Throat, Respiratory & Cardiovascular Disorders
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 noseA 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 clinician building a health history for the assigned case, there are several aspects that need to be considered. The subjective and objective data obtained, along with the diagnostic exams ordered, will help in forming differential diagnoses and providing appropriate care for the patient. The following answers address the questions related to the assigned case.
What other subjective data would you obtain?
In addition to the information provided, it is important to gather more subjective data to further understand the patient’s condition. Some additional subjective data that would be beneficial to obtain for the assigned case include:
1. Detailed cough history: Ask the patient about the duration, frequency, severity, and any associated symptoms (such as sputum production, blood in sputum, or worsening of cough with certain triggers).
2. Allergy history: Inquire about the specific allergens that are known to trigger symptoms, the duration and severity of allergic symptoms, and any previous treatments tried for allergies.
3. Smoking history: Determine the patient’s smoking history, including the number of pack-years smoked, current smoking status, and any previous attempts to quit smoking.
4. Medical history: Collect information about any comorbidities like asthma, recurrent respiratory tract infections, or other chronic conditions that could contribute to the current symptoms.
What other objective findings would you look for?
Apart from the information provided, additional objective findings that can be assessed in the assigned case include:
1. Lung auscultation: Conduct a thorough examination of the lung sounds to assess for the presence of wheezes, rhonchi, crackles, or decreased breath sounds in different lung fields.
2. Chest X-ray or CT scan: Consider ordering a radiological examination to assess lung parenchyma and detect any abnormalities like consolidation, effusion, or emphysematous changes.
3. Pulmonary function tests (spirometry): Perform spirometry to evaluate lung function and determine the severity of airflow limitation in the case of suspected chronic obstructive pulmonary disease (COPD).
4. Echocardiography: Consider conducting an echocardiogram to evaluate cardiac structure and function, especially in cases where chest pain and shortness of breath are present.
What diagnostic exams do you want to order?
Based on the assigned case, the following diagnostic exams could be ordered:
1. Chest X-ray: This imaging modality can help evaluate the lung parenchyma and identify any abnormalities, such as consolidation or pleural effusion, which may explain the patient’s symptoms.
2. Complete blood count (CBC): A CBC can provide information about the presence of infection or inflammation (elevated white blood cell count), anemia (low hemoglobin levels), and other potential underlying conditions.
3. Arterial blood gas (ABG) analysis: ABG analysis can help assess the adequacy of oxygenation and ventilation, especially in patients with respiratory symptoms.
4. ECG: An electrocardiogram can be useful to evaluate cardiac rhythm, detect any conduction abnormalities, and assess for evidence of myocardial ischemia or infarction in patients with chest pain.
Name 3 differential diagnoses based on this patient’s presenting symptoms?
Based on the provided information, three possible differential diagnoses for this patient’s symptoms could be:
1. Acute bronchitis: The patient’s symptoms of a cough, fever, and yellow nasal drainage may suggest acute bronchitis, which is commonly caused by a viral respiratory infection. The absence of chest pain and history of chronic obstructive pulmonary disease (COPD) make this diagnosis more likely.
2. Allergic rhinitis: The patient’s history of seasonal allergies, with symptoms primarily occurring during springtime and pollen seasons, is consistent with allergic rhinitis. The runny nose and nasal congestion in the absence of chest pain support this diagnosis.
3. Angina pectoris: The patient’s chest pain described as an ache or burning sensation at the center of the sternum, exacerbated by exertion (walking up steps), and relieved with rest, raises concerns for angina pectoris. The presence of risk factors like hypertension and obesity further supports this possibility.
Give rationales for each differential diagnosis.
1. Acute bronchitis: This diagnosis is supported by the patient’s symptoms of a cough, fever, and yellow nasal drainage. Acute bronchitis is commonly caused by viral respiratory infections and is often self-limiting, not requiring specific treatment unless complications arise.
2. Allergic rhinitis: The patient’s history of seasonal allergies with symptoms during specific times of the year suggests allergic rhinitis as a differential diagnosis. The presence of nasal congestion and runny nose without other significant respiratory symptoms supports this possibility.
3. Angina pectoris: The patient’s chest pain occurring with exertion, radiating to the arms, and relieved with rest is consistent with angina pectoris. Risk factors like hypertension and obesity increase the likelihood of coronary artery disease, which may manifest as angina. Further evaluation, such as stress testing or coronary angiography, may be required to confirm this diagnosis and guide appropriate management.
