Reference no: EM133714308

Problem

SA is a 56 year old woman presents to her primary care physician with shortness of breath and cough for several days. Her symptoms began 3 days ago with rhinorrhea, a chronic morning cough productive of white sputum, which has increased over the past 2 days. She has had similar episodes each winter for the past 4 years. She has smoked 1 to 2 packs of cigarettes per day for 40 years and continues to smoke. She denies hemoptysis, chills, or weight loss and has not received any relief from over-the-counter cough preparations. PMH: COPD (FEV 35%, has 3 exacerbations in the past year), DM2, HF (EF 65%) with mitral stenosis Home medications: Empagliflozin 10mg daily, Budesonide 80mcg BID (MDI), furosemide 20mg daily, metoprolol succinate 100mg bid Symptom and daily activity assessment: mMRC 3 and CAT 14 Pulse Oximetry: 90%, RR 25, No fevers, BP 120/80 Please answer the following questions related to this patient case:

A. What is SA's diagnosis based on presenting symptoms? How would you best manage her current symptoms?

B. After managing SA initial presentation, what modifications if any should be done to her medication regimen for COPD? Please include your rationale for each medication addition/subtraction/modification

C. One month later, SA presents with a lower extremity DVT and is hemodynamically stable. What oral anticoagulant would you prescribe and explain your rationale?