Throat, Respiratory & Cardiovascular Disorders
Case 2 for this one too
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.
Case 1Case 2Case 3Chief Complaint
(CC) A 65-year-old male with chronic obstructive pulmonary disease (COPD) presents to the clinic with a cough he has had for the past 2 weeks.A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose A 75-year-old female reports experiencing pain in her chest while walking up steps today.Subjectivedenies chest pain, denies night sweats, admits to having a fever but does not know the temp. States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the spring-time, pollen season. However, in the winter, her allergies are not a problem.Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a 2. Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath. Objective Data VS(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air. (BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room airBP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99% Generalpatient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5?3?; weight 175 lbsNo signs of acute distress. Patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.obese female, alert, in no acute distress. HEENTEYES: no injection, no increase in lacrimation or purulent drainage;
EARS: normal
TM: Normal
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages
Ear canals: normal;
EYES: normal;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages
Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries. Respiratorylung crackles in LLL, no wheezes or rhonchi noted; does not clear with coughing; dullness to percussion over the LLL; shallow respirations and is 30, accessory muscles use not presentCTA AP&LCTA AP&LNeck/Throatno neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged;
trachea midline
Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no
cobblestoning
carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathyHeartRegular rate and rhythm, no murmur, S3, or S4Regular rate and rhythm, no murmur, S3, or S4S1 and S2 normal without murmur, gallop, or rub
Once you received your case number, answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
Expert Solution Preview
Introduction:
As a medical professor, I am responsible for designing assignments and evaluating the performance of medical college students. In this case, we will discuss a patient with throat, respiratory, and cardiovascular disorders. The patient’s case will be provided, and we will address various aspects of the patient’s health history and clinical examination.
Answer to Question 1: What other subjective data would you obtain?
In addition to the provided subjective data, I would obtain further information from the patient regarding their medical history, specifically related to respiratory and cardiovascular disorders. This may include asking about any previous episodes of cough, shortness of breath, or chest pain. Additionally, I would inquire about the duration, severity, and frequency of symptoms, any triggers that worsen the symptoms, and any associated symptoms such as wheezing, palpitations, or swelling in the legs.
Answer to Question 2: What other objective findings would you look for?
Apart from the provided objective findings, I would perform a comprehensive physical examination to assess the patient holistically. This would involve examining the patient’s vital signs, including blood pressure, heart rate, respiratory rate, and temperature. I would also auscultate the patient’s lungs for additional abnormal breath sounds, such as wheezes or rhonchi, and assess the chest for any signs of increased work of breathing or use of accessory muscles. Further examination of the cardiovascular system, including auscultation of the heart for murmurs, extra heart sounds (S3 and S4), and assessment of peripheral pulses and edema would also be important.
Answer to Question 3: What diagnostic exams do you want to order?
Based on the patient’s presentation and examination findings, I would consider the following diagnostic exams:
1. Chest X-ray: This imaging study would help evaluate the lungs and assess for any signs of pulmonary congestion, consolidation, or underlying lung pathology.
2. Pulmonary function tests (PFTs): These tests would provide objective measurements of lung function and help assess the presence and severity of any obstructive or restrictive respiratory disorders.
3. Electrocardiogram (ECG): This non-invasive test would help evaluate the electrical activity of the heart and assess for any abnormalities, such as arrhythmias or signs of cardiac ischemia.
Answer to Question 4: Name 3 differential diagnoses based on this patient’s presenting symptoms?
Based on the patient’s symptoms, three possible differential diagnoses could include:
1. Acute exacerbation of chronic obstructive pulmonary disease (COPD): Given the patient’s chronic obstructive pulmonary disease history, the recent onset of cough, and the objective finding of lung crackles, an exacerbation of COPD should be considered.
2. Allergic rhinitis: The patient’s runny nose, history of seasonal allergies, and nasal congestion suggest the possibility of allergic rhinitis.
3. Angina pectoris: The patient’s chest pain, which worsens with exertion and improves with rest, and associated risk factors such as hypertension, raise concern for angina pectoris.
Answer to Question 5: Give rationales for each differential diagnosis.
1. Acute exacerbation of chronic obstructive pulmonary disease (COPD): COPD is characterized by chronic airflow limitation that is not fully reversible. Symptoms such as cough, increased sputum production, and breathlessness are common during exacerbations, which can be triggered by respiratory tract infections or other factors.
2. Allergic rhinitis: Allergic rhinitis is an allergic inflammation of the nasal airways. The patient’s history of seasonal allergies, runny nose, and nasal congestion suggest an allergic etiology. Allergies can be worsened by exposure to allergens such as pollen.
3. Angina pectoris: Angina pectoris is chest pain or discomfort that occurs when the heart muscle does not receive enough blood and oxygen. The patient’s symptoms of chest pain with exertion, relief with rest, and associated risk factors such as hypertension suggest a cardiac etiology.
Note: It is important for students to engage in critical thinking and provide their own rationale for each differential diagnosis based on the given information in the case.
