The Rational Clinical Examination
David L. Simel, Drummond Rennie
David L. Simel, Sheri Keitz
airway obstruction, chronic obstructive airway disease
"A 51-year-old business executive comes to the clinic for a health
checkup. He has no specific complaints, other than those he attributes
to the vagaries of reaching middle age. You know the patient well
and thus are aware that he smokes cigarettes. He has been smoking
one-half to 1 pack a day since college. His neck and chest configuration are
normal. There is no dyspnea, and he has never complained of either
shortness of breath or cough other than during flulike illnesses.
As part of his examination, you listen to his chest and hear no
wheezes. You do not think he has airflow limitation, but is it time
for spirometry testing, given his smoking history?..."
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