RESPIRATORY
A 55-year-old
man comes to the office because of shortness of breath. He has experienced mild
dyspnea on exertion for a few years, but more recently he has noted worsening
shortness of breath with minimal exercise and the onset of dyspnea at rest. He
has difficulty reclining and has been sleeping in his recliner for the past
month. He has noted a cough with yellowish-brown sputum for the past few months
in the AM. He denies chest pain, fever, chills or lower extremity edema. He was
evaluated at an urgent care center a few months ago and was given an inhaler
and referred to a primary care provider. He does not recall the name of the
inhaler and has used it only intermittently.
PMH:
“prediabetic”- treated with diet and exercise (walking)
Erectile dysfunction- takes Viagra
prn
Basal cell carcinoma-side of left
nose- treated with Mohs procedure- 5 years ago
Blepharitis and early cataract
formation
PSH: Right hernia repair at age 50
Repair of left rotator cuff at age
53
Septoplasty- age 16
FH: father- alive age
76, CAD, A. fib, arthritis
Mother-
alive age 75 uterine cancer, Meniere’s disease, basal cell carcinoma x 2
1 Brother- age 56 HTN, HLD
Social Hx:
Married, Works in sanitation, has 3 children, Smokes 1 ppd x 40 years, ETOH- a
few beers on weekend
Prescribed medications-
none
ROS: as stated in the HPI
PE: BP 138/92 RA sitting, heart rate- 92 regular,
respiratory rate- 26bpm, temp 97.8 °F oral.
Ht: 5’9” Wt 190
lbs. BMI- 28
Pt appears
slightly anxious, talking quickly, sitting in chair and leaning forward. His
respirations are slightly labored with use of accessory muscles
CV:
distant heart sounds, AP- 92 regular, S1, S2 no Murmurs/Rubs/Gallops, no JVP
distension, no edema or clubbing.
Resp:
AP diameter slightly increased with inward movement of the lower rib cage with
inspiration, Percussion- generalized hyperresonance, + wheezes and rhonchi
bilaterally, no crackles, fremitus- decreased, bronchophony-negative
Questions:
1. What
are your differentials? State positive and negatives, what is the most likely
diagnosis?
2. What
is the next best diagnostic test? Go into detail about the testing
3. What
is the best initial treatment? Explain why.
4. What
is your management plan for this patient regarding this condition? Include
follow-up plan.
5. What
other Health promotion and disease prevention strategies would you initiate? Be
specific.
INCLUDE
4 or more REFERENCES-APA format- (journal articles, research articles, EBP, national
guidelines. etc.) **No textbook, **NO Wikipedia
Rubric: 2.5% of grade- Each question is worth 5
points
Each answer will be assessed based on the following
criteria:
1. Is
the information given in the response correct?
2. Is
the information given in the response complete-i.e. Does it answer all aspects
of the question thoroughly?
3. Is
the answer clear and easy to understand, using correct grammar, punctuation,
spelling, etc.?
4. Are
the references/sources included current and appropriate, APA format, and with
No use of text book or Wikipedia?
5. Format:
Microsoft word; Font: Times New Roman 12
