Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Foundation Year Doctor working in General Practice. Your next patient is a 16-year-old female called Chloe Norris, with recurrent shortness of breath. Please take a history and perform a relevant examination.
Patient History:
Chole Norris, 16F, Student.
You've found yourself getting short of breath over the last 4 months. You've had one episode every few weeks over this period associated with a dry cough and wheeze. They mostly occur in the evening without any particular trigger, though sometimes it happens when you leave your warm house too quickly into the cold. You feel fine between these episodes, but your exercise tolerance is reduced when you're getting more breathless after just one lap at PE in school. You have missed two days at school because of your breathlessness. It does not affect your sleep.
You are currently not breathless. No haemoptysis, palpitations, fever, weight loss, dark faeces or change in menstruation.
Ideas, Concerns, Expectations:
You initially thought you had a chest infection, but it shouldn’t last this long? You’re worried you might not be able to play hockey like you usually enjoy.
Past Medical History:
Mild hayfever
Drug History:
None
NKDA
Family History:
You think your mother suffers from eczema, and your younger brother has hay fever.
Social History:
You live at home with your mother, younger brother and pet Staffordshire Bull Terrier.
No one smokes at home.
You are a student in a secondary school.
Examination Findings:
No strong positive findings.
May include: a mild bilateral widespread polyphonic wheeze
Differentials:
Asthma
Atypical pneumonia
Investigations:
Peak flow diary
Consider Skin prick test
Consider Chest X-ray
Spirometry + bronchodilator reversibility testing
FeNO testing
Direct bronchial challenge test e.g. with histamine/methacholine
Management (Asthma):