Pulmonary Case Presentations Please select one case presentation below and provide answers to the following; Three differential diagnoses Definitive diagnosis Management plan (include appropriate treatment/diagnostic tests) Indications for referral and/or consultations (if needed) Health education/lifespan considerations Schedule a F/U appointment Case I: 50 Y/O CM present with C/O dry cough x 4-5 months with 20 year H/O tobacco use of 1PPD for 20 years. Cough has become progressively worse over the past 2-3 weeks with yellow sputum production. Took OTC cough syrup without relief of symptoms. Afebrile at home. No CP or fatigue except with excessive coughing. No HAs or head injuries. No eye pain or drainage. No ear pain or difficulty hearing. Ocass. nasal drainage of clear mucus. No sore throat or difficulty swallowing. No neck pain or stiffness. Some SOB with excessive coughing. Excessive coughing interferes with ability to perform ADLs at times. No other household members with similar symptoms. Temp--97.2 Pulse--94 B/P 140/90 RR- 24 Pulse Ox check-- 86% on Room Air General: Alert, apprehensive but cooperative SKIN: W/D with rapid recoil HEENT: Normocephalic. PERRL, sclera clear, Bil. TMs pearly gray. Boggy, pale nasal mucosa. Oropharynx without erythema or exudate NECK: Supple without LAD (lymphadenopathy) HEART: Tachycardia without murmur, gallops or clicks RESP: Distant lung sounds; positive rales at base with expiratory wheezes Case II: (mom is present and is historian) 3 Y/O Asian male present with 3 day H/O dry cough that’s worse when playing outside near Spring flowers. Took OTC cough suppressant with cough resolved but reoccurred. Afebrile at home. Positive sneezing and itchy eyes at times. Consumes fluid and solid foods without difficulty. Mom reports tiring easily when outside playing with other children in neighborhood. No SOB noted per mom. Remain active and playful. No change in urinary habits with last BM this a.m, of soft brown consistency. Temp--98.4 Pulse--104 B/P 80/68 RR- 26 Pulse Ox check-- 95% General: Alert, cooperative without distress. SKIN: W/D with rapid recoil HEENT: Normocephalic. PERRL, sclera clear, Bil.TMs pearly gray. Boggy, pale nasal mucosa. O/P without erythema, masses, or lesions. Pink, moist mucous membranes. NECK: Supple without LAD HEART: Regular rate and rhythm (RRR) without murmur RESP: Expiratory wheezing without retractions or nasal flaring ABD: Soft, round, NT with positive BS Case III: J. V., a 24-year-old man, is admitted to the emergency department after a motorcycle accident. He is having trouble in breathing and is very upset. The rescue personnel tell you that his breath sounds are absent on the right side, his chest expands unequally, and that there is tracheal shift toward the left. There is a large contusion on his right rib cage. Temp--97.2 Pulse--110 B/P 140/92 RR- 28 Pulse Ox check-- 88% General: Alert & apprehensive SKIN: Cool & diaphoretic; bluish discoloration to right anterior thorax.

1. Pulmonary Case Presentations
Please select one case presentation below and provide answers
to the following;
Three differential diagnoses
Definitive diagnosis
Management plan (include appropriate treatment/diagnostic
tests)
Indications for referral and/or consultations (if needed)
Health education/lifespan considerations
Schedule a F/U appointment
Case I:
50 Y/O CM present with C/O dry cough x 4-5 months with 20
year H/O tobacco use of 1PPD for 20 years. Cough has become
progressively worse over the past 2-3 weeks with yellow sputum
production. Took OTC cough syrup without relief of symptoms.
Afebrile at home. No CP or fatigue except with excessive
coughing. No HAs or head injuries. No eye pain or drainage. No
ear pain or difficulty hearing. Ocass. nasal drainage of clear
mucus. No sore throat or difficulty swallowing. No neck pain or
stiffness. Some SOB with excessive coughing. Excessive
coughing interferes with ability to perform ADLs at times. No
other household members with similar symptoms.
Temp--97.2
Pulse--94
B/P 140/90
RR- 24
Pulse Ox check-- 86% on Room Air
General: Alert, apprehensive but cooperative
SKIN: W/D with rapid recoil
HEENT: Normocephalic. PERRL, sclera clear, Bil. TMs pearly
gray. Boggy, pale nasal mucosa. Oropharynx without erythema
or exudate
NECK: Supple without LAD (lymphadenopathy)
HEART: Tachycardia without murmur, gallops or clicks
RESP: Distant lung sounds; positive rales at base with

2. expiratory wheezes
Case II: (mom is present and is historian)
3 Y/O Asian male present with 3 day H/O dry cough that’s
worse when playing outside near Spring flowers. Took OTC
cough suppressant with cough resolved but reoccurred. Afebrile
at home. Positive sneezing and itchy eyes at times. Consumes
fluid and solid foods without difficulty. Mom reports tiring
easily when outside playing with other children in
neighborhood. No SOB noted per mom. Remain active and
playful. No change in urinary habits with last BM this a.m, of
soft brown consistency.
Temp--98.4
Pulse--104
B/P 80/68
RR- 26
Pulse Ox check-- 95%
General: Alert, cooperative without distress.
SKIN: W/D with rapid recoil
HEENT: Normocephalic. PERRL, sclera clear, Bil.TMs pearly
gray. Boggy, pale nasal mucosa. O/P without erythema, masses,
or lesions. Pink, moist mucous membranes.
NECK: Supple without LAD
HEART: Regular rate and rhythm (RRR) without murmur
RESP: Expiratory wheezing without retractions or nasal flaring
ABD: Soft, round, NT with positive BS
Case III:
J. V., a 24-year-old man, is admitted to the emergency
department after a motorcycle accident. He is having trouble in
breathing and is very upset. The rescue personnel tell you that
his breath sounds are absent on the right side, his chest expands
unequally, and that there is tracheal shift toward the left. There
is a large contusion on his right rib cage.
Temp--97.2
Pulse--110
B/P 140/92
RR- 28

3. Pulse Ox check-- 88%
General: Alert & apprehensive
SKIN: Cool & diaphoretic; bluish discoloration to right anterior
thorax
HEENT: Normocephalic; PERRL, sclera clear, Bil.TMs pearly
gray. Pink, moist nasal turbinates. O/P without erythema,
masses, or lesions. Pink, moist mucous membranes.
NECK: Tracheal deviation to left with neck vein distention
HEART: Tachycardia without murmur gallops or thrills
RESP: Tachypneic; BS absent on RUL & RLL with unequal
chest expansion; decreased tactile fremitus & hyperresonance
on RUL & RLL
ABD: Soft, round, NT with positive BS
MUSC: MAEW without limitation of ROM; strength 5/5 upper
and lower extremities
NEURO: DTRs 2t; no spasticity or tremors of extremities
Case IV:
G. E., a 52-year-old social worker, has been treated for a deep
vein thrombosis for 2 days. He calls the nurse to come to his
room right away. When the nurse arrives, she sees that he is
apprehensive, restless, diaphoretic, and extremely anxious. His
pulse oximetry reading is 82% (previously had been 97% on
room air), heart rate is 116 beats per minute and blood pressure
is 100/56 mm Hg. He is complaining of a sharp chest pain that
gets worse when he breathes in and has shortness of breath.
Temp—101
Pulse--116
B/P 100/56
RR- 26
Pulse Ox check-- 82%
General: Alert & apprehensive
SKIN: Cool & diaphoretic
HEENT: Normocephalic; PERRL, sclera clear, Bil.TMs pearly
gray. Pink, moist nasal turbinates. O/P without erythema,
masses, or lesions. Pink, moist mucous membranes.
NECK: Supple without LAD

4. HEART: Tachycardia with S4
RESP: Tachypnea with rales throughout lung fields
ABD: Soft, round, NT with positive BS
Due in 8 hours with at least 3 APA intext citation no older than
5 years minimum 450 words