Skill Checkup: An 81-Year-Old Woman With Dyspnea, Nearly Incessant Cough, and Body Aches

Enrico Brunetti, MD


November 07, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

An 81-year-old woman in Europe presents with dyspnea, nearly incessant cough, and body aches. Symptom onset was 9 days ago; at first, the patient attributed her dyspnea to heart failure and age. She notes that she intended to schedule a telemedicine appointment closer to symptom onset but was not familiar with the technology. The patient was vaccinated for coronavirus disease 19 (COVID-19) last year but has not received a booster shot. The patient manages heart failure with captopril, sotalol, and bumetanide. She also takes risedronate for osteoporosis. Her daughter has accompanied her, and the patient appears somnolent. Body temperature is 37.2°C (99°F), heart rate is 110 per minute, respiratory rate is 34 per minute, and oxygen saturation is 86%. Chest CT shows diffuse ground glass-like opacity in both lungs. Polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detected by nasopharyngeal swabs come back positive. Accessory muscle use is noted, but physical examination is otherwise normal.


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