Case: 70-year-old male who complains of having a cough for several years
and shortness of breath on exertion

Past Medical & Surgical History

• Hiatal hernia with GERD
• Fundoplication 10 years prior
• HTN
• Nephrolithiasis

Allergies

• NKA

Medicines

• Fluticasone propionate (50 mcg nasal spray) 2 sprays each nostril qd
• Tiotropium bromide oral inhalation qd
• Fluticasone/salmeterol (100 mcg/50 mcg) 1 puff bid
• Pantoprazole 40 mg bid
• Clopidogrel 75 mg per day

Family History

• Noncontributory

Social History

• 60-pack/year smoking history but quit 20 years ago. Regular ETOH use but quit 6 months ago.

Occupational History

• Retired executive with no known exposure history

Travel History

• Noncontributory

Review of Systems

• Normal except as noted in HPI and PMH

Physical Examination

• General: WD, WN male in NAD
• Vital Signs: Temp: Afeb   BP: 132/70      Pulse:   76        RR: 18 O₂: 98% RA 
• Weight: 96.5 kg
• HEENT: Normocephalic and atraumatic, PERRLA
• Neck: supple without thyromegaly
• Cardiovascular System: RRR, NL S1, S2, no murmurs, rubs or gallops
• Respiratory System: Mild Velcro-like crackles at Right Lung Base. No wheezing
• Breast Exam: NA
• Extremities: No CCE
• Abdomen: NABS, soft nontender without organomegaly
• Lymphatic System: No palpable nodes
• Musculoskeletal System: Nonfocal
• Neurological: Nonfocal
• Skin: Warm, dry and clear