Fever with Productive Cough — LRTI OPD Case Study
A practical pulmonology case discussion for general practitioners and junior doctors: a 60-year-old male presents with fever, productive cough for 3 days, chest congestion, and the feeling that mucus is stuck in the chest. The task is to separate bronchitis, pneumonia, COPD exacerbation, TB, cardiac mimics, and dangerous complications.
Why This Guide Matters
Fever with productive cough is a bread-and-butter OPD presentation, but in a 60-year-old it must never be dismissed as “just a chest infection.” Age lowers the threshold for chest imaging, pneumonia risk stratification, oxygen assessment, and active search for COPD, TB, heart failure, malignancy, aspiration, pulmonary embolism, and complications.
This guide trains the OPD discipline of separating upper from lower respiratory tract disease, infective from non-infective illness, and uncomplicated LRTI from severe or complicated disease requiring admission.
Inside This Guide
- Clinical framing — how fever, productive cough, chest congestion, and age 60 change the OPD risk level.
- Prevalence-first differentials — CAP, acute bronchitis, AECOPD, tuberculosis, and bronchiectasis exacerbation.
- Dangerous mimics — lung cancer with post-obstructive pneumonia, aspiration pneumonia, viral LRTI/COVID/influenza, heart failure, pulmonary embolism, abscess, and empyema.
- CURB-65 logic — why pneumonia severity scoring belongs in a 60-year-old with suspected CAP.
- Must-do vitals — temperature, respiratory rate, SpO₂, pulse, blood pressure, and mental status.
- Focused examination — inspection, palpation, percussion, auscultation, consolidation signs, wheeze, crepitations, effusion clues, and cardiovascular mimic screening.
- Investigation strategy — when to order chest X-ray, CBC, CRP, sputum tests, COVID/influenza testing, ECG, and further workup.
- Admission triggers — hypoxia, tachypnoea, hypotension, confusion, sepsis, severe pneumonia, poor oral intake, complications, and high-risk background disease.
This GP Topic teaches diagnosis and risk stratification. After the PDF, subscribers will find a direct link to the treatment prescription for lower respiratory tract infection so the topic becomes complete: diagnosis first, treatment next.