MDT Senarios Flashcards
S: Subjective
The patient is a 26-year-old male who presents to the emergency department with sudden onset of left-sided chest pain and shortness of breath that began earlier today.
O: Objective
Vital signs: BP 120/80 mmHg, HR 110 bpm, RR 28 bpm, SpO2 90% on room air
Physical exam: The patient appears uncomfortable and is having difficulty speaking in full sentences due to shortness of breath. Breath sounds are absent on the left side of the chest. There is mild tachycardia present, and oxygen saturation is low on room air.
A: Assessment
The patient’s symptoms and physical exam findings are, likely due to spontaneous rupture of a subpleural bleb.
P: Plan
The patient will be admitted to the hospital for further evaluation and management. A chest x-ray will be ordered to confirm the diagnosis and assess the size. A chest tube will be placed to evacuate the air and re-expand the collapsed lung. Oxygen therapy will be initiated to improve oxygen saturation, and the patient will be closely monitored for any signs of respiratory distress or complications.
Pneumothorax
S: Subjective
The patient is a 24-year-old male who presents to the clinic with complaints of recurrent episodes of shortness of breath, chest tightness, and wheezing over the past month. He reports no prior history of respiratory illness and recent exposure to environmental irritants.
O: Objective
Vital signs: BP 118/72 mmHg, HR 76 bpm, RR 16 bpm, SpO2 98% on room air
Physical exam: The patient appears to be in no acute distress. Lung exam reveals diffuse expiratory wheezing and decreased breath sounds. No cyanosis is noted.
A: Assessment
P: Plan
The patient will be prescribed a short-acting bronchodilator inhaler and an inhaled corticosteroid inhaler to use daily for maintenance therapy. He will also be instructed to monitor his symptoms and to avoid known triggers. A follow-up appointment will be scheduled in four weeks to assess his response to treatment and to adjust therapy as needed.
Asthma
S: Subjective
The patient is a 68-year-old male who presents to the emergency department with complaints of shortness of breath and chest pain that began suddenly while at rest. He reports a history of heart disease and hypertension.
O: Objective
Vital signs: BP 180/90 mmHg, HR 110 bpm, RR 30 bpm, SpO2 88% on room air
Physical exam: The patient appears to be in significant respiratory distress, with tachypnea and labored breathing. Lung exam reveals bilateral crackles and wheezing, and there is evidence of jugular veins are reduced. Blood pressure is elevated, and oxygen saturation is low on room air.
A: Assessment
P: Plan
The patient will be admitted to the hospital for further evaluation and management. Oxygen therapy will be initiated to improve oxygenation, and loop diuretics will be administered to reduce fluid overload. Nitroglycerin may also be administered to reduce myocardial oxygen demand.
An electrocardiogram (ECG) and cardiac enzymes will be ordered to evaluate for evidence of acute coronary syndrome. Further imaging studies, such as chest x-ray or echocardiogram, may be performed to assess the extent of pulmonary edema and underlying cardiac function.
Pulmonary Edema
S: Subjective
The patient is a 62-year-old female who presents to the clinic with complaints of chronic cough, shortness of breath, and wheezing for the past several years. She reports a history of smoking for 30 years and has experienced a gradual decline in her respiratory symptoms.
O: Objective
Vital signs: BP 120/80 mmHg, HR 88 bpm, RR 20 bpm, SpO2 94% on room air
Physical exam: The patient appears to be in moderate respiratory distress, with pursed-lip breathing and decreased breath sounds. Lung exam reveals diffuse expiratory wheezing and decreased breath sounds. No cyanosis is noted.
A: Assessment
The patient’s symptoms and physical exam findings are likely related to long-term smoking history.
P: Plan
The patient will be prescribed a combination of short-acting and long-acting bronchodilators, as well as an inhaled corticosteroid to use daily for maintenance therapy. Pulmonary rehabilitation and smoking cessation counseling will also be recommended to help improve her respiratory function and reduce the risk of exacerbations.
COPD
S: Subjective
The patient is a 28-year-old female who presents to the clinic with complaints of recurrent episodes of shortness of breath, chest tightness, and wheezing for the past several months. She reports a history of exposure to chemicals.
O: Objective
Vital signs: BP 110/70 mmHg, HR 76 bpm, RR 18 bpm, SpO2 98% on room air
Physical exam: The patient appears comfortable at rest. Lung exam reveals diffuse expiratory wheezing and decreased breath sounds. No cyanosis is noted.
A: Assessment
The patient’s symptoms and physical exam findings are consistent with a diagnosis of reactive airway disease, which is a term used to describe symptoms of airway obstruction that can occur in the absence of a definitive diagnosis of asthma. Allergies and a family history of asthma suggest a possible underlying atopic component.
P: Plan
The patient will be prescribed a short-acting bronchodilator to use as needed for acute symptom relief, as well as an inhaled corticosteroid to use daily for maintenance therapy. Avoidance of known triggers, such as environmental allergens or irritants, will also be recommended.
Reactive airway disease
S: Subjective
The patient is a 45-year-old female who presents with a chief complaint of a persistent cough with green sputum for the past 10 days. The patient reports feeling fatigued, having a low-grade fever of 100.2°F, and experiencing mild chest tightness.
O: Objective
Vital signs: Blood pressure 120/80 mmHg, pulse rate 70 bpm, respiratory rate 22 breaths per minute, temperature 100.2°F
HEENT: Clear mucous membranes, no sinus tenderness.
Lungs: Crackles heard bilaterally upon auscultation, no wheezing or rales.
Cardiovascular: Regular rhythm, no murmurs or rubs.
A: Assessment
The patient’s symptoms and physical exam findings are, which is a self-limited inflammation of the bronchi that is typically caused by a viral infection. The presence of productive cough cleared and shortness of breath suggest possible involvement of the lower respiratory tract.
P: Plan
The patient will be advised to rest and stay hydrated, as well as to avoid exposure to respiratory irritants such as cigarette smoke or air pollution. Over-the-counter medications, such as cough suppressants or expectorants, may be recommended for symptom relief as needed.
Antibiotics are not indicated in the absence of signs of bacterial infection, as most cases of acute bronchitis are caused by viral pathogens that do not respond to antibiotics.
Bronchitis
S: Subjective
The patient is a 65-year-old male who presents to the clinic with complaints of chronic cough and dyspnea on exertion for the past several months. He reports a history of smoking for over 40 years.
O: Objective
Vital signs: BP 140/90 mmHg, HR 90 bpm, RR 22 bpm, SpO2 92% on room air
Physical exam: The patient appears dyspneic and uncomfortable at rest. Lung exam reveals decreased breath sounds and hyperinflation, with diffuse wheezing heard bilaterally. No cyanosis is noted. Barrel Chested.
A: Assessment
The patient’s symptoms and physical exam findings are which is a chronic obstructive pulmonary disease characterized by destruction of the alveolar walls and irreversible airway obstruction. Smoking is the most common cause of emphysema, and the patient’s smoking history is a significant risk factor for the disease.
P: Plan
The patient will be advised to quit smoking, as continued tobacco use is associated with a more rapid decline in lung function and increased morbidity and mortality. Pulmonary rehabilitation, which may include exercise training, breathing techniques, and education on symptom management, will be recommended to help improve the patient’s quality of life and functional capacity.
Inhaled bronchodilators and corticosteroids may be prescribed to help manage the patient’s symptoms and reduce exacerbations. Supplemental oxygen therapy may also be considered if the patient’s oxygen saturation levels are persistently low.
emphysema
S: Subjective
The patient is a 50-year-old female who presents to the emergency department with complaints of sudden onset shortness of breath and chest pain. She reports no prior history of similar symptoms.
O: Objective
Vital signs: BP 140/90 mmHg, HR 110 bpm, RR 24 bpm, SpO2 90% on room air
Physical exam: The patient appears anxious and in moderate respiratory distress. Lung exam reveals decreased breath sounds and crackles heard bilaterally. Heart exam reveals tachycardia with no murmurs or gallops noted.
A: Assessment
P: Plan
The patient will be started on therapeutic anticoagulation, which may include unfractionated heparin or low-molecular-weight heparin, to prevent further clot formation and promote clot dissolution. Additional imaging studies, such as a computed tomography (CT) scan or ventilation-perfusion (V/Q) scan, may be ordered to confirm the diagnosis and assess the extent of the embolism.
Supplemental oxygen therapy will be initiated to maintain adequate oxygenation and reduce the risk of hypoxemia. Pain relief may also be provided as needed.
Pulmonary Embolism
S: Subjective
The patient is a 60-year-old male who presents to the clinic with a complaint of coughing up blood for the past two days. He reports no prior history of similar symptoms and denies any recent respiratory infections or traumas.
O: Objective
Vital signs: BP 130/80 mmHg, HR 90 bpm, RR 18 bpm, SpO2 96% on room air
Physical exam: The patient appears alert and oriented. Lung exam reveals scattered wheezing and crackles. There is no cyanosis. The oropharynx is clear.
A: Assessment
The patient’s symptoms and physical exam findings which is the expectoration of blood from the respiratory tract. The presence of wheezing and crackles suggests an underlying respiratory condition, such as bronchitis or pneumonia, which can cause irritation and inflammation of the airways leading to bleeding. Other possible causes include lung cancer, tuberculosis, or pulmonary embolism.
P: Plan
Further diagnostic evaluation is warranted to determine the underlying cause of hemoptysis. This may include imaging studies, such as chest x-ray or computed tomography (CT) scan, and laboratory tests, such as sputum analysis or tuberculosis screening.
Treatment will be directed at the underlying condition. If the cause is infectious, antibiotics may be prescribed. If the cause is pulmonary embolism, anticoagulant therapy may be initiated. If the cause is lung cancer, a referral to a specialist may be necessary for further evaluation and management.
hemoptysis
Subjective:
The patient is a 35-year-old male who presents with a chief complaint of a sore throat, nasal congestion, and cough for the past 3 days. The patient reports a low-grade fever of 100.4°F and reports feeling fatigued. The patient denies any shortness of breath or chest pain.
Objective:
Vital signs: Blood pressure 126/82 mmHg, pulse rate 72 bpm, respiratory rate 18 breaths per minute, temperature 100.4°F
HEENT: Injection and erythema of the pharynx, nasal mucosa is congested, and no nasal discharge. No sinus tenderness.
Lungs: Clear to auscultation bilaterally, no wheezing or rales.
Cardiovascular: Regular rhythm, no murmurs or rubs.
Assessment:
Based on the patient’s symptoms and physical examination, the patient is diagnosed with an upper respiratory infection (URI).
Plan:
Prescribe acetaminophen for fever and pain management.
Advise the patient to get plenty of rest and stay hydrated.
Advise the patient to use saline nasal spray and a humidifier to help relieve nasal congestion.
Recommend over-the-counter cough syrup to relieve the cough.
Reassess in 48 hours and if symptoms persist, recommend a follow-up visit or referral to a specialist if necessary.
Provide patient education on proper hand hygiene and respiratory etiquette to prevent the spread of the infection.
Upper Respiratory Infection
Subjective:
The patient is a 60-year-old male who presents with a chief complaint of a cough with green sputum, fever, and shortness of breath for the past 5 days. The patient reports a temperature of 101.5°F and states that the cough has been productive and worsening over the past few days. The patient reports difficulty breathing, especially with exertion, and reports chest pain and pressure. The patient denies any recent travel or exposure to sick individuals.
Objective:
Vital signs: Blood pressure 140/90 mmHg, pulse rate 100 bpm, respiratory rate 22 breaths per minute, temperature 101.5°F
HEENT: Clear mucous membranes, no sinus tenderness.
Lungs: Crackles and decreased breath sounds heard in the right lower lobe upon auscultation, no wheezing or rales.
Cardiovascular: Regular rhythm, no murmurs or rubs.
Assessment:
Based on the patient’s symptoms and physical examination, the patient is diagnosed with community-acquired.
Plan:
Prescribe a course of antibiotics to treat the underlying infection.
Prescribe supplemental oxygen to help alleviate shortness of breath.
Advise the patient to get plenty of rest and stay hydrated.
Advise the patient to use a humidifier to help relieve respiratory symptoms.
Recommend over-the-counter cough syrup to relieve the cough.
Schedule a follow-up visit in 7-10 days to assess the patient’s response to treatment and to reassess their condition.
Provide patient education on proper hand hygiene and respiratory etiquette to prevent the spread of the infection.
Pneumonia
Subjective:
The patient is a 35-year-old male who presents with a chief complaint of sudden onset of sharp, stabbing chest pain and shortness of breath. The patient reports that the pain started about an hour ago and has not improved. The patient denies any history of trauma or chest injury.
Objective:
Vital signs: Blood pressure 90/60 mmHg, pulse rate 120 bpm, respiratory rate 26 breaths per minute, temperature 99.6°F
HEENT: Clear mucous membranes, no sinus tenderness.
Lungs: Decreased breath sounds and dullness to percussion on the right side upon auscultation, no wheezing or rales.
Cardiovascular: Tachycardic, no murmurs or rubs.
Assessment:
Based on the patient’s symptoms and physical examination, the patient is diagnosed with a BLANK.
Plan:
Administer supplemental oxygen to help alleviate shortness of breath.
Obtain a chest X-ray to confirm the diagnosis and to evaluate the extent of the hemothorax.
Schedule an urgent thoracentesis to drain the accumulated blood and relieve pressure on the lung.
Administer pain management as needed.
Schedule a follow-up visit to reassess the patient’s condition and to evaluate the need for further intervention, such as surgery.
Provide patient education on the importance of prompt recognition and treatment of chest pain and injury.
Hemothorax
Subjective:
The patient is a 50-year-old male who presents with a chief complaint of excessive daytime sleepiness and snoring. The patient reports difficulty falling asleep and staying asleep at night, and reports feeling tired and irritable during the day. The patient’s bed partner reports loud snoring and periods of stopped breathing during sleep.
Objective:
Vital signs: Blood pressure 130/85 mmHg, pulse rate 80 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F
Physical examination: Obesity, neck circumference 17 inches, no other significant findings.
Polysomnography: Confirms the diagnosis with an apnea-hypopnea index (AHI) of 30 events per hour of sleep.
Assessment:
Based on the patient’s symptoms and examination findings, the patient is diagnosed with this.
Plan:
Prescribe continuous positive airway pressure (CPAP) therapy to help manage the patient’s symptoms.
Advise the patient to lose weight and to avoid alcohol and sedatives, which can worsen symptoms.
Schedule a follow-up visit in 4-6 weeks to reassess the patient’s response to treatment and to adjust the CPAP therapy as needed.
Refer the patient to a sleep specialist for further evaluation and management, if necessary.
Provide patient education on the importance of proper sleep hygiene and the dangers of untreated sleep apnea.
Chronic Obstructive Sleep Apnea.
Subjective:
The patient is a 35-year-old male who presents with a chief complaint of sharp, stabbing chest pain after a recent fall. The patient reports that the pain started immediately after the fall and has not improved.
Objective:
Vital signs: Blood pressure 120/80 mmHg, pulse rate 90 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F
Physical examination: Tenderness and deformity over the right 7th rib, no other significant findings.
Chest X-ray: Confirms the diagnosis of a right 7th rib fracture.
Assessment:
Based on the patient’s symptoms and examination findings, the patient is diagnosed with a right 7th thing.
Plan:
Administer pain management as needed.
Instruct the patient to avoid activities that exacerbate the pain, such as deep breathing, coughing, and lifting.
Recommend the use of a rib brace or wrap to help immobilize the affected rib and reduce pain.
Schedule a follow-up visit in 1-2 weeks to reassess the patient’s condition and to evaluate the need for further intervention, such as referral to a specialist or physical therapy.
Provide patient education on the importance of proper body mechanics and the dangers of untreated thing.
Rib Fracture
Subjective:
The patient is a 60-year-old male who presents with a chief complaint of severe chest pain and shortness of breath after a recent motor vehicle accident. The patient reports that the pain started immediately after the accident and has not improved.
Objective:
Vital signs: Blood pressure 90/60 mmHg, pulse rate 120 bpm, respiratory rate 26 breaths per minute, temperature 99.6°F
Physical examination: Tenderness and deformity over the right side of the chest, crepitus, and paradoxical chest movement upon respiration.
Chest X-ray: Confirms the diagnosis of a thang.
Assessment:
Based on the patient’s symptoms and examination findings, the patient is diagnosed with a thang.
Plan:
Administer supplemental oxygen to help alleviate shortness of breath.
Administer pain management as needed.
Schedule an urgent chest tube insertion to relieve the pressure on the lungs and to prevent further respiratory compromise.
Schedule a follow-up visit to reassess the patient’s condition and to evaluate the need for further intervention, such as referral to a specialist or surgery.
Provide patient education on the importance of proper body mechanics and the dangers of untreated injuries.
Flail Chest.
