Ben Bundy iHuman Case Study and Complete Guide 2025

Ben Bundy is a 75-year-old male farmer presenting with an acute exacerbation of chronic obstructive pulmonary disease (COPD) characterized by increased shortness of breath at rest, fever, and productive cough with green sputum. In this comprehensive guide, we’ll walk you through how to approach his case, from initial history-taking through physical examination to the final diagnosis of acute COPD exacerbation with possible respiratory infection. You’ll learn the key clinical reasoning steps, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this respiratory case simulation.

Ben Bundy iHuman Case Overview (Doorway Information)

Patient Overview: Ben Bundy is a 75-year-old Caucasian male farmer presenting with a chief complaint of worsening shortness of breath, productive cough, and fever over the past few days. He has a significant history of COPD related to his 40-60 pack-year smoking history and reports running out of his inhalers one week ago due to financial constraints. His wife reports that he has been unable to speak in complete sentences since yesterday, representing a significant decline in his functional status.

Key Background Information:

• Age/Gender: 75-year-old male farmer
• Chief Complaint: Increased shortness of breath at rest, fever, productive cough
• Duration: Worsening symptoms over past few days
• Respiratory Characteristics: Productive cough with green sputum, dyspnea at rest, unable to complete sentences
• Significant History: COPD, 40-60 pack-year smoking history, hypertension
• Current Medications: Ran out of inhalers one week ago (financial barriers)
• Code Status: DNI (Do Not Intubate)
• Occupation: Farmer with potential occupational exposures
• Social Issues: Unable to afford medications

The patient appears alert and oriented but in moderate respiratory distress, sitting in tripod position with visible use of accessory muscles and cyanosis to the lips. This presentation is classic for acute COPD exacerbation with possible superimposed respiratory infection, making this an excellent case for learning systematic respiratory assessment and exacerbation management skills.

Ben Bundy (75 y/o male) – COPD Exacerbation Assessment

• CC: Increased shortness of breath at rest, fever, productive cough
• MSAP: Acute COPD exacerbation with increased dyspnea at rest, productive cough with green sputum, fever, and inability to speak in complete sentences
• Associated symptoms: Use of accessory muscles, cyanosis, tripod positioning
• History: COPD (40-60 pack-year smoking history), hypertension, medication non-adherence due to cost
• Social factors: Farmer, financial barriers to medication access

History Questions:

• How can I help you today?
• Tell me about your breathing problems and when they started getting worse?
• Any other symptoms we should discuss?
• Do you have any allergies?
• Are you taking any medications currently?
• When did you last take your inhalers?
• What does your breathing difficulty feel like? (shortness of breath, wheezing, chest tightness)
• How severe is your shortness of breath on a scale of 1-10?
• Does anything make your breathing better or worse?
• Are you able to speak in complete sentences?
• Have you been coughing? If so, are you bringing anything up?
• What color is the sputum you’re coughing up?
• Have you had a fever? Any chills or night sweats?
• How is your appetite and energy level?
• Are you having any chest pain?
• Have you been sleeping well? Can you lie flat?
• Do you wake up short of breath at night?
• How far can you walk before getting short of breath?
• Have you had any recent infections or illnesses?
• Do you use oxygen at home?
• Do you smoke currently? How much have you smoked in the past?
• Tell me about your work environment and any exposures.
• Do you have problems affording your medications?
• Have you been to the hospital for breathing problems before?
• Do you have any other medical conditions?

Physical Exam:

• Vitals: Temperature, pulse, blood pressure, respirations, oxygen saturation
• General appearance: Position, respiratory distress, speech pattern
• Skin examination: Look for cyanosis, clubbing
• HEENT: Assess for cyanosis of lips and mucous membranes
• Neck: Jugular venous distension, use of accessory muscles
• Chest wall & lungs:
  • Visual inspection of chest wall configuration
  • Palpate for tactile fremitus
  • Percuss lung fields
  • Auscultate all lung fields for breath sounds, wheezes, crackles
• Heart:
  • Palpate for PMI
  • Auscultate heart sounds for murmurs, gallops
• Abdomen: Brief assessment for organomegaly
• Extremities: Check for peripheral edema, clubbing, capillary refill

Assessment Note:

B.B. is a 75-year-old Caucasian male farmer presenting with acute exacerbation of COPD characterized by increased dyspnea at rest, productive cough with green sputum, and fever over the past few days. Patient has significant respiratory distress with inability to speak in complete sentences, tripod positioning, and use of accessory muscles. Risk factors include extensive smoking history (40-60 pack-years), occupational exposures as a farmer, and medication non-adherence due to financial barriers. Physical examination reveals respiratory distress with cyanosis, bilateral wheezes, and hypoxemia requiring supplemental oxygen.

Key Findings: SpO2 86% on 3L nasal cannula, temperature 101°F, respiratory rate 24-26, bilateral inspiratory and expiratory wheezes, green sputum production, barrel chest configuration, and accessory muscle use.

Diagnosis: Acute exacerbation of COPD with possible bacterial respiratory infection

Plan:

• Optimize bronchodilator therapy with nebulized treatments
• Consider systemic corticosteroids (prednisone 40mg daily for 5 days)
• Evaluate need for antibiotic therapy given purulent sputum and fever
• Address medication access barriers through social work consultation
• Monitor oxygen saturation and consider non-invasive ventilation if needed
• Smoking cessation counseling and education about COPD management

Ben Bundy SOAP Note

Patient: Ben Bundy

Subjective Data

CC: 75-year-old male farmer presents with “increased shortness of breath, fever, and productive cough”

HPI: 75-year-old male farmer presents today with complaints of worsening shortness of breath at rest, productive cough, and fever that have been progressively worsening over the past few days. The patient describes severe difficulty breathing that has progressed to the point where he cannot speak in complete sentences. He reports productive cough with thick, green sputum and fever up to 101°F. The patient states he ran out of his prescribed inhalers one week ago and has been unable to refill them due to financial constraints. His wife reports significant decline in functional status with inability to complete sentences since yesterday. The patient denies chest pain but reports mild chest discomfort (2/10) with coughing. He is currently requiring 3L oxygen via nasal cannula with SpO2 of 86%.

Medications: Patient reports running out of inhalers (bronchodilators) one week ago – unable to afford refills

Allergies: No known drug allergies (NKDA)

PMH: COPD (longstanding), hypertension. Patient has 40-60 pack-year smoking history, quit smoking recently.

PSH: Denies any surgical procedures.

Hospitalizations: Previous hospitalizations for COPD exacerbations.

Health Maintenance: Limited access to regular healthcare due to rural location and financial constraints.

Family History: Non-contributory for this acute presentation.

Substances: Former heavy smoker (40-60 pack-years), denies current smoking, denies alcohol abuse or illicit drug use.

Home environment: Lives on farm with wife, rural setting with potential environmental exposures.

Employment type: Farmer – occupation involves exposure to dusts, chemicals, and environmental irritants that can worsen COPD.

Code Status: DNI (Do Not Intubate) – patient has advanced directive

Objective Data

ROS: Patient in moderate to severe respiratory distress, unable to complete full review of systems due to dyspnea. Focused assessment reveals worsening respiratory symptoms over past few days with fever, productive cough, and progressive dyspnea requiring supplemental oxygen.

General: 75-year-old male in moderate respiratory distress, alert and oriented x4, sitting in tripod position leaning on bedside table. Speech limited to short phrases due to dyspnea. Appears chronically ill with barrel chest configuration consistent with long-standing COPD.

Skin, Hair and Nails: Skin warm, cyanosis noted to lips and nail beds. Capillary refill delayed. No acute rashes or lesions.

HEENT: Central cyanosis noted to lips and oral mucous membranes indicating significant hypoxemia. No acute distress to head, ears, eyes, nose, throat examination.

NECK: Visible use of accessory muscles (sternocleidomastoid, scalenes). No lymphadenopathy or thyromegaly. Jugular venous distension not assessed due to patient positioning.

Thorax and Lungs: Inspection reveals barrel chest configuration, increased anterior-posterior diameter consistent with chronic air trapping. Patient in tripod position with visible accessory muscle use. Palpation reveals decreased tactile fremitus. Percussion shows hyperresonance consistent with air trapping. Auscultation reveals bilateral inspiratory and expiratory wheezes throughout all lung fields. Decreased breath sounds at bases. Productive cough with thick, green sputum visualized.

Cardiovascular: Heart rate regular at 88 bpm. Normal S1 and S2 heart sounds without murmur, gallop, or rub. No jugular venous distension appreciated. Peripheral pulses present but may be affected by positioning and respiratory distress.

Abdomen: Examination limited due to respiratory distress and patient positioning. No obvious organomegaly or distension.

Genitourinary: Deferred for this acute presentation.

Psychiatric: Alert and oriented x4. Anxious appearing due to respiratory distress but no acute psychiatric symptoms. Cooperative with examination despite dyspnea.

Musculoskeletal: Limited assessment due to respiratory distress. No obvious musculoskeletal abnormalities. Patient able to maintain tripod position.

Neurologic: Alert and oriented to person, place, time, and situation. No focal neurological deficits. Speech limited by dyspnea rather than neurological cause.

Vital Signs:

Temperature: 101°F (38.3°C), Pulse: 88 bpm, BP: 128/84 mmHg, Respirations: 24-26 bpm (labored), SpO2: 86% on 3L nasal cannula

Assessment

General: Elderly male farmer in moderate to severe respiratory distress secondary to acute COPD exacerbation with possible superimposed bacterial infection.

Respiratory: Bilateral wheezes throughout lung fields with productive cough and green sputum. Barrel chest configuration with accessory muscle use. Hypoxemia requiring supplemental oxygen.

Cardiovascular: Hemodynamically stable with mild hypertension. No acute cardiac complications noted.

Infectious: Fever and purulent sputum suggest possible bacterial respiratory infection complicating COPD exacerbation.

Differential Diagnoses

Acute COPD Exacerbation with Bacterial Infection: The patient presents with classic signs of COPD exacerbation including increased dyspnea, productive cough with purulent sputum, and fever. The green sputum and elevated temperature suggest bacterial superinfection. His medication non-adherence due to financial constraints likely precipitated this exacerbation.

Pneumonia: The fever, productive cough with green sputum, and respiratory distress could indicate pneumonia. However, the bilateral wheezes and known COPD history, along with medication non-adherence, make COPD exacerbation more likely.

Acute Respiratory Failure: The patient’s SpO2 of 86% on supplemental oxygen and severe dyspnea indicate acute respiratory failure secondary to COPD exacerbation. This requires immediate intervention and monitoring.

Congestive Heart Failure: While dyspnea could indicate heart failure, the bilateral wheezes, productive cough, and known COPD history make this less likely. However, COPD patients can develop cor pulmonale.

Most Likely Diagnosis: Acute exacerbation of COPD with possible bacterial respiratory infection evidenced by increased dyspnea at rest, productive cough with purulent sputum, fever, hypoxemia, and bilateral wheezes in a patient with known COPD and recent medication discontinuation.

Plan

Health Promotion: (appropriate screening, disease prevention, and health promotion according to the patient’s age, gender, and identified risk factors)

✓ Smoking Cessation – Continue to reinforce smoking cessation and provide resources for long-term abstinence maintenance

✓ Vaccination Status – Ensure up-to-date with influenza, pneumococcal, COVID-19, and RSV vaccines

✓ Medication Access – Social work consultation to address financial barriers to medication adherence

Screening:

✓ Pulmonary Function Testing – Post-acute phase spirometry to assess current lung function

✓ Depression/Anxiety Screening – COPD patients have high rates of mood disorders

✓ Nutritional Assessment – Weight loss common in advanced COPD

Immunizations:

✓ Annual Influenza Vaccine

✓ Pneumococcal Vaccine (PPSV23 and PCV13)

✓ COVID-19 Vaccine

✓ RSV Vaccine (for adults 60+)

Complete Step-by-Step Guide to Writing the Ben Bundy iHuman Case Study

Completing the Ben Bundy iHuman case requires a systematic approach that mirrors real clinical practice for managing acute COPD exacerbations. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, review the doorway information and formulate your initial clinical approach.

Key Information to Note:

• 75-year-old male farmer with known COPD
• Acute worsening of respiratory symptoms
• Recent medication non-adherence due to financial constraints
• Wife reports significant functional decline

Initial Clinical Mindset: Approach this case with COPD exacerbation as your primary consideration. The age, occupation, smoking history, and acute respiratory symptoms immediately suggest acute exacerbation requiring systematic respiratory evaluation and immediate intervention.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the timeline and severity of the exacerbation. Use a systematic approach focused on respiratory symptoms:

Onset: Ask about when breathing problems worsened and timeline

• Key points to elicit: Gradual worsening over past few days, acute decline yesterday

Location/Quality: Determine breathing difficulty characteristics

• Target response: Shortness of breath at rest, unable to complete sentences

Duration: How long have symptoms been present

• Important detail: Progressive worsening, most severe in past 24 hours

Character: Detailed description of respiratory symptoms

• Critical descriptors: Productive cough with green sputum, wheezing, chest tightness

Aggravating factors: What makes breathing worse

• Essential findings: Any activity, lying flat, talking

Relieving factors: What provides relief

• Key response: Sitting upright, tripod position, supplemental oxygen

Timing: Pattern and triggers

• Important pattern: Progressive worsening, correlation with medication discontinuation

Severity: Functional impact assessment

• Response: Unable to speak complete sentences, requiring constant rest

Associated Symptoms:

• Ask specifically about: fever, chills, sputum color/amount, chest pain, fatigue
• Key findings: Fever 101°F, green sputum, mild chest discomfort with coughing

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to respiratory and related systems:

Respiratory:

• Dyspnea progression (at rest vs. exertion)
• Cough characteristics and sputum production
• Chest pain or tightness
• Wheezing or noisy breathing

Constitutional:

• Fever, chills, night sweats
• Fatigue and weakness
• Appetite changes, weight loss

Cardiovascular:

• Exercise tolerance changes
• Chest pain, palpitations
• Lower extremity swelling

Infectious:

• Recent illness exposure
• Urinary symptoms
• Gastrointestinal symptoms

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

• COPD diagnosis and duration
• Previous exacerbations and hospitalizations
• Hypertension (mild, controlled)
• Smoking history: 40-60 pack-years, recently quit
• Previous pneumonia or respiratory infections

Social History:

• Occupation: Farmer with potential dust/chemical exposures
• Smoking status and cessation efforts
• Alcohol use: Denies abuse
• Drug use: Denies illicit substances
• Financial status: Unable to afford medications
• Living situation: Lives with wife on farm

Family History:

• Generally non-contributory for acute presentation
• May explore family history of lung disease or alpha-1 antitrypsin deficiency

Step 5: Physical Examination Strategy

Perform a comprehensive respiratory-focused physical exam:

Vital Signs:

• Expected findings: Fever (101°F), tachypnea (24-26), normal blood pressure (128/84), hypoxemia (SpO2 86% on 3L)
• Critical assessment: Oxygen saturation and work of breathing

Respiratory Examination:

• Inspection:
  • Positioning: Tripod position, leaning forward
  • Accessory muscle use: Sternocleidomastoid, scalenes, intercostals
  • Chest configuration: Barrel chest from chronic air trapping
  • Respiratory pattern: Labored, pursed-lip breathing
• Palpation:
  • Tactile fremitus: Decreased due to air trapping
  • Chest expansion: Limited and asymmetric
• Percussion:
  • Hyperresonance throughout lung fields
• Auscultation:
  • Bilateral inspiratory and expiratory wheezes
  • Decreased breath sounds at bases
  • Prolonged expiratory phase

Additional Key Exams:

• Cardiovascular: Heart sounds, peripheral edema assessment
• Skin: Cyanosis assessment (central vs. peripheral)
• Neurologic: Mental status, orientation

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Acute COPD Exacerbation

• Supporting evidence: Known COPD, medication non-adherence, progressive dyspnea, bilateral wheezes

Secondary Considerations:

• Pneumonia
  • Rationale to consider: Fever, purulent sputum, respiratory distress
  • Supporting factors: Green sputum, elevated temperature
• Acute Respiratory Failure
  • Rationale: SpO2 86% despite supplemental oxygen
  • Clinical significance: May require escalation of care
• Bacterial Superinfection
  • Supporting evidence: Green sputum, fever, leukocytosis
  • Clinical impact: Complicates COPD exacerbation management

Step 7: Diagnostic Test Interpretation

Interpret expected test results to support your diagnosis:

Expected Key Findings:

• Arterial Blood Gas: Respiratory acidosis with hypoxemia
• Chest X-ray: Hyperinflation, flattened diaphragms, possible infiltrates
• Complete Blood Count: Possible leukocytosis suggesting infection
• Sputum Culture: To identify bacterial pathogens
• BNP/NT-proBNP: To rule out heart failure if clinically indicated

Clinical Correlation: Use test results to confirm COPD exacerbation diagnosis and identify complications such as respiratory failure or superimposed infection.

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Acute exacerbation of COPD with possible bacterial respiratory infection

Justification:

• Progressive worsening of baseline dyspnea
• Productive cough with purulent sputum
• Fever and systemic symptoms
• Bilateral wheezes and respiratory distress
• Recent medication non-adherence
• Hypoxemia requiring supplemental oxygen

MSAP Selection: Choose “Acute COPD Exacerbation” as your Most Significant Active Problem, as this represents the primary condition requiring immediate management and stabilization.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach based on current evidence:

Immediate Management:

• Oxygen Therapy: Maintain SpO2 88-92% (avoid over-oxygenation in COPD)
• Bronchodilator Therapy: Short-acting beta-agonists and anticholinergics via nebulizer
• Systemic Corticosteroids: Prednisone 40mg daily for 5 days to reduce inflammation

Pharmacological Interventions:

• Nebulized Bronchodilators: Albuterol/ipratropium every 4-6 hours
• Systemic Steroids: Prednisone 40mg daily x 5 days (evidence-based duration)
• Antibiotic Therapy: Consider based on purulent sputum and fever
• Long-acting Bronchodilators: Resume maintenance therapy when stable

Supportive Care:

• Positioning: Maintain upright positioning, tripod as tolerated
• Monitoring: Continuous oxygen saturation, respiratory status
• Hydration: Adequate fluid intake to thin secretions
• Nutrition: Nutritional support as tolerated

Social Interventions:

• Social Work Consultation: Address medication affordability barriers
• Insurance/Financial Assistance: Explore programs for medication access
• Discharge Planning: Ensure medication supply and follow-up arranged

Follow-up Plan:

• Primary Care: Follow-up within 1-2 weeks post-discharge
• Pulmonology: Referral for optimization of long-term management
• Medication Access: Ensure sustainable plan for medication adherence

Step 10: Documentation and Submission Tips

Writing Your Summary:

• Create a concise 350-word summary explaining your clinical reasoning
• Include how you arrived at the problem list prioritization
• Cite specific assessment findings and their clinical significance
• Use professional medical terminology appropriate for respiratory conditions

Key Documentation Elements:

• Assessment Statement: Brief patient summary with key respiratory findings
• Clinical Reasoning: Explain diagnostic thought process for COPD exacerbation
• Evidence Correlation: Link physical findings to pathophysiology
• Management Rationale: Justify treatment choices based on current guidelines

Final Submission Checklist:

• ✓ Complete history focusing on respiratory symptom progression
• ✓ Comprehensive respiratory physical examination
• ✓ Appropriate differential diagnoses with rationales
• ✓ Correct final diagnosis and MSAP selection
• ✓ Evidence-based management plan following GOLD guidelines
• ✓ Professional documentation with proper medical terminology

Ben Bundy iHuman Case Summary

Grading Criteria

The Ben Bundy iHuman case will evaluate you across several critical domains to ensure comprehensive respiratory assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points):

You must ask targeted questions about respiratory symptom progression to get full credit. Essential questions include: onset and progression of dyspnea, cough characteristics and sputum production, fever timeline, functional status changes (ability to speak), medication adherence, and recent exposures. Don’t miss asking about: smoking history details, previous COPD exacerbations, current medications and barriers to access, occupational exposures, and baseline functional status. The rubric specifically rewards students who assess the impact on activities of daily living and speech patterns.

(2) Physical Examination (High Weight):

Focus your exam on respiratory system assessment. Must-do components: vital signs with oxygen saturation, inspection of respiratory effort and positioning, chest wall configuration assessment, comprehensive lung auscultation, and assessment for cyanosis. Pro tip: The rubric awards points for recognizing tripod positioning, accessory muscle use, and barrel chest configuration – key findings in COPD patients.

(3) Differential Diagnosis (Critical for Scoring):

You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: acute COPD exacerbation, pneumonia, acute respiratory failure, and bacterial superinfection. Scoring secret: The rubric rewards students who can distinguish between COPD exacerbation and pneumonia based on clinical presentation and risk factors.

(4) Final Diagnosis & MSAP:

You must correctly identify acute COPD exacerbation as your Most Significant Active Problem (MSAP). Justification is key – cite the progressive respiratory symptoms, bilateral wheezes, hypoxemia, and medication non-adherence as supporting evidence.

(5) Management Plan (Heavily Weighted):

The rubric expects comprehensive management including: bronchodilator optimization, systemic corticosteroids, oxygen therapy, infection management, and social interventions. High-scoring responses mention: evidence-based corticosteroid duration (5 days), appropriate oxygen targets (88-92%), and addressing medication access barriers.

(6) Patient Safety and Communication:

Demonstrate understanding of DNI status and respiratory monitoring. Bonus points for: discussing medication affordability barriers, providing COPD education, and explaining exacerbation prevention strategies.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Ben Bundy

Situation: 75-year-old male farmer presenting with acute COPD exacerbation complicated by possible bacterial respiratory infection.

Background: Significant respiratory risk factors including 40-60 pack-year smoking history, occupational dust exposures, and longstanding COPD. Recent medication non-adherence due to financial constraints precipitated current exacerbation.

Assessment: Physical examination notable for severe respiratory distress with tripod positioning, accessory muscle use, bilateral wheezes, and hypoxemia (SpO2 86% on 3L oxygen). Green sputum production and fever suggest bacterial superinfection.

Primary Diagnosis: Acute exacerbation of COPD with bacterial respiratory infection.

Recommendation:

• Immediate bronchodilator therapy with nebulized albuterol/ipratropium
• Systemic corticosteroids (prednisone 40mg daily x 5 days)
• Antibiotic therapy for suspected bacterial infection
• Oxygen therapy targeting SpO2 88-92%
• Social work consultation to address medication affordability barriers
• Pulmonology follow-up for long-term COPD optimization
• Patient education on exacerbation recognition and prevention

Patient Education Provided: Explained COPD exacerbation triggers, importance of medication adherence, proper inhaler technique, when to seek emergency care, and smoking cessation maintenance strategies.

Conclusion

By following this comprehensive approach to the Ben Bundy case, you’ll demonstrate the clinical reasoning skills that iHuman evaluates for respiratory conditions. Remember, success in COPD exacerbation cases requires systematic thinking: gather detailed history about symptom progression and triggers, perform focused but thorough respiratory examination, consider appropriate differentials, and develop evidence-based management plans that address both acute stabilization and long-term COPD care. The key is treating each iHuman simulation as you would a real patient encounter – be thorough, think critically about respiratory pathophysiology, and always prioritize patient safety while addressing social determinants of health. With this guide, you’re well-prepared to excel in this challenging but essential case simulation.

Frequently Asked Questions

What is the correct diagnosis for Ben Bundy’s respiratory symptoms?

Ben Bundy’s primary diagnosis is acute exacerbation of COPD with possible bacterial respiratory infection. The key distinguishing features include progressive worsening of baseline dyspnea, productive cough with purulent green sputum, fever, and bilateral wheezes in a patient with known COPD and recent medication non-adherence. Students often struggle between COPD exacerbation and pneumonia, but remember that COPD exacerbation typically has bilateral wheezes and builds on existing respiratory compromise, while pneumonia may have more localized findings.

What are the critical physical exam components I need to perform to score well?

Essential physical exam elements include measuring vital signs with oxygen saturation, assessing respiratory effort and positioning (tripod position), evaluating accessory muscle use, performing comprehensive lung auscultation for wheezes and decreased breath sounds, and checking for cyanosis. Many students miss points by not recognizing the significance of barrel chest configuration, tripod positioning, and the inability to speak in complete sentences as markers of respiratory distress severity.

How do I pass the Ben Bundy case and meet the 70% requirement?

Focus on systematic respiratory assessment using the GOLD guidelines framework. Score well by conducting thorough history-taking about symptom progression and medication adherence, completing all recommended physical exam components with attention to respiratory distress signs, proposing appropriate differential diagnoses including COPD exacerbation and pneumonia, and developing a comprehensive management plan that includes bronchodilators, corticosteroids, and social interventions for medication access barriers.

What management interventions should I include in my treatment plan?

The comprehensive management plan should address immediate respiratory stabilization and long-term COPD care. Include nebulized bronchodilator therapy (albuterol/ipratropium), systemic corticosteroids (prednisone 40mg daily for 5 days), appropriate oxygen therapy targeting SpO2 88-92%, antibiotic consideration for suspected bacterial infection, and social work consultation for medication affordability. Students often forget to address the underlying cause (medication non-adherence) and social determinants of health, which are crucial components for comprehensive COPD care and can significantly impact your overall score.