Reference no: EM133604682
A few hours after you last talked with Mr. ABC about his shortness of breath, you received some lab and diagnostic test results. For your convenience, the case will be reviewed again. Remember, you go to see Mr. A.B.C. in the emergency room, who is a 34 year old Hispanic male who presented with a complaint of severe dyspnea. He has been experiencing dyspnea for two weeks that has slowly but progressively gotten worse. He was brought back immediately from triage because he has a respiratory rate of 40 and the O2 sat of 88 percent and a temperature of 101. His O2 sat has improved on four liters of nasal cannula of oxygen to 92 percent. His review systems is positive for fevers, chills, weight loss, malaise, fatigue, diaphoresis, cough, dyspnea, weakness, swelling in his lower extremities, a feeling of abdominal fullness and unintentional weight loss. He denies any other symptoms. His past medical history is positive for asthma. His past surgical history is negative. He is a single male, has sexual relations with men and women, denies smoking. He has a history of I.V. drug use, but has not used anything for five years and has a history of heavy use of alcohol. He has not drank for two years. His physical exam. Tis temperature is 101, heart rate is 120, respiratory rate is thirty eight. Blood pressure is 110 over 60, and O2 SAT is 92 percent on 4 liters of nasal cannula, He is alert and oriented times three. He is thin, his head is normocephalic and atraumatic. Pupils are equal round and reactive to light. There is no nystagmus or sclera icterus noted. He does have white patches on his tongue and buccal mucosa. His neck is supple. There is no JVD, there's no tracheal deviation, no thyromegaly or thyroid nodules. He has a normal heart rate. S1 is normal. There's an S2 present without an S3, S4, gallop, friction rub, murmur or splitting, +1 edema in the lower extremities. As noted, brachial, radial, dorsalis pedis and posterior tibial pulses are two plus over four plus bilaterally. He is dyspneic. Respirations, however are regular and even. Lungs have rales in all lung fields. His abdomen is rounded, distended and soft. His bowel sounds are active. He has no masses noted and there is no CVA tenderness. Hepatomegaly is present along with shifting dullness. There is no rigidity, rebound or guarding. His lymph nodes There is widely spread lymphadenopathy. Cranial nerve 2 through 12 are intact. His skin is warm, dry and intact. There's a line of vesicles on the left thorax that extends from the anterior to the posterior thorax. Mood and affect are normal, calm and cooperative behavior, and his judgment is intact. So his available labs are listed, his sodium is 130, potassium is 5.0, creatinine is 1.0, BUN is 15, glucose is 97, bicarb, also known as the CO2, is 25. Anion gap is 13. WBCS are 2,000. The hemoglobin is 10.2 hematocrit is 30 percent. MCV is 90. Platelets are 78,000. AST is 60. ALT 58. Albumin is 2.8 and PT INR 17 seconds and 2. An abdominal ultrasound shows that he has mild ascites and significant fibrotic changes in the liver.
Upon reviewing the available labs and diagnostic test results, you go back to see Mr. A.B.C. to discuss his new diagnoses.
1. What diagnoses does Mr. A.B.C. have?
2. What additional lab or diagnostic test are needed?
3. What specific items of Mr. ABC's case may have caused the primary diagnosis.
4. Described the pathogenesis, which explains Mr. ABCs physical symptoms and lab results.
5. What education is important for Mr. A.B.C. to receive?