Question

58 yo female presents to clinic c/w SOB and increasing slowly for yrs. Symptoms worse in...

58 yo female presents to clinic c/w SOB and increasing slowly for yrs.

Symptoms worse in recent months, last 2 days much worse with productive cough.

Ankles swelling.

Additional hx:

60 pack-yr; quit 5 yrs. Ago

Yellow sputum

No fever, no chills or chest pain

No weight loss

No hx of heart disease

What would you like to ask about her medical hx?

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Answer #1

Things to see in her are:

  • Since there is shortness of breath, it may indicate cardiac disease (but it's given that no heart disease), non-cardiorespiratory conditions like anemia, thyrotoxicosis, or metabolic acidosis, respiratory conditions like COPD (chronic obstructive pulmonary disease) , asthma, pleural effusion, restrictive lung disorders, pulmonary hypertension, chronic pulmonary emboli, other conditions like obesity, neuromuscular disorders may cause shortness of breath. So it is necessary to ask the patient about each and every conditions
  • For anemia ask for : fatigue, light-headedness, malaise, skin pallor, fast heart beat. Do blood investigation - hemoglobin level , complete blood count.
  • For thyrotoxicosis : excessive sweating, heat intolerance, increased bowel movement,tremor nervousness. Do Thyroid level in blood test- TSH, T3, T4 .
  • For metabolic acidosis : confusion , sleepiness, fatigue, headache, lack of appetite, jaundice. Check blood pH level.
  • For respiratory problems that are mentioned before : wheezing, pain in the chest. Send the sputum to culture. Do lung function tests, chest x-ray.

Since there is ankle swelling it indicates the following :

  • Cardiac problems . So we have to do a ECG to find out the heart status.
  • There maybe any lymphatic obstruction at the ileofemoral vein which may cause edema of the lower limb.
  • Kidney problems may also result in leg swelling. There maybe urinary excretion of plasma protiens like albumin which is required to maintain the osmotic pressure (required to not to let the fluid out of blood vessels). So renal function tests should be done.
  • Liver problems may also cause leg swelling. As liver synthesize the plasma proteins, damaged liver can't synthesize it. So liver function tests should be done.
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