COMPRENSIVE IHUMAN CASE WEEK #9, CLASS 6550, FOR
A 64-YEAR-OLD FEMALE PATIENT. REASON FOR VISIT
SHORTNESS OF BR
Case
, Patient: 64-year-old female
Chief Complaint: Shortness of breath (Dyspnea)
Part 1: Immediate & High-Yield Questions (The "Cannot Miss" &
Characterizing Questions)
These questions aim to rule out emergencies and characterize the symptom.
1. Question: "How sudden did the shortness of breath start? Was it over seconds,
minutes, hours, or days?"
* Rationale: Distinguishes acute, life-threatening causes (pulmonary embolism,
pneumothorax, acute coronary syndrome) from subacute or chronic ones (CHF, COPD,
anemia).
* Ideal Answer for Learning: "It started about 3 days ago and has been getting
progressively worse." (Points away from sudden PE/tamponade, towards CHF,
pneumonia).
2. Question: "Are you having any chest pain, pressure, or discomfort? If so, can you
point to it with one finger?"
* Rationale: Assesses for cardiac ischemia (central, pressure), pericarditis (sharp,
pleuritic), or pulmonary embolism (pleuritic). One-finger localization often suggests
musculoskeletal origin.
* Ideal Answer for Learning: "Yes, a heavy pressure in the center of my chest when I
walk up the stairs." (Strongly suggests angina/ACS).
3. Question: "Are you short of breath at rest, or only when doing things? If with
activity, what level of activity causes it?"
* Rationale: Quantifies functional limitation (NYHA Class). Dyspnea at rest is more
severe.
A 64-YEAR-OLD FEMALE PATIENT. REASON FOR VISIT
SHORTNESS OF BR
Case
, Patient: 64-year-old female
Chief Complaint: Shortness of breath (Dyspnea)
Part 1: Immediate & High-Yield Questions (The "Cannot Miss" &
Characterizing Questions)
These questions aim to rule out emergencies and characterize the symptom.
1. Question: "How sudden did the shortness of breath start? Was it over seconds,
minutes, hours, or days?"
* Rationale: Distinguishes acute, life-threatening causes (pulmonary embolism,
pneumothorax, acute coronary syndrome) from subacute or chronic ones (CHF, COPD,
anemia).
* Ideal Answer for Learning: "It started about 3 days ago and has been getting
progressively worse." (Points away from sudden PE/tamponade, towards CHF,
pneumonia).
2. Question: "Are you having any chest pain, pressure, or discomfort? If so, can you
point to it with one finger?"
* Rationale: Assesses for cardiac ischemia (central, pressure), pericarditis (sharp,
pleuritic), or pulmonary embolism (pleuritic). One-finger localization often suggests
musculoskeletal origin.
* Ideal Answer for Learning: "Yes, a heavy pressure in the center of my chest when I
walk up the stairs." (Strongly suggests angina/ACS).
3. Question: "Are you short of breath at rest, or only when doing things? If with
activity, what level of activity causes it?"
* Rationale: Quantifies functional limitation (NYHA Class). Dyspnea at rest is more
severe.
