Comprehensive i-Human Case Study: 39-Year-Old Male With
Shortness of Breath (Chamberlain University) | Advanced DDx
Case Play Setup & Full Case Analysis Including HPI, ROS, PE,
Diagnostics & Final Management Plan – 100% Correct
, • Patient: James Taylor, 39-year-old male
• Chief complaint (CC): "I'm short of breath" (progressive over 3 days)
• Setting: Outpatient urgent clinic/emergency department triage
• Context/Goal: Walk through an i-Human-style case from initial triage to
disposition. Provide reasoning and teaching notes for every step so learners
understand why each action is taken.
Initial triage & vital signs
• Triage note: Arrives by self-transport, appears mildly distressed, sitting
upright.
• Triage vitals:
o Temperature: 37.8°C
o HR: 112 bpm (tachycardic)
o BP: 138/86 mmHg
o RR: 28/min (tachypnea)
o SpO2: 88% on room air (low)
o Weight/height: 88 kg, 180 cm (BMI ≈ 27.2)
Teaching/explanation: Triage identifies immediate concerns: hypoxemia (SpO2
88%) and tachypnea. These findings prioritize oxygen assessment and placement
in an area with monitoring. Tachycardia may be compensation for hypoxemia,
pain, anxiety, or arrhythmia. Early supplemental oxygen and continuous
monitoring are indicated while the clinician obtains a targeted history and exam.
3) Focused History of Present Illness (HPI)
• Onset: 3-day history of progressive shortness of breath; worse with
exertion, now occurs at rest.
, • Course: Gradual onset, previously mild SOB with climbing stairs 2 weeks
ago. No recent travel. Symptoms worsened after a viral URTI 1 week prior.
• Quality/associated symptoms: Orthopnea (needs 2 pillows), PND (woke
once gasping), intermittent chest tightness, nonproductive cough, mild
ankle swelling.
• Severity: At baseline can speak in short phrases; current ambulatory
function limited.
• Timing: Worse at night; progressive each day.
• Modifying factors: Slight relief with sitting upright; no relief with OTC
inhaler (patient tried an albuterol inhaler and reports minimal benefit).
• Prior episodes: None similar.
• PMHx: Hypertension (diagnosed 2 years), smoker: 15 pack-years (current),
no known asthma. No known CAD.
• Meds: Lisinopril 10 mg daily, OTC ibuprofen; used albuterol inhaler once
recently.
• Allergies: NKDA
• Family history: Father: MI at 62; Mother: HTN.
• Social: Works as an accountant, occasional alcohol, smokes 7–10
cigarettes/day, no illicit drug use. Lives with spouse.
Teaching/explanation: HPI seeks red flags (sudden onset, hemoptysis, pleuritic
chest pain) and chronic contributors (cardiac disease, COPD). Orthopnea, PND,
and ankle swelling point toward cardiac causes (heart failure). Smoking increases
risk of COPD and PE. Minimal response to bronchodilator reduces likelihood of
pure asthma exacerbation. The recent URI raises possibility of post-infectious
myocarditis or decompensated heart failure.
4) Review of Systems (ROS)
Shortness of Breath (Chamberlain University) | Advanced DDx
Case Play Setup & Full Case Analysis Including HPI, ROS, PE,
Diagnostics & Final Management Plan – 100% Correct
, • Patient: James Taylor, 39-year-old male
• Chief complaint (CC): "I'm short of breath" (progressive over 3 days)
• Setting: Outpatient urgent clinic/emergency department triage
• Context/Goal: Walk through an i-Human-style case from initial triage to
disposition. Provide reasoning and teaching notes for every step so learners
understand why each action is taken.
Initial triage & vital signs
• Triage note: Arrives by self-transport, appears mildly distressed, sitting
upright.
• Triage vitals:
o Temperature: 37.8°C
o HR: 112 bpm (tachycardic)
o BP: 138/86 mmHg
o RR: 28/min (tachypnea)
o SpO2: 88% on room air (low)
o Weight/height: 88 kg, 180 cm (BMI ≈ 27.2)
Teaching/explanation: Triage identifies immediate concerns: hypoxemia (SpO2
88%) and tachypnea. These findings prioritize oxygen assessment and placement
in an area with monitoring. Tachycardia may be compensation for hypoxemia,
pain, anxiety, or arrhythmia. Early supplemental oxygen and continuous
monitoring are indicated while the clinician obtains a targeted history and exam.
3) Focused History of Present Illness (HPI)
• Onset: 3-day history of progressive shortness of breath; worse with
exertion, now occurs at rest.
, • Course: Gradual onset, previously mild SOB with climbing stairs 2 weeks
ago. No recent travel. Symptoms worsened after a viral URTI 1 week prior.
• Quality/associated symptoms: Orthopnea (needs 2 pillows), PND (woke
once gasping), intermittent chest tightness, nonproductive cough, mild
ankle swelling.
• Severity: At baseline can speak in short phrases; current ambulatory
function limited.
• Timing: Worse at night; progressive each day.
• Modifying factors: Slight relief with sitting upright; no relief with OTC
inhaler (patient tried an albuterol inhaler and reports minimal benefit).
• Prior episodes: None similar.
• PMHx: Hypertension (diagnosed 2 years), smoker: 15 pack-years (current),
no known asthma. No known CAD.
• Meds: Lisinopril 10 mg daily, OTC ibuprofen; used albuterol inhaler once
recently.
• Allergies: NKDA
• Family history: Father: MI at 62; Mother: HTN.
• Social: Works as an accountant, occasional alcohol, smokes 7–10
cigarettes/day, no illicit drug use. Lives with spouse.
Teaching/explanation: HPI seeks red flags (sudden onset, hemoptysis, pleuritic
chest pain) and chronic contributors (cardiac disease, COPD). Orthopnea, PND,
and ankle swelling point toward cardiac causes (heart failure). Smoking increases
risk of COPD and PE. Minimal response to bronchodilator reduces likelihood of
pure asthma exacerbation. The recent URI raises possibility of post-infectious
myocarditis or decompensated heart failure.
4) Review of Systems (ROS)
