0
Clinical Crossroads | Clinician's Corner

A 65-Year-Old Woman With Acute Cough Illness and an Important Engagement

Ralph Gonzales, MD, MSPH, Discussant
JAMA. 2003;289(20):2701-2708. doi:10.1001/jama.289.20.2701.
Text Size: A A A
Published online

Extract

DR REYNOLDS: Mrs W is a 65-year-old woman who recently switched to a commercial Medicare insurance plan and who presents for an urgent visit with symptoms of an upper respiratory tract infection [URI]. She works in the family business and lives with her husband; they have 3 grown children.

Because her new insurance plan did not cover her former physician, Mrs W made an appointment with a new physician in a large, university-affiliated group practice. Before her initial appointment, however, she became ill and requested an urgent visit. Seen the same day, she complained of 24 hours of sore throat, cough occasionally productive of small amounts of green sputum, and subjective fevers and chills. She also had mild shortness of breath, but no pleuritic chest pain. She had not taken her temperature at home. She denied ear pain, sinus pressure, headache, orthopnea, or paroxysmal nocturnal dyspnea. She had been treating herself with fluids and acetaminophen. Her husband had similar symptoms the previous week and had been empirically treated with levofloxacin. Mrs W requested antibiotics because she hoped to feel well for a planned family party for her birthday, and because she wanted to avoid infecting her family, especially her pregnant daughter.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 7

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();