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Home Internal medicine QUIZ: Deterioration of daily life quality... *solved*

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QUIZ: Deterioration of daily life quality... *solved* PDF Print E-mail
Author: abakow
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Saturday, 24 October 2009 08:58

54-years old male admitted to a hospital for extension of a diagnostic. History: ChOPD, hypertension, large degree of obesity.

The patient notifies, that since several months his overall form and life quality deteriorated. He has a problem concentrating during the day, sometimes he falls asleep a few times during a day, at morning he wakes up fatigued and at night he is awakened by dyspnoea. Further more, he has headaches in the morning. He doesn't relate his symptoms to his weight, because he was obese a long time before the symptoms started to occur

Which tests would you order at first?
 

Comments  

 
0 #1 dsk 2009-10-24 12:03
Does the patient smoke (if so, how much) Any occupational hazards

First of all - CBC, what's his blood pressure and his maximum pressure. Weight, height (BMI).
With high hypertension we can have dysfunctions within the nervous system, even encephalopathy, alongside dyspnoea, weaknesses and add those to a ChOPD
 
 
0 #2 Michał 2009-10-24 12:40
The patient has his BP regulated with standard drugs, which he's been using for a couple of years. Currently after Eneral, thiazides and beta-blockers it stands at 125-130/80-90
CBC: normal, no signs of anemia
Weight ~ 124kg with 182cm of height
ABG in the morning: PaO - 87 mm Hg, PaCO2 ~ 47 mm Hg, which suggests respiratory distress.
Patient is on welfare, he worked as an electrician
 
 
0 #3 Gonzo 2009-10-24 15:23
chest X-ray, ECG (both resting and under a physical excercise)
 
 
0 #4 G.J. 2009-10-24 21:53
I'd prescribe a visit to a laryngologist and a polysomnography , suspecting a sleep apnea.
 
 
0 #5 Michał 2009-10-24 22:11
G.J. - bullseye! :-) The patient is suffering from obturatory sleep apnea and is currently assisted by a constant positive inspiratory pressure during his sleep. Congratulations
 
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