Hypertension and obesity

Case: DS is a 38 y/o female who presents to the clinic complaining of continuous coughing and difficulty breathing. Her medical history includes mild hypertension and obesity. She had a minor surgical procedure on her right eye five days ago and sinus surgery eight months ago. What questions will you ask of DS to develop your differential diagnoses? Which PFTs would you consider? Which PFTs are contraindicated today?

Full Answer Section

     
  • Medical history: Do you have any chronic medical conditions, such as asthma, COPD, or heart disease? Have you had any recent surgeries or illnesses?
  • Medications: Are you taking any medications?
  • Allergies: Do you have any allergies?
  • Environmental exposures: Are you exposed to any irritants, such as cigarette smoke or dust?
Differential diagnoses:
  • Pneumonia: Pneumonia is an infection of the lungs. It is a common cause of cough and difficulty breathing.
  • Bronchitis: Bronchitis is an inflammation of the airways. It can be caused by a viral or bacterial infection, or by exposure to irritants.
  • Asthma: Asthma is a chronic condition that causes the airways to narrow and become inflamed. This can make it difficult to breathe and can lead to coughing and wheezing.
  • COPD: COPD is a chronic lung disease that causes breathing difficulties. It is caused by long-term exposure to irritants, such as cigarette smoke.
  • Congestive heart failure: Congestive heart failure is a condition in which the heart cannot pump blood as effectively as it should. This can lead to fluid buildup in the lungs, which can cause coughing and difficulty breathing.
  • Pulmonary embolism: A pulmonary embolism is a blood clot that travels to the lungs and blocks a blood vessel. This can cause sudden shortness of breath, chest pain, and coughing.
  • Lung cancer: Lung cancer is a type of cancer that starts in the lungs. It can cause coughing, difficulty breathing, and other symptoms.
PFTs to consider:
  • Spirometry: Spirometry is a test that measures how much air you can breathe in and out of your lungs and how quickly you can breathe it out. Spirometry can be used to diagnose asthma, COPD, and other lung diseases.
  • Lung volumes: Lung volumes tests measure the amount of air in your lungs. Lung volumes tests can be used to diagnose restrictive lung diseases, such as pulmonary fibrosis.
  • Diffusing capacity of the lung for carbon monoxide (DLCO): The DLCO test measures how well oxygen passes from the lungs into the blood. The DLCO test can be used to diagnose emphysema and other lung diseases.
PFTs that are contraindicated today:
  • Spirometry: Spirometry is contraindicated in patients who have recently had surgery or who are experiencing severe respiratory distress.
  • Lung volumes: Lung volumes tests are contraindicated in patients who have recently had surgery or who are experiencing severe respiratory distress.
  • DLCO: The DLCO test is contraindicated in patients who have recently had surgery or who are experiencing severe respiratory distress.
Conclusion: DS's presentation is concerning for a number of different lung diseases. The most likely diagnoses are pneumonia, bronchitis, and asthma. However, it is important to consider other diagnoses, such as COPD, congestive heart failure, pulmonary embolism, and lung cancer. PFTs can be helpful in diagnosing lung diseases. However, spirometry, lung volumes tests, and the DLCO test are contraindicated in patients who have recently had surgery or who are experiencing severe respiratory distress. The next step is to obtain a complete medical history and physical examination from DS. This will help to narrow down the differential diagnoses and determine which tests are needed.  

Sample Answer

   

Questions to ask DS to develop differential diagnoses:

  • Onset and duration of cough: When did the cough start? How long has it been going on?
  • Character of cough: Is the cough dry or productive? What color is the sputum? Is the cough associated with wheezing or chest pain?
  • Severity of cough: How often do you cough? Does the cough interfere with your sleep or daily activities?
  • Other symptoms: Do you have any other symptoms, such as fever, shortness of breath, chest tightness, or difficulty breathing?