Question

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#1. Your patient is a 70 year old female who was living in an assisted living community. She was admitted yesterday with a fever of unknown origin. She alert and oriented X3. Her physical findings are: HR 110, BP 146/80, Temperature 40 C, RR 28 and shallow, SpO2 87% on room air. Skin is warm and dry, she appears to be slightly cachectic, her left hemithorax is expanding more than her right, she has increased vocal fremitus over her right middle lobe and dull percussion over her right middle lobe. BBS are decreased except over her right middle lobe where you hear crackles.

1. What would you diagnosis be, and the likely etiology of this disease? Be specific!

2. What signs and symptoms lead you to believe that she has this disease?

3. What are you suggested basic treatments?

#2. Your patient is a 54 year old female. She was admitted to the emergency department for a fall on her left side at work. She is alert and oriented to person, place, and time. Her physical findings are: HR 130, RR 30 shallow and labored, BP 94/40, temperature is 36.2 C, SpO2 is 85% on a 2 LNC. Chest excursion is decreased on the left side, percussion is hyperresonant on the left side, BBS are absent on the left. Her chest x-ray shows 30% of the left side radiolucent. ABG is 7.30/50/50/26 on 2 LNC.

1. What would you diagnosis be?

2. What signs and symptoms lead you to believe that he has this disease?

3. What are you suggested basic treatments?

Answer 1

#Patient 1 - 70 year old female

1) The possible diagnosis is Pneumonia . Which is defined as an infection that inflames air sacs in one or both lungs which may fill with fluid. With Pneumonia the air sacs may fill with fluid or pus. This infection may be life threatening to anyone.

Etiology: Many germs can cause pneumonia.The most common are bacteria and viruses in the air we breathe.

Pneumonia is classified according to the causative organisms such as

- bacterial pneumonia

-bacteria like organism causing pneumonia

- fungal pneumonia

- viral pneumonia

2)* Increased Vocal Fremitus: An increased Vocal Fremitus indicates denser lung tissue which can be caused by consolidation in disease such as pneumonia.

* Asymmetric expansion of the lungs is abnormal. The abnormal side expands less and lags behind the normal side. Any form of unilateral lung or pleural disease can cause asymmetric lung expansion.

*BBC - Bilateral Breath Sounds decreased except for the right middle lobe but with crackles is most suggestive of pneumonia.

3) Treatment for Pneumonia:

- Antibiotics can treat any common type of pneumonia.

- Pneumonia can be prevented by vaccines.

- supportive care like oxygen,oral rehydration therapy and iv fluids can be given .

# Patient 2 - 54 year female with rib fracture and collapsed lungs.

1) The diagnosis suggests of a collapsed lungs due to rib fracture.

2) A broken rib can puncture the in lungs. In severe cases the escaping air

Can bulid up pressure on the lung and heart which might cause life threatening problem such as loss of blood pressure.

-These is decreased chest exercision on the left lung.

- Percussion hyperressonated on the left side.

- Bilateral Breath Sounds (BBS) absent on the left side.

- She has fallen on the left side.

- These symptoms relate to rib fracture with collapsed lungs.

3) Treatment Suggestions:

* Treatment depends on the cause of collapse. It may heal with rest, although a close monitoring is necessary.

* Draining of air or fluid with needle of tube placed between the chest and collapsed lung helps to reduce the pressure built in.

* In most cases pneumonectomy that is removal of the lungs . Survival rate is good with a single lung.