2014 foem clinical pathological case competition
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2014 FOEM Clinical Pathological Case Competition. Ashley DeBarba, DO Midwestern University October 12, 2014. History of Present Illness.

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2014 FOEM Clinical Pathological Case Competition

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2014 foem clinical pathological case competition

2014 FOEM Clinical Pathological Case Competition

Ashley DeBarba, DO

Midwestern University

October 12, 2014


History of present illness

History of Present Illness

59 y/o caucasian male presents with 4 day history of congestion, fatigue, dyspnea on exertion, and occasional palpitations. He reports nothing makes the symptoms better but symptoms seem to worsen with exertion. He denies any cough, throat pain, fever, or chest pain. No dizziness or recent syncopal episodes. Started on Rapafloabout 2 weeks ago. No other new medications.


2014 foem clinical pathological case competition

Past Medical History

Past Surgical History

Cholecystectomy

  • Non-Hodgkins lymphoma, stage 3 – in remission since 1994, treated with chemotherapy

  • Vasovagal Syncope

  • BPH


2014 foem clinical pathological case competition

Family History

Social History

No tobacco

No illicit drug use

Occasional etoh

Lives with wife,1 adult son and 1 adult daughter who are both healthy.

  • Parents with DM, brother and cousin with pacemakers


2014 foem clinical pathological case competition

Medications

Allergies

None

  • Rapaflo

  • Multivitamin

  • Ibuprofen


Review of systems

Review of Systems

  • General: + fatigue, - fever, - weight loss

  • HEENT: + nasal congestion, - sore throat, - headache

  • Resp: + dyspnea on exertion, - cough, - wheezing

  • CV: + palpitations, - chest pain, - edema

  • Abd: - abdominal pain, - nausea, - vomiting

  • Extrem: - no extremity pain or weakness

  • Neuro: - focal deficits, - dizziness


Physical exam

Physical Exam

  • Vital Signs – HR 42, BP 132/84, RR 14, O2 98% on RA, Temp 99.1F

  • Gen – NAD, alert and oriented x 3, sitting up in bed

  • HEENT – Normocephalic, EOMI, PERRLA, clear nasal drainage, no pharyngeal erythema or edema, no sinus tenderness. No tonsillar exudate, no uvular deviation, no peritonsillarabscess


Physical exam1

Physical Exam

  • CV – Bradycardic, S1/S2, no murmur/rub/gallop

  • Resp– Clear to auscultation bilaterally

  • Abdomen – Soft, nontender, nondistended, normal bowel sounds

  • Extremities – No edema, normal strength x 4, normal ROM


Test results

Test Results

  • WBC: 5.6

  • Hgb: 16.4

  • Hct: 49.6

  • Plt: 195

  • Troponin: <0.03

  • INR: 1.0

  • Na: 144

  • K: 3.4

  • Cl: 103

  • HCO3: 34

  • Bun: 15

  • Cr: 1.0

  • Glucose: 92


Chest xray

Chest Xray


2014 foem clinical pathological case competition

EKG


Ed course

ED Course

  • Patient remained asymptomatic with heart rate ranging from 34-58

  • EP and Cardiology consulted with request for Echo and CTA heart

  • Echo: LVEF 55-60%, mildly dilated left atrium

  • CTA Heart: No coronary artery disease

  • Patient admitted


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