I have this case study that I'm trying to figure out and getting nowhere with-
22 year old obese female presents to her GP complaining of a tightness in her chest over the past three days. Curiously, the sensation only manifests itself in the evening and does not worsen when she lies down. She reports using an Albuterol inhaler to relieve the tightness but states that the relief has been minimal. Patient's past history is significant for seasonal allergies, bronchitis and asthma though she states she has not had an asthma attack in four years. She is currently on oral contraceptives and thyroid medication. Vitals: BP is 110/70, pulse 79 bpm, respiration 16 breaths/min.
Differentials anyone?
I can't think of a single reason why I should be a doctor, but I can think of a thousand reasons why I should quit. They make it hard on purpose. There are lives in our hands. There comes a moment when it's more than just a game, and you either take that step forward or turn around and walk away. I could quit but here's the thing, I love the playing field. [MG]
5 comments:
PE due to high risk factor (oc's and obesity).
wow - that's awfully vague.
Obesity itself can manifest as restrictive disease. Could be a physical obstruction. PE's also on my list. Atypical pneumonia's always a favourite. The timing suggests something environmental - particulate-related asthma or a temperature thing. The age is wrong for lung cancer but it has to be on the list too. The age and gender is perfect for autoimmune pulmonary fibrosis or something similar,though the timing is weird. I vote for lupus.
Let us know when you find out!
First thought was stress to the heart (given her weight, chest tightness and gender, with females usually presenting with non-hallmark signs), but laying down should make it worse. Maybe restrictive lung disease 2* to her weight? Or non-exercise induced asthma? It doesn't sound musculoskeletal, neuromuscular or integumentary to me. Cardiopulmonary issues are still on the list, but I don't think it's cardiac in origin. And that's the end of my expertise as a PT. REFER OUT TO AN INTERNIST! hahaha
hmm...well it shouldn't be drug-induced bronchospasm if that's all she's on.. i vote for nocturnal asthma. lol and that's the extent of my knowledge as a pharmacy intern. please tell us the answer though!
from watching house, i say: go search her house!
Post a Comment