Question

A previously healthy 27-year-old man comes to the physician complaining of a cough with sputum production for the past 3 days. The cough has been keeping him up at night and it is affecting his job performance. He has no prior history of respiratory disease. His temperature is 37 C, BP 130/80, pulse 70, and RR 18. Physical examination is unremarkable. Which of the following is the most appropriate next step in management?

a) Admit for medical management
b) Perform chest x-ray
c) Perform sputum culture
d) Send home with antibiotics

Answer 1

The best next step is to perform a chest x-ray to investigate for potential serious conditions. Hospitalization or prescribing antibiotics without further diagnostics is premature. Real-world clinical scenarios support the importance of chest radiographs in directing appropriate treatment.

Step-by-step explanation:

The most appropriate next step in managing a previously healthy 27-year-old man with a 3-day history of cough and sputum production, whom physical examination found to be otherwise unremarkable, would be to perform a chest x-ray. This is to rule out any serious underlying conditions such as pneumonia, which could present with such symptoms. Given that his vital signs are within normal ranges, immediate admission for medical management (hospitalization) is not indicated. Similarly, sending the patient home with antibiotics or performing a sputum culture is premature without evidence of a bacterial infection confirmed by imaging or other diagnostic means.

Related scenarios show that a chest x-ray can reveal significant conditions such as extensive consolidation or pneumonia, which require specific treatments like antibiotics or, if the outcome is severe, hospitalization. As in the case of John in the Clinical Focus, the chest radiograph provided crucial information that guided subsequent management.