WEEK TWO CASE STUDY
A 50-year-old man presents with a 5 month history of daily non-productive cough. He reports that the cough is somewhat worse at night and is accompanied by some voice raspiness, but he denies breathlessness or wheezing. There is no hemoptysis. He denies a history of heartburn or known gastroesophageal reflux. He has never smoked and has had no prior lung problems. His past medical history is notable for hypertension, and he is currently being treated with a beta blocker but not with an angiotensin-converting enzyme (ACE) inhibitor. On physical examination, his blood pressure is 155/88 in his right arm sitting. Examination of the head, eyes, ears, nose, and throat shows some clear nasal discharge but no sinus tenderness. His chest is clear to percussion and auscultation. Cardiac examination is unremarkable, as is the remainder of the physical examination. Laboratory tests available at this initial …show more content…
In this case we should note the patients pre-existing hypertension. His blood pressure was taken during physical examination, at 155/88. A chest x-ray was taken and shows a normal-sized heart and clear lung fields with no pleural effusions. Examination showed clear nasal discharge. His current medications include a beta blocker without an angiotensin-converting enzyme (ACE) inhibitor. Auscultation shows clear breath sounds.
Assessment
The fact that he is experiencing more symptoms at night suggests that he is experiencing orthopnea. We can rule out emphysema since he has no history of smoking or wheezing and his chest x-ray shows clear lung fields. We can rule out pneumonia and other infections since he has clear nasal discharge and breath sounds so infection is unlikely. Beta blockers that block B2 receptors may cause shortness of breath in asthmatics. Serious side effects of beta blockers include bronchospasms.
A 50-year-old man presents with a 5 month history of daily non-productive cough. He reports that the cough is somewhat worse at night and is accompanied by some voice raspiness, but he denies breathlessness or wheezing. There is no hemoptysis. He denies a history of heartburn or known gastroesophageal reflux. He has never smoked and has had no prior lung problems. His past medical history is notable for hypertension, and he is currently being treated with a beta blocker but not with an angiotensin-converting enzyme (ACE) inhibitor. On physical examination, his blood pressure is 155/88 in his right arm sitting. Examination of the head, eyes, ears, nose, and throat shows some clear nasal discharge but no sinus tenderness. His chest is clear to percussion and auscultation. Cardiac examination is unremarkable, as is the remainder of the physical examination. Laboratory tests available at this initial …show more content…
In this case we should note the patients pre-existing hypertension. His blood pressure was taken during physical examination, at 155/88. A chest x-ray was taken and shows a normal-sized heart and clear lung fields with no pleural effusions. Examination showed clear nasal discharge. His current medications include a beta blocker without an angiotensin-converting enzyme (ACE) inhibitor. Auscultation shows clear breath sounds.
Assessment
The fact that he is experiencing more symptoms at night suggests that he is experiencing orthopnea. We can rule out emphysema since he has no history of smoking or wheezing and his chest x-ray shows clear lung fields. We can rule out pneumonia and other infections since he has clear nasal discharge and breath sounds so infection is unlikely. Beta blockers that block B2 receptors may cause shortness of breath in asthmatics. Serious side effects of beta blockers include bronchospasms.