Paul Lambert OSCE Case

Question 1

Opening Statement

Answer 1

I have a cough that is getting worse

Question 2

Current Episode

Answer 2

I started coughing when playing in the yard with my grandkids. I coughed up streaks of blood with mucus so I went to the ER with my wife.

Question 3

Past episode

Answer 3

I climbed up the stairs in my home and could not catch my breath. I coughed up greenish-yellow mucus with streak of bloods

Question 4

Any shortness of breath

Answer 4

Yes, I had various episodes of shortness of breath and productive cough

Question 5

Duration of Shortness of Breath

Answer 5

6 months

Question 6

Any Cough

Answer 6

Yes the cough is produced from the shortness of breath producing mucus

Question 7

Description of Cough

Answer 7

I feel like my chest tightens in each episode when I start coughing. I been wheezing a lot

Question 8

Any attempted over the counter medication

Answer 8

I used an inhaler

Question 9

Past Medical History

Answer 9

1. COPD (Emphysema) 2. Pneumonia: treated outpatient (10 years ago) and hospitalization (7 years ago) 3. Hypertension

Question 10

How long for the hypertension was diagnosed?

Answer 10

10 years ago

Question 11

Do you smoke

Answer 11

I smoke 1 pack of cigarettes per week for past 40 years. I stopped smoking 3 days ago due to illness

Question 12

Do you drink alcohol

Answer 12

No

Question 13

Do you used any recreational drugs

Answer 13

No

Question 14

Are you married

Answer 14

married to a woman for about 40 years ago

Question 15

Do you have children

Answer 15

Yes, I have 2 children and 3 grandchildren

Question 16

Presenting Situation

Answer 16

66-year-old man presents to the ER complaining of worsening cough

Question 17

Lung Exam

Answer 17

Scattered expiratory, wheezes bilaterally

Question 18

Tactile fremitus

Answer 18

decreased fremitus throughout the exam

Question 19

Family Medical History

Answer 19

No major illnesses

Question 20

Any contact with sick ones

Answer 20

I have not been around anyone sick recently

Question 21

Past surgical history

Answer 21

None

Question 22

Fatigue

Answer 22

For the past 6 months, I noticed increasing fatigue

Question 23

Any weight loss

Answer 23

Have unintentional weight loss of 20 lbs. over the last 3 months

Question 24

Any recent travel

Answer 24

I recently travel to my son ranch in Arizona about 6 or 7 months ago

Question 25

Any shaking chills

Answer 25

No

Question 26

Any night sweats

Answer 26

No

Question 27

Any chest pain

Answer 27

No

Question 28

Any sick contact

Answer 28

No

Question 29

Any bad breath

Answer 29

No

Question 30

Any surgical history

Answer 30

None

Question 31

Do you work?

Answer 31

No I am a retired postal worker

Question 32

Duration of worsening cough

Answer 32

3 days