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The medical problem list you have compiled should be a list that includes everything that is out of the ordinary about this patient, even when it is not a "problem" in the true sense of the word. In this case, the most significant active problem(MSAP) is shortness of breath (SOB). With every MSAP it is important to mentally review the “problems” that can result in this symptom. For SOB as a respiratory issue, the major categories include: infection (viral, bacterial, fungal), destruction of lung tissue (emphysema, COPD), collapse of lung tissue (pneumothorax), lack of perfusion of lung tissue (pulmonary embolism, congestive heart failure, circulatory impediment/collapse), lack of oxygen carrying capacity from the lungs (anemia, blood loss). Using this list, look through your problem list and group together all those that suggest a pulmonary process; SOB, tachypnea, PND, bi-basilar crackles and cough. The risk factor for a pulmonary process is smoking history and what appears to be poorly controlled hypertension. The cough is non-productive and there is no evidence of fever, hence the likelihood of infection is reduced. With a 50 pack-year