Problem solving 13/09/21 - 01

 



Comments

Post a Comment

Popular posts from this blog

Picture of the day - An elderly lady with shortness of breath

Image
A 62 years old lady presented with a history of shortness of breath for 2 years. She denied cough or wheezing. There was no history of ischemic chest pain in the past. Family history was unremarkable. On examination she was tachycardic. Blood pressure was 110/80mmHg. The house officer could not detect a murmur. Lungs were clear. In view of the cardiomegaly on the Xray, the house officer started IV frusemide and aspirin. The next day during the ward round, the consultant asked the HO to re-auscultate the patient. What is the diagnosis?
Read more

Things not to miss - Rickettsial infections

Image
A 55 years old man from Hatharaliyadda (A small town which forms the margin between districts of Kurunegala, Kandy, and Kegalle) presented with a history of fever for 4 days duration. He had a headache, myalgia, arthralgia, and a faint generalized erythematous rash. There was no contact history of fever. He was a farmer who consumed alcohol regularly. On examination he looked ill, pulse rate was 100/min, blood pressure 90/60mmHg, lungs were clear and there was mild epigastric tenderness. What are the possibilities? The first differential diagnosis for this presentation is invariably dengue. An in-ward ultrasound scan was done to look for evidence of leaking. Leaking or not?? Urgent PCV was done - it was 42%. As there was no evidence of leaking, the patient was managed as dehydration. One pint of normal saline was given for resuscitation and 100cc/hr drip was continued for maintenance as the patient was reluctant to take fluids orally. A blue chart was maintaine...
Read more