H&P
Patient is a 62-year-old Caucasian male who comes into the office with a complaint of shortness
of breath. He has been having a cough intermittently for the past 6 months but frequent and
worse in the morning. He has a productive cough with whitish-yellow phlegm. The cough is
aggravated with activity and is relieved with rest. Patient has tried OTC medication such as:
Robitussin DM but without no relief of symptoms. He is unable to walk more than 20 feet
without stopping to catch is breath. Same time last year, he was able to walk a mile without
difficulty breathing. Patient denies any fever,chills weight loss,otalgia and otorrhea, rhinorrhea,
nasal congestion, sneezing or post nasal drip, tenderness or swelling in neck. Complain of chest
pain due to cough. He has a history of hypertension and surgical history of cholecystectomy and
appendectomy. He is allergic to Penicillin which causes hives. He is a former smoker (20-packs
a year). Patient currently takes Metoprolol Succinate ER 50 mg daily and MVI daily.
Auscultation of bilateral lungs with expiratory wheezes in based.
Differentials
1. COPD is a progressive lung disease. It is a chronic inflammatory lung disease that causes
obstructed airflow from the lungs (Qureshi, Sharafkhaneh, & Hanania, 2014). Pertinent
finding: Wheezing, shortness of breath, mucus in the morning, phlegm is white/yellow
and chronic cough.
2. Bronchiectasis is a chronic condition where the walls of the bronchi are inflamed
(Amalakuhan, Maselli, & Martinez-Garcia, 2015). Pertinent finding: chronic daily cough,
wheezing, chest pain, SOB.
3. Pneumonia is where the air sacs are inflamed in one or both lungs caused by an infection,
usually bacterial (Thompson, 2016). The air sacs may fill with fluid or pus which can
cause cough with phlegm, fever, chills, and difficulty breathing.Pertinent findings: cough.
Diagnostics:
In order to properly diagnosis the patient it is important to order exams:pulmonary function test,
chest x-ray and CT scan of the chest, arterial blood gas and lab test (Mayo Clinic, 2017). The
patient is a former smoker. These diagnostic test would prove the pertinent information to
correctly diagnosis the patient from the three possible differential diagnosis. According to the
Lung Association in 2019, the most reliable way to diagnose COPD is the use of spirometry
Amalakuhan, B., Maselli, D. J., & Martinez-Garcia, M. (2015). Update in bronchiectasis 2014.
American Journal of Respiratory and Critical Care Medicine, 192(10), 1155-1161.
Breathe The Lung Association (2019). Chronic obstructive pulmonary disease (COPD). retrieved
from: https://www.lung.ca/lung-health/lung-disease/copd/diagnosis
Mayo Clinic (2017), Copd. retrieved from:
https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685
Qureshi, H., Sharafkhaneh, A., & Hanania, N. A. (2014). Chronic obstructive pulmonary disease
exacerbations: Latest evidence and clinical implications. Therapeutic Advances in Chronic
Disease, 5(5), 212–227. doi:10.1177/2040622314532862
Thompson, A. E. (2016). Pneumonia, JAMA 315(6), 626.
Patient is a 62-year-old Caucasian male who comes into the office with a complaint of shortness
of breath. He has been having a cough intermittently for the past 6 months but frequent and
worse in the morning. He has a productive cough with whitish-yellow phlegm. The cough is
aggravated with activity and is relieved with rest. Patient has tried OTC medication such as:
Robitussin DM but without no relief of symptoms. He is unable to walk more than 20 feet
without stopping to catch is breath. Same time last year, he was able to walk a mile without
difficulty breathing. Patient denies any fever,chills weight loss,otalgia and otorrhea, rhinorrhea,
nasal congestion, sneezing or post nasal drip, tenderness or swelling in neck. Complain of chest
pain due to cough. He has a history of hypertension and surgical history of cholecystectomy and
appendectomy. He is allergic to Penicillin which causes hives. He is a former smoker (20-packs
a year). Patient currently takes Metoprolol Succinate ER 50 mg daily and MVI daily.
Auscultation of bilateral lungs with expiratory wheezes in based.
Differentials
1. COPD is a progressive lung disease. It is a chronic inflammatory lung disease that causes
obstructed airflow from the lungs (Qureshi, Sharafkhaneh, & Hanania, 2014). Pertinent
finding: Wheezing, shortness of breath, mucus in the morning, phlegm is white/yellow
and chronic cough.
2. Bronchiectasis is a chronic condition where the walls of the bronchi are inflamed
(Amalakuhan, Maselli, & Martinez-Garcia, 2015). Pertinent finding: chronic daily cough,
wheezing, chest pain, SOB.
3. Pneumonia is where the air sacs are inflamed in one or both lungs caused by an infection,
usually bacterial (Thompson, 2016). The air sacs may fill with fluid or pus which can
cause cough with phlegm, fever, chills, and difficulty breathing.Pertinent findings: cough.
Diagnostics:
In order to properly diagnosis the patient it is important to order exams:pulmonary function test,
chest x-ray and CT scan of the chest, arterial blood gas and lab test (Mayo Clinic, 2017). The
patient is a former smoker. These diagnostic test would prove the pertinent information to
correctly diagnosis the patient from the three possible differential diagnosis. According to the
Lung Association in 2019, the most reliable way to diagnose COPD is the use of spirometry
Amalakuhan, B., Maselli, D. J., & Martinez-Garcia, M. (2015). Update in bronchiectasis 2014.
American Journal of Respiratory and Critical Care Medicine, 192(10), 1155-1161.
Breathe The Lung Association (2019). Chronic obstructive pulmonary disease (COPD). retrieved
from: https://www.lung.ca/lung-health/lung-disease/copd/diagnosis
Mayo Clinic (2017), Copd. retrieved from:
https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685
Qureshi, H., Sharafkhaneh, A., & Hanania, N. A. (2014). Chronic obstructive pulmonary disease
exacerbations: Latest evidence and clinical implications. Therapeutic Advances in Chronic
Disease, 5(5), 212–227. doi:10.1177/2040622314532862
Thompson, A. E. (2016). Pneumonia, JAMA 315(6), 626.
