CASE STUDY:
55-Year-Old Female With Progressive Dyspnea

CLINICAL INFORMATION

PAST MEDICAL HISTORY

Minor surgeries. Denies a history of asthma, prior pneumonia, or chronic lung diseases.

ALLERGIES: Indomethacin (headache and nausea), methylprednisolone (dyspnea), erythromycin (nausea).

SOCIAL HISTORY: The patient is single, resides with her daughter, and has worked in an office for the last 3 years. Rare alcohol use and nonsmoker. For 5 years she has raised cockatiels, which had babies earlier this year. Patient removed birds from her home 2 weeks ago and reported improvement in symptoms.

FAMILY HISTORY: No history of pulmonary disease.

CURRENT MEDICATIONS: Vitamins and herbal remedies

SYSTEMS REVIEW

CONSTITUTIONAL: Fever up to 101°F every 4 to 5 days, occasional chills, flu-like symptoms, joint pain, and headaches. Denies any night sweats. Weight loss of 5 to 10 pounds in the last 9 months.

HEENT: She wears glasses. Experiences occasional dizziness with leaning over. Has had seasonal allergies, predominantly in the spring, for the last 4 years.

PULMONARY: Refer to HPI.

CARDIOVASCULAR: Occasional heart palpitations. Denies any lower extremity edema.

GI: Denies any GERD or dysphagia.

GU: Negative.

MUSCULOSKELETAL: Refers to HPI.

NEURO: Denies any syncopal episodes, strokes, falls, or migraine headaches.

DERM: Negative.

PSYCHOSOCIAL: Negative.

ENDOCRINE: Negative.

VITAL SIGNS: Height: 165.1 cm (64.99 in); weight: 66.68 kg (147 lb); temperature: 36.3°C (97.3°F); blood pressure: 132/78 mm Hg; pulse: 70 bpm (left); respiratory rate: 16 bpm; room air O₂: 98%.

PHYSICAL EXAMINATION

GENERAL: A pleasant, cooperative female in no acute distress.

HEENT: Sclerae anicteric; PERRLA; ear canals and TMs are clear bilaterally; nasopharynx is negative; oropharynx is negative.

NECK: Supple. There is no lymphadenopathy. Thyroid is nonpalpable.

PULMONARY: Clear to auscultation; diminished bibasilarly; no rhonchi or rales.

CARDIOVASCULAR: RRR; no murmur.

ABDOMEN: Soft, nontender, with active bowel sounds. No organomegaly.

EXTREMITIES: No peripheral edema, clubbing, or cyanosis.

PULMONARY FUNCTION TESTS

Patient had some difficulty performing the FVCs and SVCs, coughing throughout the study. She desaturated within 1 minute of exertion.