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2014 FOEM Clinical Pathological Case Competition

2014 FOEM Clinical Pathological Case Competition. Ashley DeBarba, DO Midwestern University October 12, 2014. History of Present Illness.

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2014 FOEM Clinical Pathological Case Competition

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  1. 2014 FOEM Clinical Pathological Case Competition Ashley DeBarba, DO Midwestern University October 12, 2014

  2. History of Present Illness 59 y/o caucasian male presents with 4 day history of congestion, fatigue, dyspnea on exertion, and occasional palpitations. He reports nothing makes the symptoms better but symptoms seem to worsen with exertion. He denies any cough, throat pain, fever, or chest pain. No dizziness or recent syncopal episodes. Started on Rapafloabout 2 weeks ago. No other new medications.

  3. Past Medical History Past Surgical History Cholecystectomy • Non-Hodgkins lymphoma, stage 3 – in remission since 1994, treated with chemotherapy • Vasovagal Syncope • BPH

  4. Family History Social History No tobacco No illicit drug use Occasional etoh Lives with wife,1 adult son and 1 adult daughter who are both healthy. • Parents with DM, brother and cousin with pacemakers

  5. Medications Allergies None • Rapaflo • Multivitamin • Ibuprofen

  6. Review of Systems • General: + fatigue, - fever, - weight loss • HEENT: + nasal congestion, - sore throat, - headache • Resp: + dyspnea on exertion, - cough, - wheezing • CV: + palpitations, - chest pain, - edema • Abd: - abdominal pain, - nausea, - vomiting • Extrem: - no extremity pain or weakness • Neuro: - focal deficits, - dizziness

  7. Physical Exam • Vital Signs – HR 42, BP 132/84, RR 14, O2 98% on RA, Temp 99.1F • Gen – NAD, alert and oriented x 3, sitting up in bed • HEENT – Normocephalic, EOMI, PERRLA, clear nasal drainage, no pharyngeal erythema or edema, no sinus tenderness. No tonsillar exudate, no uvular deviation, no peritonsillarabscess

  8. Physical Exam • CV – Bradycardic, S1/S2, no murmur/rub/gallop • Resp– Clear to auscultation bilaterally • Abdomen – Soft, nontender, nondistended, normal bowel sounds • Extremities – No edema, normal strength x 4, normal ROM

  9. Test Results • WBC: 5.6 • Hgb: 16.4 • Hct: 49.6 • Plt: 195 • Troponin: <0.03 • INR: 1.0 • Na: 144 • K: 3.4 • Cl: 103 • HCO3: 34 • Bun: 15 • Cr: 1.0 • Glucose: 92

  10. Chest Xray

  11. EKG

  12. ED Course • Patient remained asymptomatic with heart rate ranging from 34-58 • EP and Cardiology consulted with request for Echo and CTA heart • Echo: LVEF 55-60%, mildly dilated left atrium • CTA Heart: No coronary artery disease • Patient admitted

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