Primary Care Discussions

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  • You are seeing a 55-year-old college professor in clinic today. He is complaining of a non-productive cough for the past 10 years. He states that he has “tried everything” for the cough without improvement. He denies heartburn, allergies, or any history of asthma. He is a non-smoker, no history No ACE inhibitor use. He has no other constitutional symptoms. Physical exam without significant findings.

Questions:

  1. What additional questions may you ask this patient?
  2. What additional objective data will you assess for?
  3. What tests (if any) will you order?
  4. Will you be looking for a consult?
  5. What is your plan of care?
  6. What additional patient teaching is needed?

 

 

 

 

 

 

2) A 66-year-old woman presents to your office complaining of shortness of breath and bilateral leg edema that has been worsening for three months. She emphatically tells you, “I get out of breath when I do housework, and I can’t even walk to the corner.” She has also noticed difficulty sleeping secondary to a dry cough that wakes her up at night and further worsening of her shortness of breath while lying flat. It has forced her to use three pillows for a good night’s sleep. She denies any chest pain, wheezing, or febrile illness. She has no past diseases and takes no medications. She never smoked and drank socially.

On examination, her blood pressure (BP) is 187/90 mm Hg, her pulse is 97 beats/min, her respiratory rate is 16 breaths/min, her temperature is 98°F (36.6°C), and her oxygen saturation is 93% on room air by pulse oximetry. She has a pronounced jugular vein. The cardiac examination reveals a pansystolic murmur. Examination of her lung bases produces dullness bilaterally. You find 2+ pitting edema of both ankles. An electrocardiogram (ECG) shows normal sinus rhythm, and a chest x-ray demonstrates mild cardiomegaly with bilateral pleural effusions.

Questions:

  1. What additional subjective data do you think the patient will share?
  2. What other objective data will you assess?
  3. What tests will you order?
  4. Will you be looking for a consult?
  5. What is your plan of care?

 

 

 

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