A 67-year-old male with a smoking history of 120-pack years ...

[LaDunn]

A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness of breath, chronic cough, and wheezing.
 
  On physical examination, patient shows barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields. Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and non-tender. Extremities show no significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and symptoms are characteristic of:
  A. Congestive heart failure
  B. Chronic obstructive pulmonary disease
  C. Asthma
  D. Lung cancer

Question 2

A 44-year-old female comes in for a physical examination. She complains of having trouble losing weight, excessive fatigue, sluggishness, and loss of excessive blood with menses.
 
  On physical examination, there are no significant findings except her BMI of 28 is in the overweight category. What other question(s) would assist in the diagnosis?
  A. Is there a history of thyroid disorders in the family?
  B. Do you feel excessively cold or hot when others are not ?
  C. Have you had a recent upper respiratory infection?
  D. A and B

[emilymalinowski12]

Answer to Question 1

ANS: B
Chronic obstructive pulmonary disease, such as chronic asthma/bronchitis, bronchiolitis, and emphysema, may be associated with fatigue, shortness of breath, cough, and wheezing. The patient in the above scenario shows signs of chronic bronchitis and emphysema. Cough and cyanosis are caused by chronic bronchitis. Barrel-shaped chest and acidosis are caused by emphysema.

Answer to Question 2

ANS: D
Anemia in a middle-aged male is a key sign to investigate. Iron deficiency anemia is commonly a sign of colon cancer in a male; therefore, a colonoscopy is necessary. A digital rectal exam can provide a specimen for hemoccult testing and allow the clinician to palpate the prostate gland. A malignancy any place in the body may cause the patient to feel fatigued. It is often an indirect cause of fatigue, stemming from anemia, shortness of breath, decreased appetite, nausea and vomiting, decreased renal function, or a variety of other symptoms caused by the malignancy. The signs and symptoms depend on the system where the malignancy exists. If a patient presents with a primary complaint of fatigue, an index of suspicion for a malignancy should alert you to ask about other signs or symptoms that patient might have noticed. If malignancy is advanced enough to cause fatigue, there are usually other symptoms present.