A 58-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
Resp: AP diameter slightly increased with inward movement of the lower rib cage with inspiration,
Percussion- generalized hyperresonance, + wheezes and rhonchi bilaterally, no crackles, fremitusdecreased, bronchophony-negative
Questions:
What are your differentials? State positive and negatives, what is the most likely diagnosis?
What is the next best diagnostic test? Go into detail about the testing
What is the best initial treatment? Explain why.
What is your management plan for this patient regarding this condition? Include follow-up plan.
What other Health promotion and disease prevention strategies would you initiate? Be specific
INCLUDE 3 or more REFERENCES-APA format- (journal articles, research articles, EBP, national
guidelines. etc.) **No textbook, **NO Wikipedia
Rubric: 5% of grade- Each question is worth 5 points
Each answer will be assessed based on the following criteria:
Is the information given in the response correct?
Is the information given in the response complete-i.e. Does it answer all aspects of the question thoroughly?
Is the answer clear and easy to understand, using correct grammar, punctuation, spelling, etc.?
Are the references/sources included current and appropriate?
Full credit will be given for a correct, complete response that is clear with appropriate references