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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What could cause shortness of breath?

A 67 years old male is admitteed to the hospital with a chief complaint of shortness of breath. History started a month prior to admission when patient was noted to have unproductive cough, night sweats and decreasing appetite. Two weeks prior to admission patient had undocumented fever, this time cough was productive yellowish sputum. Symptoms was said to be more appreciated at night. Patient self medicated with Paracetamol, an recalled antibiotic and Salbutamol nebulization. An hour prior to admission patient had perrsistent coughing, with expectoration of blood tinged sputum and dyspnea. This prompted admission. Patient is known asthmatic and is maintained on as needed Salbutamol nebulizer on attacks. He is also hypertensive with highest BP recorded 170/90. Patient is on irregular intake of his anti-hypertensive medications. there is a family history of Asthme, Hypertension and DM. He is a smoker consuming 1 pack per day for the last 20 years or so. He reportedly stopped smoking a month prior to admission. Other findings include weight loss 25%, polyuria, polydipsia. On PE patient has BP of 140/90, RR of 24 cycles/min, (+) cervical lymphadenopathy, decreased breath sounds on right lower lung field, distant heart sounds but otherwise regular rate and normal rhythm, flabby abdomen with normal bowel sounds. There is also a grade II bipedal edema. Neurologic exam normal. What could be the differential diagnosis of the patient aside from Tuberculosis?
Wed, 14 Dec 2016
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Pulmonologist 's  Response
Hello
Thank you for asking in HCM
According to the given information the patient is known and under treatment for Arterial Hypertension and Bronchial Asthma.
Given the fact that he has smoked it is necessary to rule out COPD with a test called Spirometry with bronchodilatators.
Weight loss 25%, polyuria, polydipsia are signs of diabetes so it is to confirm.
Persistent coughing, with expectoration of blood tinged sputum and decreased breath sounds on right lower lung field,in a patient probably diabetic maybe it is pneumonia.
Distant heart sounds,a grade II bipedal edema probably cardiac pathologies.

In conclusion my opinion is that tha patients should do:

Hole blood count
CRP
HBA1C
Uremia Creatinemia,Electrolites,ABG
Glucose in blood empty stomach
Chest X Ray
Pulmonologist, endocrinologist and cardiologist consultation

Thank you

Dr.Jolanda
Pulmonologist
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