What issues should you consider in relation to a patient who feels they don’t have ‘any health issues or problems’?

What issues should you consider in relation to a patient who feels they don’t have ‘any health

issues or problems’?

A 35yo male presents to you in clinic. His presenting symptoms include a hacking cough, sometimes with

mucus, shortness of breath, sometimes wheezing. He has had four (4) respiratory tract infections in the

past 14 months. He works in a printing and copying business and is currently renovating a house with his

partner. The dust from work and renovating seems to aggravate the cough. He tries to remember a good

dust mask at while renovating.

His health history includes childhood asthma, which he grew out of in his early teens – he has not used any

medication for this since he was (he thinks) about 14 – he had ‘a puffer’. He did smoke in his late teens and

early twenties, but hasn’t smoked since about age 25. His father (now aged 65) had a stroke at age 51 and

is being treated for high blood pressure and high cholesterol. His father has never smoked or drank

alcohol. His mother (age 62) has been a life long smoker, and despite a recent diagnosis of emphysema,

continues to smoke about 5 cigarettes a day – she hopes to quit soon.

You notice that he scratches the inside of his elbows during the consultation and ask if there is a problem.

He says he has ‘eczema’ and it also appears behind his knees, behind his ears and at his hairline. It gets

worse with heat or in the spring and sometime he think what he eats might ‘set it off’, but hasn’t really paid

attention to it. His doctor gave him some cream, but he never remembers to use it until it is too late.

Specific questions relating to the case study

1. What physical examination could you undertake in clinic to provide additional information that

might clarify this case? (dot points are allowed – you must give a reason for why you undertake

each physical examination to show its relevance to this case)

2. Is there any other information you would like to clarify this case or questions you could ask? (dot

points are allowed- briefly explain why the question is relevant to this case)

3. Provide a probable diagnosis with justification and at least 1 other differential diagnosis