Case Part 1: The Man who Lost His Breath

Instructions:

It’s time to meet our patient, Bob! Below is the transcript of your interview with him in the Emergency Department. You’re going to be asked to think like a doctor here to help diagnose and treat this patient!

The Interview

When you are interviewing a patient, you need to collect a lot of key information:

  • Who are they?

    • Name, age, gender

  • What is their overall health like?

    • Past medical history -- any diseases or medical problems they currently have or had in the past

    • Past surgical history -- any surgeries they’ve had

    • Medications

    • Allergies

    • Family history -- any diseases that run in the family

    • Social history -- What is their life like? Do they work? Where do they live and in what type of conditions? Who do they live with? Do they drink, smoke or use drugs?

      • This helps us understand potential causes of their medical condition, as well as develop a treatment plan with the patient that is compatible with their lifestyle.

  • Why are they here today?

    • Chief complaint -- What is the #1 problem that brought them into the hospital today?

    • History of present illness -- the storyline behind this problem that brought them into the hospital

While you are reading through the interview, print this table or create a similar table to fill out with your notes to keep track of all of the information you learn:

Student Doctor (You): Hi, it’s nice to meet you! I am the student doctor who will be taking care of you today. What is your name? What is your age and what gender do you identify with?

Bob (Patient): My name is Bob and I’m 65 years old. I identify as a man.

Source: Verywell Health

Student Doctor (You): I heard you’re not feeling so well. What brings you into the clinic?

Bob (Patient): I’ve been having a hard time breathing.

Student Doctor (You): Can you tell me more about that?

Bob (Patient): It started about a week ago and keeps getting worse. I also think I’ve had a fever. I’ve been coughing and feeling really tired. I don’t know how I got sick because I don’t know anyone around me who has been sick.

Student Doctor (You): What is your health normally like?

Bob (Patient): I have a lung disease called COPD (more on this in the next section) and it affects my life a lot. I usually get a little short of breath when climbing stairs or walking long distances, and cough every day because of my COPD. However, I noticed I am much more short of breath than normal and have been coughing a lot more.

Student Doctor (You): Do you have any other health problems?

Bob (Patient): I also have high blood pressure.

Student Doctor (You): Have you ever had surgery before?

Bob (Patient): I had my appendix removed 40 years ago.

Student Doctor (You): Do you take any medications?

Bob (Patient): I take a pill for my high blood pressure and use some inhalers for my COPD. I don’t know the names.

Student Doctor (You): Do you have any allergies?

Bob (Patient): No.

Student Doctor (You): Do any diseases run in your family?

Bob (Patient): My father had a heart attack and my mom had cancer.

Student Doctor (You): Can you tell me about your day-to-day life?

Bob (Patient): I am retired -- I used to work in construction but can’t anymore because of my breathing issues. I live alone in an apartment in Boston. In the last 2 weeks, I have had a few doctor's appointments and had to go to the pharmacy to pick up medications a few times, as well as go to the grocery store. I used to smoke cigarettes and smoked 2 packs of cigarettes a day for 35 years, but I quit 10 years ago. I do not drink alcohol or use other drugs.

Check-in 2:

Complete the quiz below before moving on

Physical Exam

Nurse Morgan: Would you like me to perform a physical exam on the patient?

Student Doctor (You): Yes please. Could you pay extra attention to how the lungs sound?

Source: UCSD

Nurse Morgan: Most of the physical exam was normal, however, the lungs do not sound clear. Here are the sounds I’m hearing in the lungs:

Crackles and Wheezing

Student Doctor (You): Thank you so much. What are the patient’s vital signs?

Nurse Morgan:

Key:

Heart rate - also known as the pulse. How many times your heart beats a minute.

Blood pressure - the pressure in your blood vessels when the heart is squeezing (number on top= systolic blood pressure) and when the heart is relaxed (number on bottom= diastolic blood pressure).

Temperature - body temperature

Oxygen saturation - percent of hemoglobin (protein in blood that binds oxygen) that is currently carrying oxygen

Respiratory rate - how many times you breathe in a minute

Check-in 3:

Complete the quiz below before moving on:

Nurse Morgan: I rechecked Bob’s vitals after I gave him the treatment, here they are:

Check-in 4:

Complete the quiz below before moving on

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