Nr601Week 2: COPD Case Study Part 1

Purpose

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1)  (CO,2,3,4,5)
2. Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)
3. Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)

Due Date: 

Student enters initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT.

A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible:  50

Case Study – Part 1

Date of visit: November 20,2019

A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.

History of Present IllnessOnset6 monthsLocationChestDurationCough is intermittent but frequent, worse in the AMCharacteristicsProductive; whitish-yellow phlegmAggravating factorsActivityRelieving factorsRestTreatmentsTried Robitussin DM without relief of symptoms SeverityUnable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficultyReview of Systems (ROS)ConstitutionalDenies fever, chills, or weight lossEarsDenies otalgia and otorrheaNoseDenies rhinorrhea, nasal congestion, sneezing or post nasal drip.ThroatDenies ST and rednessNeckDenies lymph node tenderness or swellingChestDescribes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.CardiovascularDenies chest pain and lower extremity edema

HistoryMedicationsMetoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin dailyPMHPrimary hypertensionPSHCholecystectomy, appendectomyAllergiesPenicillin (hives)SocialMarried, 3 childrenSenior accountant at a risk management firmHabitsFormer smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.FHFather died of MI & CHF at age 59 years (diabetes, hypertension, smoker)Mother is alive (osteoporosis)Healthy siblings

Physical exam reveals the following:

Physical ExamConstitutionalAdult male in NAD, alert and oriented, able to speak in full sentencesVSTemp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RAHeadNormocephalicEarsTympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.NoseNares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.ThroatOropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.NeckNeck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVDCardiopulmonaryHeart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.AbdomenSoft, non-tender. No organomegaly

Requirements/Questions:

1. Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
4. Rank the differential in order of most likely to least likely.
5. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.

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