PBL Case Discussion: Pulmonary

• Part One (graded)

Setting: A free medical clinic that provides health care for the underinsured.

Part 1: The days at the free clinic are always full. People have waited patiently to get an appointment.

Your next patient, Cathy R., age 48, is a regular of the clinic. The chart states she is here for increased difficulty breathing with exercise.

You enter the room and Cathy is standing up looking at a health poster on the wall. She warmly greets you as you introduce yourself. You ask what brings her into the clinic today. “I’m so glad I could get this appointment. I have had more problems breathing this spring than usual. Two months ago I was running 5 miles every day without any problems. Now I can barely run a mile. I am not wheezing, but I feel kind of breathless and just don’t have the energy to keep running.”

• Part Two (graded)

Further questioning for Cathy: Uses < 1 albuterol inhaler/year. Has noticed chest feels a little tight upon waking, has had increased morning headaches and white thin nasal discharge. She denies sputum. No new allergy triggers noted. She denies heartburn.

Discussion Questions Part Two:

1. What is your primary diagnosis for Cathy given the symptoms, exam results, and history? Include the rationale and a reference for your diagnoses.
2. What is your first line treatment plan for Cathy including medications, labs, education, referrals, and follow-up?

• SOAP Note

C.R. 48 yo, F

S.

CC- increased difficulty breathing with exercise

HPI- 2 months ago she was running 5 miles daily without any problems. Now she can barely run a mile without feeling breathless and loss of energy to keep running. Reports she has gotten over a spring cold that lasted over 2 weeks. She had lots of congestion and a bad cough, which is resolving. It has been hard to catch her breath when running, even after using two puffs of albuterol. No chest tightness but has not tried to run without using inhaler.