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Case 72: Paul Jackson

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please read the following history. The results of the examination will be available from the facilitator. Using this history and the examination findings, outline your diagnosis and management plan to Paul.

Scenario

Paul Jackson is a 20-year-old man who is about to start a painting and decorating apprenticeship. Paul had asthma as a child but has been well since. Four weeks ago, he had a viral upper respiratory tract infection. Since then he has had a cough, which is keeping him awake at night. He has to stop playing soccer after only 10 minutes due to shortness of breath and wheeze. He is noticing some wheeze occasionally during the day, maybe two to three times per week.

The following information is on his summary sheet:

  • Past medical history

  • Childhood asthma

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Maternal osteoporosis

  • Social history

  • Lives with de facto partner

  • Non-smoker.

INSTRUCTIONS FOR THE PATIENT, PAUL JACKSON

You are 20 years old and will soon start a painting and decorating apprenticeship.

As a child you had asthma. Four weeks ago, you had a cold and since then you have had a cough. The cough is dry and worse at night; your girlfriend is getting really irritated by it. You are worried because you are short of breath and wheezy after exercise. You can manage only around 10 minutes of playing soccer before coming off. You have occasionally (two to three times per week) felt a little wheezy at other times during the day. It feels as though your asthma has come back.

The following information is on your medical record:

  • Past medical history

  • Childhood asthma

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Maternal osteoporosis

  • Social history

  • Lives with de-facto partner

  • Non-smoker.

INSTRUCTIONS FOR THE FACILITATOR

Please give the doctor the following information when requested specifically:

  • Height 1.85 m

  • Pulse 92

  • Blood pressure 106/70 mmHg

  • No cyanosis

  • Talking in sentences

  • Respiratory

    • — Respiratory rate 14/min

    • — No use of accessory muscles

    • — Chest expansion normal

    • — Percussion note normal

    • — Widespread wheeze on auscultation

    • — Oxygen saturation 99% in room air.

|Download (.pdf)|Print
Peak expiratory flow rate actual 350 L/min
Peak expiratory flow rate predicted 580 L/min
Peak expiratory flow rate after salbutamol 450 L/min

Please hand these results to the doctor if spirometry is requested:

|Download (.pdf)|Print
Actual: FEV1 3.5 L FVC 5.78 L Ratio FEV1/FVC 60.5%
Predicted: FEV1 5.05 L FVC 6.09 L Ratio FEV1/FVC 82.9%
After salbutamol: FEV1 4.3 L FVC 5.82 L Ratio FEV1/FVC 73.9%

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