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20 year old female comes to A&E complaining of progressively worsening…
20 year old female comes to A&E complaining of progressively worsening breathlessness over the past 6 hours
Accompanying symptoms
Fever
Pneumonia. Other Sx: cough; insensitive signs = productive cough, fever, pleuritic chest pain
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Chest Pain
Heaviness, pressure or crushing substernal pain radiating to jaw or left arm => Acute Myocardial Infarction (may not always be present esp. in older patients, women, diabetics). Other Sx: weakness, nausea & vomiting, palpitations
Unilateral pleuritic pain => Spontaneous pneumothorax. Other Sx: hyperresonant on percussion; tracheal deviation if late; decreased breath sounds and vocal resonance
Unilateral/bilateral pleuritic pain => Pulmonary embolism (PE). Other Sx: increased RR (tachypnea) and HR; signs of DVT e.g. swelling/erythema; hx of contraceptives/estrogen. DVT with PE: unilateral leg edema.
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Weakness => Neurological, e.g. myasthenic crisis; GBS; motor neuron dysfx
Hypotension => Cardiac tamponade. Other Sx: distended neck veins; muffled heart tones; ECG: sinus tachycardia/low voltage
Other clues
Foreign object aspiration. Other Sx: acute onset of dysphagia; inability to swallow saliva; neck tenderness; chronic cough/hemoptysis; fever; foul-smelling sputum (regurgitation of undigested food); chest pain; wheezing
Chest signs i.e. decreased expansion and breath sounds => Pleural effusion. Other Sx: stony dull on percussion; bronchial breathing above the effusion, cough
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Recent new medications, e.g. beta-lactams, ACE inhibitors => Allergic rxns; angioedema
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Other less common causes
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Poisoning. Other Sx: varied, e.g. vomiting/diarrhoea/vertigo with salicylate; headache/malaise/altered mental status with CO; hx of polyuria/polydipsia/polyphagia with DKA
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