Wendell Marty Case Studies

Lab Tests and Results: The patient lab result shows a left shift with WBC, which indicates inflammation or possible infection. Her chest x-ray (CXR) shows hyperinflation of bilateral lungs with increased AP diameter and the electrocardiogram (EKG) indicate normal sinus rhythm.

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

An elderly patient is complaining of a bad cough at her yearly physical. She has recently been diagnosed with diabetes and regularly takes prescription pain medication for her arthritis.

HPI: Margaret Elliot is a 52-year-old Caucasian female that is presenting with shortness of breath that has recently worsen. Mrs. Elliot states that her problems began 20 years ago when she had bronchitis, which she consistently has 2-3 times a year. She said that her symptoms have been getting worse the last 2.5 month, but have severely worsen over the past three days. She states that it has been restricting her daily activities and has been troubling her while sleeping lying down. She states that her symptoms improve alittle when she takes her medications. She also states that her symptoms worsen when she tries to walk across the room

Such patients endure a long list of sleep issues including insomnia, alpha wave intrusions, obstructive sleep apnea (OSA), narcolepsy, and restless leg syndrome.

----- Clinic presents a black male 68 years old. Currently experiencing dyspnea and lethargy. For the past week he has been having a increase of difficulty breathing. Complains of alternating periods of sweating and chills. Other symptoms he has been experiencing is a productive cough with expectoration of thick yellow sputum. Patient is a ex- smoker, he was a 40 pack year history, denies smoking, stopped over 10 years ago. Medical history includes chronic bronchitis, hypertension, MI five years ago, has had a angioplasty, and denies chest pain since having angioplasty. Current medication combined albuterol/ipratropium MDI, nebulized albuterol prn, captopril, and hydrochlorothiazide.

This is 51 year old AAF. Patient is here complaining of several issues as listed. Patietn reports for the past several days she had increased SOB at rest, non-productive cough, adiouble wheezes. Patient denies chest pain, N/V/ D. Patient is a current tobacco user wit 20 pack year hisotyr. Denies use of alcohol or illicit drug use. Denies depressive moods, current pain 3/10.

Moving forward, if Lysbet's heart scan is clear, another possibility for the chest tightness and shortness of breath is that of asthma. She had normal lung function tests with us, but I have suggested that if the heart test was clear, she could trial some Ventolin to see if she has any symptomatic benefit and if so, perhaps even an extended trial of an inhaled corticosteroid.

I have caught up with Bronwyn around five months since her last appointment. In early July, Bronwyn stopped Symbicort having taken the lower strength 100/3 inhaler for a couple of months. The plan was to perform a mannitol provocation test off inhaled steroids. Within ten days, Bronwyn noticed a recurrence of symptoms with wheeze and dry cough, thus I instructed her to recommence Symbicort. Again her symptoms settled and on review today, se feels quite well.

Presently, experiencing a cough, fatigue, fever of 100°F, and increased shortness of breath with activity for the past 5 days. Patient reports productive, “cough is a large amount of thick, tan sputum occurring day, and night, worse at night when lying on my back”. In the mornings John K has a thick, productive cough of “whitish sputum” for the last 18 months. Admits to sleeping with two pillows at night for comfort. John K, has difficulty breathing with climbing one flight of stairs and intercourse. In evaluating John K, presented sitting in tripod position with active mild respiratory distress, physically fatigued, oxygen saturation of 92% room air, respirations 24 (shallow), and temperature 99.8°F. Further physical findings identify early finger nail clubbing, moderate use of the abdominal muscles as evidence in compensating to breath, bilateral tympany on percussion, diffuse coarse crackles and few scattered end expiratory wheezes throughout bilateral lung fields. Electrolyte lab values within normal limits (no evidence of infection), ruling out pneumonia and chronic bronchitis. Chest x ray results COPD confirmed, ruling out pneumonia and chronic bronchitis. Sputum sample results normal flora congruent to COPD with no evidence to bacteria growth or pathogens identified, ruling out pneumonia and chronic bronchitis. Diagnostic

Data gathered tonight includes electrocardiogram is unchanged from previous showing slightly low voltage, left anterior fascicular block. No definite ischemic changes. White count of 6.2, hemoglobin 11.00, platelets 117, glucose 90, BUN 43, creatinine 2.56, sodium of 138, potassium of 3.4, chloride 106, CO2 of 24.8, calcium of 8.2, bilirubin 0.92, alkaline phosphatase 307, ALT of 23, AST of 21, magnesium of 1.8, a troponin is 0.06, BNP is 2650. Labs done almost 24 hours ago had a lower BUN at 41, and a lower creatinine 2.23, a higher potassium at 3.7, BNP that was higher earlier at 3350, and a troponin that was slightly less at 0.04. Chest x-ray may have more congestion now than previous. Frontal view this morning was obtained the radiologist says the findings are concerning for minimal congestion versus atelectasis in lung bases and a stable mild to moderate cardiac

Thank you very much for referring Pamela on for her long-term issues with sleep. She describes both sleep onset and sleep maintenance issues and has essentially free running circadian rhythm. She will go to bed anywhere from 10.00pm to 2.00am and have a lot of trouble getting to sleep. She does find though that if she goes to bed at a later time, particularly 2.00am, that she does sleep better and will often then arise from bed at between 9.00am and 10am. She arises unrefreshed and has excessive daytime sleepiness throughout the day and will often fall asleep in passive situations. Reassuringly, she is not drowsy whilst driving.

She was seen by her new primary care provider to present episodic cough, dry, irritative, in paroxysms and nocturnal predominance also exacerbating by physical exercise in her case by swimming. She cannot precisely when this problem began to develop, just refer periods of a lot of coughs. No concerns during this period of evolution of other accompanying symptoms. There has been no runny nose and catarrh of the upper airways, has not presented fever or concerns epigastric discomfort or heartburn. She has received several treatments that included several antitussive (dextromethorphan, chlorpheniramine, Dimetapp) with no obvious improvement of the acute episode. The patient has not sought any other treatment. Otherwise the patient reports that she is in good health.

However, obstructive sleep apnea is just the opposite in which, it affects around two to four percent of kids’. The results of sleep

Yes I would order a chest x ray due to the duration of her cough, the fact that it is post infectious, her age, and to evaluate for pneumonia and masses. Due to the duration of the cough and the fact that her cough is becoming productive with yellow sputum, I would tell the patient she probably started out with a viral bronchitis that now could be transitioning into a bacterial bronchitis and/or Pertussis and I would prescribe an antibiotic that will cover both: Azithromycin 500mg PO day 1, then 250mg PO Daily X 4 days. I would instruct her to buy over the counter mucinex take as directed on box, and drink plenty of fluids. If the cough does not improve in 3 weeks have her follow up.