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Hi. I Am Working On A Case Study, The Pt
Question: Hi. I am working on a case study, the pt has just traveled and came back complaining of weakness, shortness of breath, cough and night sweats for the past month. What would be the cause?
Brief Answer:
the cardiac cause needs to be ruled out at first...
Detailed Answer:
Hello there,
Welcome to 'Ask A Doctor' service...
I've gone through your query in details...
Well, first and foremost, it's important to know the age and gender of the patient (this two are the most basic info which itself can give an immeasurable number of details to the treating physician/clinician)...
Secondly, how long is s/he suffering from for these complaints? Are there any other complaints?
You've mentioned regarding travelling, from where? Was it a long-flight travel? Or did you mean to say something else?
Does the patient have any pre-existing medical conditions? Was s/he under any specific medications during the presentation?
Any history of smoking/alcohol recently?
These are the standard history taking format I've mentioned for your convenience. A good clinician/physician must abide by this, and if taken properly, can itself provide a lot of valuable info regarding the possible provisional diagnosis.
Now, as per this description, the primary suspicion should be focussed on cardiac causes (namely any acute coronary event or acute/chronic heart failure). The second area of focus should be the lung and pulmonary circulation regarding concerns followed by infective causes.
Some basic investigations to be done on presentation should comprise of a Hemogram, LFT, KFT, 12-lead EKG, Chest X-ray, 2D-echocardiography, Cardiac Enzymes (CPK, CK-MB, Trop-I) along with NT pro-BNP (a highly sensitive marker for heart failure) and a blood gas analysis (preferably arterial)...
Let me know if I can assist you further...
Take Care
Kind Regards
the cardiac cause needs to be ruled out at first...
Detailed Answer:
Hello there,
Welcome to 'Ask A Doctor' service...
I've gone through your query in details...
Well, first and foremost, it's important to know the age and gender of the patient (this two are the most basic info which itself can give an immeasurable number of details to the treating physician/clinician)...
Secondly, how long is s/he suffering from for these complaints? Are there any other complaints?
You've mentioned regarding travelling, from where? Was it a long-flight travel? Or did you mean to say something else?
Does the patient have any pre-existing medical conditions? Was s/he under any specific medications during the presentation?
Any history of smoking/alcohol recently?
These are the standard history taking format I've mentioned for your convenience. A good clinician/physician must abide by this, and if taken properly, can itself provide a lot of valuable info regarding the possible provisional diagnosis.
Now, as per this description, the primary suspicion should be focussed on cardiac causes (namely any acute coronary event or acute/chronic heart failure). The second area of focus should be the lung and pulmonary circulation regarding concerns followed by infective causes.
Some basic investigations to be done on presentation should comprise of a Hemogram, LFT, KFT, 12-lead EKG, Chest X-ray, 2D-echocardiography, Cardiac Enzymes (CPK, CK-MB, Trop-I) along with NT pro-BNP (a highly sensitive marker for heart failure) and a blood gas analysis (preferably arterial)...
Let me know if I can assist you further...
Take Care
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
follow-up consultation...
Detailed Answer:
Welcome back,
Now that you've mentioned the age, it could be respiratory also, but the standard investigations protocol still remains the same, (only I'd perhaps replace the NT-pro BNP and add D-dimer, to evaluate any suspected pulmonary thromboembolism)...
What else does the case study state? Does it mention any obesity, any long travel, any palpitation, chest pain or any other symptoms?
Any history fever/weight loss/rash anywhere in the body?
Do they describe the cough? is it dry/productive? Since how long?
Any other info (not necessarily need to be medical only, even socioeconomic or other details can be handy)?
Awaiting...
Take Care
Kind Regards
follow-up consultation...
Detailed Answer:
Welcome back,
Now that you've mentioned the age, it could be respiratory also, but the standard investigations protocol still remains the same, (only I'd perhaps replace the NT-pro BNP and add D-dimer, to evaluate any suspected pulmonary thromboembolism)...
What else does the case study state? Does it mention any obesity, any long travel, any palpitation, chest pain or any other symptoms?
Any history fever/weight loss/rash anywhere in the body?
Do they describe the cough? is it dry/productive? Since how long?
Any other info (not necessarily need to be medical only, even socioeconomic or other details can be handy)?
Awaiting...
Take Care
Kind Regards
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
The patient is 29 y.o. Who has newly migrated to the U.S.The case study does note state from where. No other medical history listed. I was thinking more of a respiratory problem?
No other medical conditions listed. It just states a cough but not what type of a cough or whether its a dry cough or a productive cough. No other information was given. Other than 29 y.o female who has recently migrated, with c/o cough, night sweats and SOB for the last one month.
I was thinking more of respiratory due to recent migration, and night sweats so I was leaning more towards TB, but am confused on the SOB of breath
I was thinking more of respiratory due to recent migration, and night sweats so I was leaning more towards TB, but am confused on the SOB of breath
Brief Answer:
Yes, keep TB first, please see the detailed answer below...
Detailed Answer:
Welcome back,
See, night sweat with a history of a cough for one month can be seen in TB. Yes, even SOB is seen in TB (but it'll be a secondary complication due to either Pleural Effusion or pulmonary tissue damage). So, that's possible. Weakness again can be there due to malnutrition, poor circulation and several other factors. Yes, you're thinking correctly, stick to TB as the primary provisional diagnosis.
However, just keep these other options as the differential diagnosis (if there's a scope to enter), i.e. OSA (obstructive sleep apnea), there's always a possibility of some undiagnosed Pulmonary Hypertension, Bronchial Asthma since no mention of any fever, rashes or any other details. I'd not go for any further extensive differentials as they can give rise to even more confusion.
I hope this will suffice in this...Let me know how it goes...
Take Care
Kind Regards
Yes, keep TB first, please see the detailed answer below...
Detailed Answer:
Welcome back,
See, night sweat with a history of a cough for one month can be seen in TB. Yes, even SOB is seen in TB (but it'll be a secondary complication due to either Pleural Effusion or pulmonary tissue damage). So, that's possible. Weakness again can be there due to malnutrition, poor circulation and several other factors. Yes, you're thinking correctly, stick to TB as the primary provisional diagnosis.
However, just keep these other options as the differential diagnosis (if there's a scope to enter), i.e. OSA (obstructive sleep apnea), there's always a possibility of some undiagnosed Pulmonary Hypertension, Bronchial Asthma since no mention of any fever, rashes or any other details. I'd not go for any further extensive differentials as they can give rise to even more confusion.
I hope this will suffice in this...Let me know how it goes...
Take Care
Kind Regards
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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