Wednesday, 7 March 2007

Quiz No 2

Today is a quiz. I have included a short history and physical with some nice pictures for you to interpret. There are no formal blood results for you to rely on.

This patient presented with a sudden onset of cough and dyspnoea.

Patient remained breathless for 4 days before presenting to hospital.

There was no sputum produced and no haemoptysis.

Patient complained of a dull chest ache when coughing. There was no acute / sharp chest pain.

The patient had a previous history of angina pectoris and rheumatoid arthritis.

Daily medications included: Prednisolone, amlodipine, ISDN, ranitidine.

Patient was a non-smoker.

There was no history of DVT /PE.

On examination:

Temperature of 39.1, pulse 120 regular, RR= 25/min, SpO2 95% on 5 L O2, BP 120/80.

Drowsy consciousness but able to answer questions

Dry tongue and decreased skin turgor

Aortic ejection systolic murmur and tachycardia.

Dullness to percussion at left base and coarse breath sounds. No crackles.

Abdomen within normal limits.

Right lower limb very warm more than left. No evidence of calf muscle tenderness / dilated veins / redness / pain. Mild oedema bilaterally but equal in amount.

Blood Gas: Hypoxaemia SpO2 70mmHg (room air), pH 7.46, HCO3 22, pCO2 30

Chest Xray

CT scan

Question 1: Give two possible diagnoses that may coexist.

Question 2: What does the CXR show?

Question 3: What does the CT scan show?

Question 4: What other two important blood tests would you do to separate the two diagnoses?

Question 5: What treatments would you start empirically in this acutely in this patient?

Please send me your answers and they will be moderated and published.

Answers in one week from today !!

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