Chronic
Respiratory System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M14_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027re still reminiscing over that fantastic pizza you had last night as you walk into your office, partly because it\u0027s going to mean extra hours at the gym.\n\n\u0022Definitely worth it,\u0022 you tell yourself.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M14_F2.jpg"}},{"insert":"\n\n"},{"insert":"The first consult this afternoon is Mr. Robertson, a smiling 72-year-old man referred by his family physician with complaints of dyspnea.\n\nAs he describes his problem, you take note that he is dyspneic even for ordinary activities like climbing a single flight of stairs. He also complains of an unproductive cough that worsens in the evening.\n\n\u0022Do you have any other issues with your health, Mr. Robertson?\u0022 you ask, and he tells you he has hypertension (\u0022Always well controlled, doctor!\u0022 he beams), dyslipidemia (\u0022Well controlled also!\u0022) and a \u0022hay fever\u0022 since the age of fifteen.\n\nOn further questioning, he says that he has been smoking since he was 21 years old, a total of 39 pack-years. He also drinks a glass of red wine with lunch and dinner.\n\nHe proudly adds that he has never been hospitalized.\n\nHe lays his medication out on the table and you see boxes of telmisartan 40mg\/day, atorvastatin 10mg\/day and hydroxyzine 25mg as necessary.\n"}]}
2
{"ops":[{"insert":"You request to examine him and he nods in assent.\n\nMr. Robertson\u0027s BP is 136\/82 mmHg, pulse is 74 bpm and saturation on ambient air is 93%. He has bimaleolar edema. Cardiopulmonary auscultation is unremarkable, as is the rest of the systemic exam.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M14_F4.jpg"}},{"insert":"\n\n"},{"insert":"You discuss the possible differentials, and the need for further tests. For his next visit, you request a basic blood analysis, spirometry, echocardiography, ECG and CT of the thorax.\n\nAs you hand him the prescription for the tests and schedule a follow up appointment, Mr. Robertson looks puzzled. \u0022How about some medication, doctor? Won\u0027t you give me something for my breathlessness?\u0022\n"}]}
4
{"ops":[{"insert":"How do you respond?\n"}]}
1. "Of course," you answer, and write a prescription for a formoterol/budesonide combination inhaler and oral furosemide 40 mg/day
2. "Not yet, Mr. Robertson. In order to accurately diagnose the cause of your breathlessness I need you to do these tests first"
6
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7
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5
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