You may use a group of up to 4 total students to work through the study, however

Question

You may use a group of up to 4 total students to work through the study, however each student must submit their own unique write-up. You are welcome to use outside healthcare providers for help. Reference any major sources in the format of your choosing. Finally, in 5-6 paragraphs, explain the following: • Working diagnosis, using a rationale to include differential diagnosis • Review of any significant clinical findings (labs, EKG’s, etc.) to support diagnosis • Disease etiology • Possible treatment plan to include any immediate interventions to establish a longterm plan • Patient prognosis

Clinical Presentation History A 79 year old male presents to the emergency room complaining of shortness of breath and respiratory distress. The patient states they have no past medical history other than 15 years of chronic shortness of breath, due to not having seen a physician in the last 20 years. The patient states today is worse than it has ever been. The patient denies any specific pain, denies any recent trauma, and describes the onset of this episode as being gradual.
Vital Signs Heart Rate: 75 beats per minute. Blood Pressure: 140/90 mmHg sitting in tripod position. Temperature: 98.6 degrees Fahrenheit. Respirations: 25 per minute. Pulse Oximetry: 71% on room air. Mental Status: Alert & Oriented to person, place, events, but not time. 15/15 on Glasgow coma scale. Physical Examination Overall, the patient’s skin is pale, cool, and moderately diaphoretic. The patient is generally weak. Head/Ears/Eyes/Throat: Pupils are equal, round, reactive to light. Atraumatic, afebrile. No tracheal deviation. No jugular vein distention. Patent airway. Thorax: Lungs sounds clear and equal chest rise bilaterally with marked accessory assistance of intercostals in (respiratory) inspiration. Tachypneic at a rate of 25 respirations/min. Otherwise unremarkable physically. Abdomen: Some diaphragmatic breathing noted. No pain on palpation. No obvious distention, physically otherwise unremarkable. Pelvis: Stable and weight bearing, atraumatic and unremarkable. GI/GU: Patient reports irregular nocturia that is normal for him, normal bowel movements and no urine output today. Lab Values EKG and blood work over next 2 pages.

Biology 356 Summer 2017 STICKER Normal ranges BG 10/ 35: 80.0 Laboratory Results WBC = GRA- MID%= LYM%= 9.0 77.5 4.6 17.9 10 11 33.5 800aboratory Results % 2.0: 15.0 0 15.0 50. 109/1 1.2 8.0 Physician: LYM = 109 /1 0.5: 5.0 Date: 1012/1 3.505.50Time: RBC L 2.17 HGB=L 6.2 MCV84.4 HCT L 18.4 MCH= 28.8 MCHC= 34.2 RDW%-13. g/dl 11.5 :. 16.5 L £1 75.0 100.0 35.0: 55.0 pg 25.0 35.0 g/dl 31.0 38.0 % 11.0: 16.0 PLT L 85 MPV = 9.9 10/1 100 400 fl 8.0: 11.0 NA+ 140 128-145 mmol/L K+ 5.8 3.8-5.1 nnol/L tC025 8-33 mrol/L CL 115 98-108 mo/L GLU 12073-118 n/dL CA 9.1 8.0-10.3 ng/dL BUN 1807-22 ng/dL CRE 20.0 0.6-1.2 ng/dL ALP 2842-14 U/L ALT 1 10-47 U/L AST 11 11-38 UL TEL 0.4 0.2-1.6 /dL ALB 3.7 3.3-5.5 a/dL TP 6.9 68 a/dL 30 100 200 30100 2003, PL.T (£1)-> 1.31 mol/L CKMB 1.2 ng mL ng mL THI '0.05 ng/mL BNP 42.0 P3 mL

Explanation / Answer

According to the given Vital Signs:

Heart Rate: 75 beat per minute.

Blood Pressure: 140/90 mmHg sitting in tripod position.

Temperature: 98.6 degrees Fahrenheit.

Respirations: 25 per minute.

Pulse Oximetry: 71% on room air.

The 79 year Old man who presented to the Emergency Room has some serious issues. Firstly since there's no documented history of Smoking by this man so the primary cause of his Shortness of breath is non-Pulmonary, making our diagnosis to shift towards a Cardiac cause. His vitals are per se Normal except for the Blood pressure that's elevated and his pulse oximeter saturation that's less. In his blood investigation the major concern is the raised levels of myoglobin which is found in cardiac muscle and skeletal muscle. With all these presenting signs and symptoms the most apt diagnosis would be Acute Myocardial Infarction. Since the levels of myoglobin is raised and the BNP levels are normal (42 that's less than 100, raised levels are seen in Congestive Heart failure), Myocardial infarction would be the diagnosis. Note that the patient is Tachypneic and diaphoretic (sign of MI) but isn't complaining of any Substernal pain that would happen in a Silent MI in which there is an underlying neuropathy too.

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