Jeanne M. Ferrante, M.D.

Specific Objectives

On-line Articles
    1.  Acute Bronchitis (American Family Physician, 3/98)
    2.  Appropriate Use of Antibiotics for URIs in Children (American Family Physician, 10/98)
    3.  An Office Approach to the Diagnosis of Chronic Cough (American Family Physician, 12/98)
    4.  Acute Sinusitis: A cost-effective approach to diagnosis and treatment (American Family Physician, 11/98)
    5.  Managing Community Acquired Pneumonia (Postgraduate Medicine, 4/99)
    6.  Allergic and Nonallergic Rhinitis (Postgraduate Medicine, 8/96)
    7.  Overview of Methods for Treating Allergic Rhinitis (American Family Physician, 1/2000)

Cough and Congestion Case Study

Specific Learning Objectives

• Knowledge

Student should be able to describe:
1. the anatomy of the respiratory tract including the nose, paranasal sinuses, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli
2. the criteria used to classify a cough as acute or chronic
3. signs and symptoms associated with the most common causes of acute cough:
• viral upper respiratory infection
• bronchitis
• pneumonia
4. signs and symptoms associated with the most common causes of chronic cough:
• post nasal drip/allergies
• asthma
• chronic bronchitis/COPD
• gastroesophageal reflux
• angiotensin-converting inhibitors
• lung cancer
• TB
• pertussis
• CHF
5. the pathogenic, epidemiologic, and pathophysiologic differences among:
• viral vs. bacterial upper respiratory infections
• acute vs. chronic sinusitis
• community-acquired vs. hospital-acquired pneumonia
• lobar vs. interstitial pneumonia
• aspiration pneumonia vs. viral/bacterial pneumonia
6. the severe complications of acute bacterial pneumonia (bacteremia, sepsis, emphysema, meningitis, metastatic microabscesses)
7. the common antimicrobials used for pharyngitis, sinusitis, bronchitis, pneumonias (review antibiotic pharmacology)
8. the common treatments for allergic rhinitis
9. the indications for pneumococcal and influenza immunization
• Skills

Students should demonstrate specific skills including:
1. History-Taking Skills

Students should be able to obtain, document and present an age-appropriate medical history, that differentiates among etiology of disease, including:
• obtaining a thorough history of environmental/occupational allergies and determining the likelihood of atopic disease
• assessing a patient for symptoms of acute vs. chronic disease
• assessing a patient for an infection (viral vs. bacterial) or a dangerous cause of cough
• assessing a patient for symptoms of gastroesphageal reflux disease
• assessing a patient's medication use
2. Physical Exam Skills

Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including:
• taking the vital signs such as temperature, pulse, respiratory rate, and determining evidence of respiratory distress
• examination of the ears, eyes, nasal mucosa, sinuses, oropharynx, neck, and lungs
• recognizing the pharyngeal signs of post-nasal drip syndrome
• distinguishing normal breath sounds from adventitious sounds
• distinguishing pleural effusion from pulmonary consolidation.
3. Differential Diagnosis

Students should be able to generate a differential diagnosis recognizing specific history and physical exam findings and suggest a specific etiology of acute or chronic cough.
4. Laboratory Interpretation

Students should be able to recommend when to order and be able to interpret diagnostic and laboratory tests, both prior to and after initiating treatment based on the differential diagnosis.

Laboratory and diagnostic tests may include:

• gram stain of sputum
• sputum culture and susceptibility reports
• limited sinus CT examination
• chest x-ray examination
• barium swallow
• pulse oximetry or arterial blood gases
• pulmonary function testing
• sputum cytology
• acid fast stain of sputum (Ziehl-Neelsen)

 
5. Communication Skills

Students should be able to:
• explain specific treatment plans for the individual patient's situation.
• counsel and educate patients about:
• environmental contributors to their disease
• allergen skin testing
• smoking cessation
• use of over the counter medicines and nasal decongestants sprays
• pneumococcal and influenza immunizations
6. Management Skills

Students should be able to design a management plan for:
• symptomatice treatment of the common cold including identifying the benefits and risks of cough suppressant therapy.
• the treatment of post-nasal drip, allergic rhinitis, and gastroesophageal reflux.
• assessing atopic disease, including the indications for allergen skin testing.
• selecting appropriate antimicrobial therapy for:
• acute bronchitis
• acute and chronic sinusitis
• pneumonia
• identifying the presence of potential complications of bacterial and viral pneumonias including:
• respiratory failure
• meningitis
• bacteremia/sepsis
• empyema
• pericarditis
• Attitudes and Professional Behaviors

Each student should be able to:
1. Demonstrate commitment to using cost-benefit considerations in the selection of drug therapies for acute and chronic cough, including over the counter medications.
2. Appreciate the functional disruption of a patient's life caused by these illnesses.

Answers to Cough and Congestion Case 1

Self Assessment Quiz (you must be using Internet Explorer to view the quiz)
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