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“I have a cough that won’t go away.”
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History of Present Illness
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A 63-year-old male presents to the emergency department with complaints of cough/shortness of breath which he attributes to a “nagging cold.” He states he fears this may be something worse after experiencing hemoptysis for the past 3 days. He also admits to waking up in the middle of the night “drenched in sweat” for the past few weeks. When asked, the patient denies ever having a positive PPD and was last screened “several years ago.” His chart indicates he was in the emergency department last week with similar symptoms and was diagnosed with community-acquired pneumonia and discharged with azithromycin.
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Hypertension, dyslipidemia, COPD, atrial fibrillation, generalized anxiety disorder
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Father passed away from a myocardial infarction 4 years ago; mother had type 2 DM and passed away from a ruptured abdominal aortic aneurysm
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Retired geologist recently moved from India to live with his son who is currently in medical school in upstate New York. Smoked ½ ppd × 40 years and drinks 6 to 8 beers per day, recently admits to drinking ½ pint of vodka “every few days” since the passing of his wife 6 months ago.
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Sulfa (hives); penicillin (nausea/vomiting); shellfish (itching)
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Albuterol metered-dose-inhaler 2 puffs q4h PRN shortness of breath
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Atorvastatin 40 mg PO daily
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Budesonide/formoterol 160 mcg/4.5 mcg 2 inhalations BID
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Clonazepam 0.5 mg PO three times daily PRN anxiety
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Lisinopril 20 mg PO daily
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Metoprolol succinate 100 mg PO daily
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Tiotropium 2 inhalations once daily
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Venlafaxine 150 mg PO daily
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Temp 100.8°F, P 96, RR 24 breaths per minute, BP 150/84 mm Hg, pO2 92%, Ht 5′10″, Wt 56.4 kg
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Slightly disheveled male in mild-to-moderate distress
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Normocephalic, atraumatic, PERRLA, EOMI, pale/dry mucous membranes and conjunctiva, poor dentition
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Bronchial breath sounds in RUL
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Soft, non-distended, non-tender, (+) bowel sounds