Question

CASE 1: A 45-year-old female, conscious and coherent, presents with cough for 2 weeks, fever and malaise. Physical examination reveal rales in the left lung base, respiratory rate of 30 breaths / min. associated with minimal difficulty of breathing. Blood pressure is measured at 90 / 60mmHg. Laboratory results show elevated WBC and Urea levels at 8mmol / L. A. Based on the case presented above, evaluate the severity of the patient's condițion. B. What recommendation or treatment option will you expect or anticipate from the doctor as a form of management? (Base answer on Letter A)

Answer 1

A) Here, the patient could be suffering from Pneumonia due to the presence of rales in the left lung base, cough, fever, malaise, slightly elevated urea levels, reduced blood pressure, elevated WBC count, some difficulty of breathing, and elevated respiratory rate.

Based on the presented case, the severity of the patient's condition can be evaluated on the basis of following parameters (parameters used to determine CURB - 65 score.

• Since ​​​​​​respiratory rate >=30 breaths/min, therefore 1 point given.
• Since systolic blood pressure =<90 mm of Hg and diastolic blood pressure =<60 mm of Hg, therefore 1 point given.
• Since urea level > 7 mmol/L. Therefore 1 point given.
• Since confusion is absent in the patient, therefore 0 point given.
• Since age of the patient is less than 65 years, therefore 0 point given.

Therefore, total CURB - 65 score is 1+1+1+0+0=3, therefore patient's condition is moderately severe.

B) Based on the severity of patient's condition, hospitalization is recommended and some specific recommendation or treatment options can be expected or anticipated from the doctor as a form of management.

The treatment options anticipated from the doctor can include antibiotics (macrolides, fluoroquinolones, aminoglycosides, cephalosporins, etc), simple analgesics, antipyretics, oxygen therapy and fluids.