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GROUP ACTIVITY 6 PBL Case Design - Group #17 - Coggle Diagram
GROUP ACTIVITY 6 PBL Case Design - Group #17
Chief Complaints
“My chest has been hurting really bad, and I have had a tough time breathing due to shortness of breath. I have stabbing pain in my chest.”
History of Present Illness
“I was recently diagnosed with COPD and had been coughing up a lot of snotty-blood-like stuff. I was also diagnosed with a lung mass a few months ago but denied a CT scan because I don’t have the money.”
Past Medical History
Diagnosed with COPD at age 43.
Diagnosed with lung mass 10 weeks ago
Diagnosed with pneumonia twice in the last year
Sporadic use of OTC cold medications to reduce cough
Surgical History
Patient had a vasectomy at age 31.
Family History
Mother diagnosed with DM Type II
Father died due to complications of coronary artery disease.
Social History
Smokes about a pack of cigarettes a day, for the past 20 years.
Drinks often but in moderation (8-10 drinks a week). According to the patient's wife, the patient becomes verbally abusive and combative after drinking sometimes.
Patient has worked as a school janitor for the past 15 years
Patient denies use of marijuana, vaping devices or cigars
Father died due to complications with coronary artery disease.
“I’ve been having some random leg pain recently, don’t know if that means anything serious, but it's in my calf area.”
“I’ve had a few random coughing spells, where I get so worked up with all of the coughing I start to hyperventilate a bit. I’m usually able to catch my breath after a couple minutes, but it hurts my chest.”
Medications
Albuterol (bronchodilator inhaler) with nebulizer for COPD, 3 or 4 times per day
OTC cold and cough syrup to alleviate constant cough
Allergies
Seafood allergy that causes choking and difficulty breathing
Vaccination Status
Up to date on all recommended & required vaccinations.
List of Possible Differential Diagnosis
Body Systems: respiratory, cardiovascular, cancer, immune system
Pulmonary embolism
Lung Cancer
Myocardial infarction
Collapsed lung
Pulmonary hypertension
Pericarditis
Pleurisy
Pneumonia
Tuberculosis
Asthma
Stroke
Lung Abscess
Lymphoma
Aortic Dissection
Bronchitis
Review of Systems
Gastrointestinal: Experienced constipation, vomiting, and nausea
Genitourinary: Frequent urination
Neurologic: Suddenly experiencing fainting and light-headness
Respiratory: Patient is hypoxic, and coughing spells keep triggering hyperventilation. Sputum is thick and bloody.
Cardiovascular: Patient complains of chest pain, rates the pain 8/10, says it is sharp and stabbing.
How would you manage this disease?
Oral anticoagulants help resolve pulmonary embolism, but will not be effective in treating cancer.
Surgery, chemotherapy, and radiation therapy can all be effective in treating lung cancer, but must be selected and executed carefully due to the PE.
Cessation of smoking, healthier diet, physical activity, and weight loss are all lifestyle changes that benefit the prognosis.
Reflection
Questions for the Learners to Reflect on:
Did you have trouble narrowing down the diagnosis?
Were there any key components of the case that allowed you to confirm or rule out diagnoses?
Important Lessons to Impart to the Learners:
Making a single diagnosis is not always sufficient in the world of medicine, and oftentimes the healthcare provider needs to examine consequences and comorbidities associated with the primary diagnosis in order to effectively treat the ailment.
Look at the bigger picture and not to focus on one small detail
Sources you used for inspiration, reference, images, etc.
https://erj.ersjournals.com/content/19/4/722
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406079/
https://curi.com/news/case-study-pulmonary-embolism/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134828/
Case Presentation
A 47 year old, white, obese male presented to the ER, accompanied by his wife. The patient appeared to have been under the influence of alcohol. The patient also appeared to be struggling to regain his breath.
Multimedia Aspects
“I’ve been having some random leg pain recently, don’t know if that means anything serious, but it's in my calf area.”
"I've had a few random coughing spells where I get so worked up with all of the coughing that I start to hyperventilate a bit. I'm usually able to catch my breath after a couple minutes, but it hurts my chest."
Physical Examination
General appearance: patient had coughing spells resulting in severe SOB with hyperventilation
Neck: Swelling and redness over the vein
Lungs: no respiratory distress but observed positive crackles with minimal rhonchi
Abdomen: minimal RUQ tenderness; no organomegaly or masses
Slight edema in lower extremities
Skin: slightly cyanotic/discolored skin and clammy
MSK: sensation normal and symmetric; gait normal
Neurologic: Oriented & alert, anxious due to SOB
Cardiovascular: unexplained shortness of breath at times
