Case No 1

  • Instructions: Please read the Case history and then attempt the Ist question. On getting the correct answer the link to proceed to next question will appear. Click on it to go to next question.

  • The case history is repeated on each page

History:65 year old lady, not diabetic or hypertensive, presents with one month history of gradual and progressive shortness of breath with PND and orthopnea. She also reports having had an upper respiratory tract illness and cough six weeks ago.

Past medical history : Non.

Social History: Non-smoker.

Physical examination: Positive for 10 cm JVP. PR 105 BPM. BP 110/65 mmhg. Halfway up bilateral chest rales. Diffuse point of maximal apical impulse, regular soft S1 , S3 and grade 3/6 holosystolic murmur over the apex. 2+ LLE.
 
Question 1

The etiology of the patient’s SOB is most likely:

COPD exacerbation.
 CHF
 Pulmonary embolism
 Primary pulmonary hypertension
 Idiopathic interstitial fibrosis
Patient’s prior medical history, presentation, and examination are consistent with shortness of breath due to a cardiac etiology. The physical exam is inconsistent with COPD exacerbation, idiopathic interstitial fibrosis, or primary pulmonary hypertension. Gradual onset and rales on exam make pulmonary embolism less likely.
 
 

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