FM # 13- 40-year-old male with a persistent cough - Mr.

Dennison

This case begins with Mr. Dennison, a 40-year-old male, with a past medical history
of allergic and now presents with a persistent cough and wheezing for two
months duration. His inferior nasal turbinates show signs of inflammation and has a
persistent clear nasal drainage. Spirometric testing confirmed the diagnosis of
asthma as evident by reversible obstructive disease. This case was a review as
asthma had been dealt with in an earlier case. However, persistent cough and its
differentials including sinusitis were new and I learned the difference between
acute sinusitis and chronic sinusitis. I also learned that patients with asthma can use
peak flow measurements twice a day at home to see if their asthma is under control
or not. Overall a good case reviewing a common presenting symptom in a clinic
setting.

Simple # 28 - 70-year-old man with shortness of breath and leg swelling - Mr. Honig

This case begins with, Mr. Honig is a 70-year-old male, who presents with dyspnea,
productive cough, and weight loss. He has a past medical history of chronic smoking.
His oxygen saturation is 91% on 4 liters of oxygen which is very low and indicating
an underlying pathology. During physical exam, he is noted to have a prolonged
expiratory phase during auscultation and wheezing, edema, and a prominent second
heat sound. He is eventually diagnosed with COPD exacerbation with cor pulmonale.
I did not know that COPD is the fourth leading cause of death in US and cost over
thirty billion dollars per year in direct and indirect costs, so it is not only a
significant source of morbidity but also mortality. I learned that BNP may be
elevated in those with right heart failure from chronic lung disease such as cor
pulmonale but one must be careful as BNP is excreted by kidneys so renal failure
can elevate BNP falsely. Overall a good case that reviews COPD but also adds the
complication of cor pulmonale with it.