[Solved]: Differential Diagnosis Shortness of Breath Case…

Differential Diagnosis Shortness of Breath Case Study HPI: 28-year-old white female reports to the Emergency Department with complaints of sharp left sided chest pain and shortness of breath of one day duration. The patient was in excellent health until yesterday. She was awakened from her sleep by sharp left sided chest pain. The pain worsened with motion and deep breathing. The pain has been progressively increasing in severity and she now has severe left shoulder pain. She complains of shortness of breath and is very apprehensive about dying. She denies any cough, fever, sputum production or hemoptysis. PMH: She is married and had one normal delivery three years ago. She has never been hospitalized except for labor and delivery. Social History: She works as a computer programmer. She smokes one pack of cigarettes a day for the past eight years. She considers herself a social drinker. Meds: She is currently on birth control pills. Review of systems: negative. She denies any past history of venous problems. Physical Examination Blood pressure 114/80; pulse 118; temperature 37.0 (oral) She appears to be in moderate respiratory distress. She is well developed and nourished. Pertinent findings include Lungs: a respiratory rate of 30 and shallow breathing. Decreased chest expansion and decreased breath sounds in the left base. There were no rales or rubs. Cardiac: Heart reveals PMI in the 5th intercostal space in MCL. Regular: No murmurs Abdomen: pelvic and rectal exams are normal. Extremities: reveal no evidence of edema, cyanosis or clubbing. Patient has negative Homan’s Sign. Joint exam revealed shoulder movements complete in range. No warmth or tenderness noted. The rest of the patient’s joints are normal. The following test results are available; Hematology: CBC: Hgb 15.0; Hct 43; WBC 11,000 Chemistry: Normal Arterial blood gases on RA: pH 7.46; PCO2 30; HCO3 24; PO2 80 and SO2 95% 12 Lead EKG: reveals sinus tachycardia and non-specific ST wave changes CXR clear Shoulder x-ray is normal. 1. Interpret the blood gases. 2. What is your top 3 working diagnosis now, after the screening lab tests? Why? 3. What additional studies would you like to order to confirm or rule out your DD? Why? 4. What are key features? 5. What are treatments for your differentials?