Explore Breathless, our latest Interactive Medical Case.
A 50-year-old woman presented with fatigue and shortness of breath. One week before presentation, she experienced the gradual onset of dyspnea after moderate exertion, profound malaise, and a non-productive cough. In the 48 hours before admission, her shortness of breath worsened, such that she was dyspneic while at rest. She reported palpitations, nausea, and bilious emesis . . .
Each interactive case presents an evolving patient history and a series of questions and exercises designed to test your diagnostic and therapeutic skills. You will receive immediate feedback on your answers and treatment choices, along with the opportunity to compare your final score with those of your peers. Video, animation, and interactive content allow you to learn more about mechanisms, diagnostic tests, and treatments.
CME credits are also available by taking the exam at the end of the case. CME exams associated with Interactive Medical Cases are worth up to 2 AMA PRA Category 1 Credits™.
You may also wish to try one of our previous Interactive Medical Cases: Bird’s Eye View of Fever, A Problem in Gestation, A Sleeping Giant, A Sweet Source of Abdominal Pain, Lying Low, A Crazy Cause of Dyspnea, Bitter Pills, Hard to Conceive, A Rash Hypothesis, The Beat Goes On, Stalking the Diagnosis, Painful Purple Toes, A Crisis in Late Pregnancy, A Bloody Mystery, and The Writing on the Wall.
Dyspnoea on exertion, palpitation suggests cvs cause. Non productive cough may be due to pulm edema. But the cause is acute. Bilious emesis suggests intestinal obstruction. So I would think of a cvs problem secondary to some cause. may be tumour metastasis, drugs, infection etc..
1st inv would be an echo..
Also I would do an barium enema.
treat heart failure and do an upper GI endoscopy to find the cause.
the combination of progressive dyspnea with bilious vomiting may point to a gastroitestinal problem with chest involvement possibly a rapidly accumulating pleural effusion.
i will start with careful physical examination to be followed by a chest x-ray,plain x-ray of abdomen ,blood urea and an ecg and i will act accordingly.