Case Study 2

Question 1

55 yrs woman with SOB, known diabetes and smokes 30 per day, what is your differential?

Answer 1

LVF
Pulmonary oedema
Pleural effusion
Pneumonia

Question 2

Her examination shows reduced right sided expansion, vocal fremitus, stony dull percussion and reduced breaths sounds, what is the likely diagnosis?

Answer 2

Plueral effusion/ collapsed lung

Question 3

Due to her respiratory chest symptoms, which investigation is the most useful?

Answer 3

Chest X Ray

Question 4

The patient has a pleural effusion- how do you investigate the cause?

Answer 4

Pleural Tap then clinical chemistry, microbiology (microscopy, culture and sensitivity) and cytology

Question 5

What is the difference between transudate and exudate?

Answer 5

Transudate: protein < 30 g/dl
in HF

Exudate : protein > 30 g/dl
in infection and cancer

Question 6

What are the most likely infections of pneumonia?

Answer 6

Strep. pneumoniae (G+ve diplococcus) Treat with benzyl penicillin
Haemophilus influenzae (G-ve rod) Treat with amoxicillin

Question 7

How long does sensitivty take?

Answer 7

48h