Background

L.J. is a 65-year-old Hispanic male who presents to the office with increased shortness of breath that has gotten worse over the last few months. He reports that having shortness of breath is nothing new, but he has recently started to feel shortness of breath when he is performing his daily activities. He denies any fever, contact with any sick individuals or any weight loss. Other than the shortness of breath, he indicates that he has a chronic cough that is occasionally productive of whitish sputum. He has a 65-pack-year history of cigarette smoking. He is in the clinic today because of his concern about his worsening shortness of breath.

PMH

L.J. has a history of hypertension, cataracts, and osteoarthritis

Current Medications

Ibuprofen 600 mg po TID

Lisinopril 20 mg po QD

Hydrochlorthiazide 25 mg po QD

Simvastatin 20 mg po QD

Meloxicam 7.5 mg QD

Surgeries

Left knee arthroplasty in 2013

Allergies: No know allergies

Social History: 65 pack year history of cigarette smoking; denies alcohol intake or illicit drug use; is married and recently retired

Family history: Father has history of HTN; Mother has history of “mild” stroke; Brother has a history of hyperlipidemia.

Discussion Questions Part One:

• Describe the patient symptoms that concern you on today’s visit. What other aspects of the patient history also concern you?
• Provide OLDCARTS and ROS questions needed to develop the differential diagnosis (DD) list.
• Provide a minimum of three differential diagnoses (DD) with rationale for each.
• Based on the patient data provided, choose two geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. NOTE: one of the assessment tools must focus on assessing the patient’s respiratory status. Provide a rationale for why you are choosing these tools.