i-Human Margaret Wilson Case Week #4 | Shortness
of Breath | Clinical Reasoning & SOAP Note
/Advanced Differential Diagnosis (DDx) i-Human Case
| Margaret Wilson | Nurse Practitioner Case Study
,SECTION 1: Case Intake & Baseline Demographics
Patient Name: Margaret Wilson
Age / Gender: 60 years old / Female
Height: 5' 4" (163 cm)
Weight: 183.0 lb (83.2 kg)
BMI: 31.4 (Obesity Class I)
Reason for Encounter: Shortness of breath
SECTION 2: History of Present Illness (HPI)
Margaret Wilson is a 60-year-old female who presents with a 3-to-4-week history of
progressive shortness of breath on exertion. The symptoms began gradually, initially
noticed while climbing stairs or walking moderate distances, but have severely escalated
over the past month. She now experiences dyspnea after walking less than one block on flat
ground, preventing her from completing routine household activities like vacuuming or
making the bed.
She describes the sensation as "air hunger" and a "heaviness in her chest," noting a feeling
as if her lungs are filling with fluid. The dyspnea is accompanied by a chronic, nonproductive
cough present for approximately 2 years, which worsens when she lies flat. She has
developed orthopnea over the past 6 to 8 weeks, requiring her to prop herself up on two
pillows to sleep. Additionally, she reports paroxysmal nocturnal dyspnea (PND), waking up
gasping for air 2 to 3 times per week, requiring her to sit upright for 10–15 minutes. She
notes mild, bilateral pitting ankle edema that builds up by the evening and resolves
overnight with leg elevation. She denies retrosternal chest pain, radiation to the jaw or arms,
hemoptysis, colored sputum production, or chills.
, SECTION 3: Required i-Human Interview Questions & Answers
i-Human
Clinical Significance & Grading
# Interview Patient Response
Rationale
Question
Differentiates
"About 3 to 4 weeks
"When did your subacute/progressive etiologies
ago, but it has gotten
1 shortness of (Heart Failure, COPD) from
much worse over the
breath start?" hyperacute events (Pulmonary
last month."
Embolism, Pneumothorax).
"Does the "It's much worse with
Highlights classic exertional
shortness of activity. At rest, I feel
dyspnea, indicating an inability to
2 breath happen okay, but I avoid doing
meet increased cardiac or
with activity or things that make me
pulmonary demand.
rest?" breathless."
"Yes, I wake up
"Do you wake gasping 2 or 3 times a Confirms Paroxysmal Nocturnal
up suddenly at week and have to sit Dyspnea (PND), a high-specificity
3
night gasping upright on the edge of marker for left-sided heart failure
for air?" the bed to catch my and pulmonary congestion.
breath."
"How many "I've had to prop myself Confirms orthopnea,
4
pillows do you up on two large pillows documenting progressive fluid
of Breath | Clinical Reasoning & SOAP Note
/Advanced Differential Diagnosis (DDx) i-Human Case
| Margaret Wilson | Nurse Practitioner Case Study
,SECTION 1: Case Intake & Baseline Demographics
Patient Name: Margaret Wilson
Age / Gender: 60 years old / Female
Height: 5' 4" (163 cm)
Weight: 183.0 lb (83.2 kg)
BMI: 31.4 (Obesity Class I)
Reason for Encounter: Shortness of breath
SECTION 2: History of Present Illness (HPI)
Margaret Wilson is a 60-year-old female who presents with a 3-to-4-week history of
progressive shortness of breath on exertion. The symptoms began gradually, initially
noticed while climbing stairs or walking moderate distances, but have severely escalated
over the past month. She now experiences dyspnea after walking less than one block on flat
ground, preventing her from completing routine household activities like vacuuming or
making the bed.
She describes the sensation as "air hunger" and a "heaviness in her chest," noting a feeling
as if her lungs are filling with fluid. The dyspnea is accompanied by a chronic, nonproductive
cough present for approximately 2 years, which worsens when she lies flat. She has
developed orthopnea over the past 6 to 8 weeks, requiring her to prop herself up on two
pillows to sleep. Additionally, she reports paroxysmal nocturnal dyspnea (PND), waking up
gasping for air 2 to 3 times per week, requiring her to sit upright for 10–15 minutes. She
notes mild, bilateral pitting ankle edema that builds up by the evening and resolves
overnight with leg elevation. She denies retrosternal chest pain, radiation to the jaw or arms,
hemoptysis, colored sputum production, or chills.
, SECTION 3: Required i-Human Interview Questions & Answers
i-Human
Clinical Significance & Grading
# Interview Patient Response
Rationale
Question
Differentiates
"About 3 to 4 weeks
"When did your subacute/progressive etiologies
ago, but it has gotten
1 shortness of (Heart Failure, COPD) from
much worse over the
breath start?" hyperacute events (Pulmonary
last month."
Embolism, Pneumothorax).
"Does the "It's much worse with
Highlights classic exertional
shortness of activity. At rest, I feel
dyspnea, indicating an inability to
2 breath happen okay, but I avoid doing
meet increased cardiac or
with activity or things that make me
pulmonary demand.
rest?" breathless."
"Yes, I wake up
"Do you wake gasping 2 or 3 times a Confirms Paroxysmal Nocturnal
up suddenly at week and have to sit Dyspnea (PND), a high-specificity
3
night gasping upright on the edge of marker for left-sided heart failure
for air?" the bed to catch my and pulmonary congestion.
breath."
"How many "I've had to prop myself Confirms orthopnea,
4
pillows do you up on two large pillows documenting progressive fluid
