Abdelmohaymin Abdalla MD

Lewis J. Wesselius MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ USA

History of Present Illness

A 55 years-old woman presented to pulmonary clinic with shortness of breath and chest pain for 4-6 weeks. No specific timing for her symptoms or triggers. The symptoms occurring occasionally at random times. Her dyspnea was not limiting her daily activities, though she has been asking her partners to help with chores more than before. Her chest pain was sharp localized to left posterior chest wall that seldom get worse with taking a deep breath. At worse it’s mild. She also experienced dry cough that is occasional and not bothersome.

Past Medical History (PMH), Social History (SH), Family History (FH)

PMH

• Paraplegia secondary to gunshot wound to T11-12 in 2003; wheelchair-bound
• COVID 2021, incidentally diagnosed with no pulmonary symptoms
• Carpal tunnel syndrome, bilateral
• Acne
• GERD
• Splenectomy 2003 after uncontrolled bleeding from splenic laceration following gunshot wound
• Tubal ligation 2005

SH

• Former tobacco use, 15 pack-years, quit 2007
• Drinks alcohol twice weekly
• No illicit drug use

FH

• Markedly positive for cancer in parents, siblings, aunt and uncles

Medications

• Baclofen 15mg TID
• Gabapentin 600mg QID
• Ketoconazole 2% cream every other day
• Omeprazole 40mg QD

Physical examination

• Heart rate 78, respiratory rate 14, SpO2 97% on room air, blood pressure 130/82, weight 70 kg, BMI 23.5
• Respiratory: Clear breath sounds bilaterally. No crackles or wheezing. No clubbing
• Cardiovascular: normal S1, S2; no murmurs
• Abdominal: Soft, nontender. Normoactive bowel sounds
• Extremities: No edema, warm.          
• Skin: No rashes.
• Neuro: Mood appropriate. Alert and oriented x 3. Paraplegia, wheelchair-bound.

Which of the following should be done next? (Click on the correct answer to be directed to the second of seven pages)

1. Pulmonary function testing
2. CBC
3. Chest x-ray
4. 1 and 3
5. All of the above