Question

A 37 year old teacher has had three months of non-productive cough. The cough seems to be worst at night and upon awakening in the morning. She denies fevers, dyspnea, chest pain, wheezing, purulent nasal discharge, or heartburn. Past medical history includes IBS and hypertension. Medications include candesartan and an oral contraceptive pill. She has never smoked or traveled outside of the United States. Physical examination reveals an afebrile, well-nourished, healthy appearing female. The oropharynx is moist and without erythema or exudates. Nasal mucosa is pink and slightly edematous. Breath sounds are clear to auscultation bilaterally. First and second heart sounds are within normal limits, and no additional heart sounds or murmurs are noted. There is no peripheral edema. Chest x-ray shows normal lung fields. Which of the following is the most appropriate intervention at this time?

A. Stop candesartan
B. Begin antihistamine and decongestant
C. Amoxicillin/clavulanate
D. Place tuberculin purified protein derivative (PPD)
E. Chest CT

Answer 1

The most appropriate intervention would be to begin antihistamine and decongestant therapy for a teacher with a non-productive cough.

Step-by-step explanation:

The most appropriate intervention at this time for a 37-year-old teacher with three months of non-productive cough and worsening at night and in the morning, along with other negative symptoms and normal physical examination findings, would be to begin antihistamine and decongestant therapy. The student does not exhibit any symptoms of bacterial infection, such as fevers, purulent nasal discharge, or chest pain, and the chest x-ray shows normal lung fields. Therefore, the most likely cause of the cough is postnasal drip caused by allergic rhinitis.