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This 69 year old man had attended for a routine clinic appointment for a chronic medical condition. Please take a history, focusing on the impact this condition has had on the patient’s life. Current medication GTN spray.

HPC: You are Reg, 69. You are coming to the doctors today as you have had bother with your breathing for a long time. It’s been a bit worse over this last month. You have been breathless for over 15 years and it’s been getting increasingly worse over this time. You get breathless on walking around and being active. You don’t get breathless when you are sitting down. You are able to walk about 200 yards, have to have a sit down and wait to catch your breath. After sitting for about 5 minutes you get your breath back and can go again. You have a unproductive cough all the time, you don’t bring anything up, there has never been any blood. You do occasionally get chest pain but you but this down to your angina. You have unintentionally lost some weight over the last year, not really sure how much, just your clothes feel a bit looser.

ICE: Your condition is getting you down - you can’t play with your grandkids when you want to, which is a real pain. Despite this, you still manage to go for your weekly pint with the boys and out on drives with the wife. The shortness of breath had been worse for the last month and you haven’t previously seen a doctor. Last week your friend Bertie got diagnosed with lung cancer and this really scared you. Therefore, you thought you had better come to the doctors today! He did work in the shipyards for years though, which you have never done. You have been told that your chest condition will get progressively worse, but you are not worrying about that. You just want it to be ok for now as you have only just retired last year and you want to enjoy it!

PMH: Angina

DH: A spray for the heart Allergic to penicillin, you get a horrible red rash, it’s really not nice

SH: You have found it increasingly difficult to manage at home, you are less able to care for yourself but manage to potter around at home and go to the shop and things. You live with your wife who is really good at helping you when you are having an ‘off’ day.
Your children and grandchildren come to visit regularly You have never smoked You have always worked in an office for a betting company and you retired last year.

Please ask the student to; • Summarise their history. • Give a differential diagnosis. • Explain the clinical findings found on examination in Idiopathic pulmonary fibrosis • Explain what investigations you would perform in this case. • Explain how you differentiate between COPD and Idiopathic pulmonary fibrosis. • Explain how to manage Idiopathic pulmonary fibrosis. • Explain what medication is available for Idiopathic pulmonary fibrosis.