The Case
A 64 year old female is brought in by her sister with a variety of chief complaints.
1. Blurry vision – acutely worse this morning.
2. Worsening shortness of breath, especially on exertion and on lying flat for 3 weeks. She has also developed bilateral lower extremity edema during this time period.
3. Not acting like herself, more lethargic over the last two days.
4. Paresthesias to her bilateral hands over the last 2 days.
The sister does not know the patient’s past medical history exactly, but remembers that she had something wrong in her blood involving her “globes”
ROS + for mild cough, mild abdominal pain, and mild headache
Denies fevers, chills, chest pain, weakness, hematuria, dysuria, nausea, vomiting, neck stiffness, recent travel, sick contacts, rashes, a history of eye problems or any other complaint.
VS HR 101, RR 25, Temp 100.1 F oral, O2sat 92%
PE is normal except for
Bilat crackles 2/3 way up back
Bilat 2+ lower extremity edema
Lethargic but arousable.
Neuro exam is difficult as the patient is unable to properly follow instructions, but is grossly negative for acute findings.
For prize and glory, please answer the following questions…
What are your top three diagnoses in order?
What tests do you want to order for this patient?
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andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
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