|Case 1||Case 2||Case 3|
|A 65-year-oldmale with chronic obstructive pulmonary disease (COPD) presents to theclinic with a cough he has had for the past 2 weeks.||A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose||A 75-year-old female reports experiencing pain in her chest while walking up steps today.|
|Subjective||denies chest pain, denies night sweats, admits to having a fever but does not know the temp.||States that hersymptoms began about 12 days ago. She suffers from allergies; she gets arunny nose during the spring-time, pollen season. However, in thewinter, her allergies are not a problem.||Could not sleepprevious night. Feels like an ache or a burning sensation at the centerof sternum. Denies any arm pain, pain was at a scale of 8 in the AM nowit is at a 2. Suffers from History of hypertension, denies heartdisease, denies leg swelling up, denies pain feeling worse when takingdeep breath.|
|VS||(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air.||(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air||BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%|
|General||patient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5?3?; weight 175 lbs||No signs ofacute distress. Patient appears mildly fatigued. She is breathingthrough her mouth. Breathing easily. Voice has a nasal quality to it.||obese female, alert, in no acute distress.|
|HEENT||EYES: no injection, no increase in lacrimation or purulent drainage;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages
|Ear canals: normal;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages
|Atraumatic,normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent,nasopharynx clear, poor dentition multiple carries.|
|Respiratory||lung crackles inLLL, no wheezes or rhonchi noted; does not clear with coughing; dullnessto percussion over the LLL; shallow respirations and is 30, accessorymuscles use not present||CTA AP&L||CTA AP&L|
|Neck/Throat||no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged;
|Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no
|carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy|
|Heart||Regular rate and rhythm, no murmur, S3, or S4||Regular rate and rhythm, no murmur, S3, or S4||S1 and S2 normal without murmur, gallop, or rub|
- What other subjective data would you obtain?
- What other objective findings would you look for?
- What diagnostic exams do you want to order?
- Name 3 differential diagnoses based on this patient presenting symptoms?
- Give rationales for your each differential diagnosis.
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