When does systemic vascular resistance in infants begin to rise?Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing.

When does systemic vascular resistance in infants begin to rise?Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing.

A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing. Assuming, she is drug seeking he sends her home. She comes back to the ER four hours later and now you see the patient. She explains that she was running track this past afternoon at school and that despite being very hot (100 F) she pushed on. Afterwards, she starts feeling extensive pain in her chest and abdomen. She has jaundiced eyes, her blood pressure is 98/50, pulse is 112, T = 99.9 F, R = 28. The pain seems out of proportion to the physical findings.

· What is your list of differential diagnoses in this case and explain how each of these fits with the case patient as described above. Be sure to list at least three (3) pertinent differential diagnoses. Indicate which of these you would select as the most likely diagnosis and explain why.

· Now, as she is in the ER she begins to exhibit stroke like features. ? Does this change your differential?

· How do you treat this patient now? Are they any preventative actions that could have been taken?

PART No. 2:

Jesse is a 57-year-old male who presents with gradual onset of dyspnea on exertion and fatigue. He also complains of frequent dyspepsia (GERD) with nausea and occasional epigastric pain. He states that at night he has trouble breathing especially while lying on his back (Orthopnea). This is relieved by him sitting up. His vitals are 180/110, P = 88, T = 98.0 F, R = 20.

· Write three (3) differential diagnoses in this case and explain how each item in your differential fits and how it might not fit.

· What tests would you order? What immediate treatment would you consider giving this patient and what treatment when he went home? Assume your first differential is definitive.

· Now, he comes back to your clinic 3 months later and both his ankles are slightly swollen. What possible explanations are there for this observation? CHF now involving right side Must order Echo with EKG and Nuc stress test, labs Pro BNP.

PART No. 3:

Explanation & Answer

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