam unremarkable. Bloodwork – leukocytosis and mild bandemia

  3. Q1: Interpret the CXR. • Answer (Q1)

  4. Q2: Based on the clinical and radiographic information provided, what are the diagnostic possibilities and your most likely diagnosis? • Answer next slide

  5. Answer (Q2) Lung Cavity Usually seen with multiple cavities Lung Abscess Cavitating Malignancy • Certain gram positive cocci, gram negative bacilli, anaerobes • TB, fungus • Squamous cell • Adenocarcinoma Vasculitis Mets to the lung Septic emboli

  6. Q3: How would you manage this patient? • Answer (Q3)

  7. After 3 weeks of antibiotics, the patient has minimal symptomatic improvement. CXR – no change Q4: How would you manage the patient lacking symptomatic or radiographic improvement? Answer on next slide

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