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 33 year old man who presents to the clinic with a cough. He states that approximately 10 days ago he began to develop a persistent, “hacking” cough. He states that nothing seemed to make the cough better. He reports that typically taking a deep breath causes him to cough. He states that his cough has been productive of small amounts of white, thick sputum that sometimes has a “greenish tinge” to it. He denies experiencing any hemoptysis. During this time he has also been feeling “chest congestion” and that he has been becoming increasingly short of breath on exertion. He denies any precipitating factors or prior occurrence, but does state that his wife had similar symptoms a few weeks ago.
FMH: Father, mother and sister all alive and healthy
SH: Patient works at the local high school as a math teacher and football coach. He lives with his wife and 2 daughters. He reports only “having a couple of beers” once a month. He states that he occasionally chews tobacco during football practice, but denies ever smoking cigarettes.
General: No recent unintended weight changes. He reports that it feels like he has been feverish off and on, but no report of an objective fever.
HEENT: Reports having a headache off and on during the last several days. No rhinorrhea, otorrhea or otalgia. No epistaxis.
Cardiovascular: Mild chest discomfort from frequently coughing. No palpitations.
Respiratory: Complains of feeling like he is wheezing when he breathes. No pleuritic pain.
Physical Examination –
VS: Height 6’2’’, Weight 230lbs, BMI 29.5 HR 60, BP 124/88, RR 12, Temperature 97.8
General Appearance: Patient is in no acute distress, but coughs frequently.
HEENT: Normocephalic, atraumatic, PERRLA, examination of nasopharynx and oropharynx is unremarkable with no erythema or exudates. Uvula is pink, moist, and midline. Tympanic membranes are unremarkable bilaterally.
Cardiac: Normal S1, S2 present with no rubs, gallops, or murmurs.
Lungs: Expiratory wheezes present bilaterally in all posterior lung fields. Percussion to posterior lung fields reveals resonance bilaterally.