Level 1: Dizziness – Contrasting Case #3: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 65 year old man whose symptoms he describes as light headedness.

HPI: He has not seen a doctor in 15 years. For the past year, he has experienced lightheadedness when walking up flights of stairs or after vigorously walking the dog. Over the past week, this lightheadedness has been constant and he has also been short of breath. His niece spent the weekend with him 10 days ago and had a “head cold.”

PMH: No significant cardiac events or congenital diseases.

PE: Cardiovascular exam reveals a heart rate of 90 beats per minutes and is regular, no murmurs/gallops/rubs/clicks. Respiratory exam reveals a 1:1 anterior to posterior ratio and pursed lip breathing. Auscultation reveals a prolonged expiratory phase and decreased breath sounds throughout all lung fields.

Labs: Chest X-Ray shows flattening of the diaphragms. Hemoglobin of 17.7 mg/dl)