mlawizard

Instructions

You are a foundation doctor in A&E. A patient presents with sudden onset breathlessness.

1. Take a focused history from the patient.

2. Explain your differential diagnoses and management plan to the examiner.

Checklist

Checklist "RespiratoryHistory" not found

Management

Explain most likely differential diagnosis is Pulmonary Embolism.
Explain less likely and red flag differential diagnoses could be acute coronary syndrome, pneumothorax, aortic dissection.
Suggest bedside investigations of vital signs including SpO2, ECG, chest examination, leg examination.
Suggest laboratory investigations of FBC, U&Es, troponin, D-dimer, arterial blood gas.
Suggest imaging of chest X-ray, CTPA if Wells score ≥2 or positive D-dimer.
Suggest interventions of immediate oxygen therapy if hypoxic, hospital admission, therapeutic anticoagulation if no contraindications, urgent medical team referral.

Internally Approved

Surname/Nom (1)

Haque

Given names/Prenoms (2)

Sara

Date of birth/Date de naissance (4)

12 DEC 1975 (48)

Sex/Sexe (5)

PRESENTING COMPLAINT

You developed sudden shortness of breath about 2 hours ago. You also have sharp chest pain that gets worse when you breathe in. You feel anxious and your heart is racing.

IDEAS, CONCERNS AND EXPECTATIONS

You're worried because you've never felt this breathless before.

SYSTEMS REVIEW

Severe breathlessness at rest. Sharp, pleuritic chest pain right side. Palpitations. Mild cough but no sputum. No fever. Right calf slightly sore and swollen.

PAST MEDICAL HISTORY

Hypertension. Depression. Right total knee replacement 3 weeks ago.

DRUG HISTORY

Ramipril 5mg once daily. Sertraline 50mg once daily. Paracetamol and codeine for knee pain. No allergies.

FAMILY HISTORY

Mother had DVT after hip surgery.

SOCIAL HISTORY

Works as an office manager. Lives with husband. Mostly housebound since surgery. Non-smoker. Minimal alcohol. Takes combined oral contraceptive pill.