Casos Clinicos Ingles

CLINICAL CASES

Teacher : Luis Enrique Huere Curi

Asignature : English – III

School : Medicine
ANGINA

Chief complaint  "Pain on my chest" on and off for the past six months.
History of present illness Mr. Solomon is a 58 year old insurance broker who presents tonight in the office following an episode of "chest pain" that he experienced earlier in the day during a golf game.Although he minimizes the severity of the pain and attributes it to being "out of shape," his wife insisted that he see a physician because he has had similar episodes during the past six months.

Mr. Solomon describes the pain as being more of a discomfort or heaviness. It is localized to "my breast bone" and does not radiate. Today, following a brief rest, the pain subsided and he returned tohis golf game. Previous episodes of the heavy feeling tended to occur following large meals and one occasion, while dancing at a wedding. None of the episodes lasted more than "several minutes."
Although Mr. Solomon did not experience nausea or vomiting today, he notes many episodes in the past of feeling a burning sensation in his chest. He describes the sensation as being "like acid behind mybreast bone." This feeling occurs most often late at night when he lays down. Usually he has had a large meal or drank alcohol. The sensation does not radiate.
Patient's perspective: When asked about how he feels about these episodes, he admits to being concerned about his health and longevity, considering his father died at age 52 of "heart problems." He says, business is poor, my kid is alwaysin trouble. "Who’s going to take care of things?"
 Physical Examination
Mr. Solomon is a short, moderately obese man who appears somewhat anxious but is in no apparent distress. He is wearing clean casual shirt/pants. Vital sings: BP right arm 162/94; left arm 160/92. Weight 176lbs; Height 5’7". Respiratory rate is 16/minute. Temperature, 98.4� F.
Examination of cardiovascular system reveals aregular, apical heart rate of 86/minute. S1 is heard best at the apex; a loud S2 is heard best in the R2ICS and L parasternal border. A questionable S4 is heard at the apex. There are no murmurs or apical prominence. There is no peripheral edema.
Lungs are clear to percussion and auscultation. An indirect hernia is noted in the right inguinal region. The abdomen is examination is negative forabnormalities

ASTHMA

A 37 y/o black female with a history of asthma, presents to the ER with tachypnea, and acute shortness of breath with audible wheezing. Patient has taken her prescribed medications of Cromolyn Sodium and Ventolin at home with no relief of symptoms prior to coming to the ER. A physical exam revealed the following: HR 110, RR 40 with signs of accessory muscle use. Ausculationrevealed decreased breath sounds with inspiratory and expiratory wheezing and pt was coughing up small amounts of white sputum. SaO2 was 93% on room air. An arterial blood gas (ABG) was ordered with the following results: pH 7.5, PaCO2 27, PaO2 75. An aerosol treatment was ordered and given with 0.5 cc albuterol with 3.0 cc normal saline in a small volume nebulizer for 10 minutes. Peak flows donebefore and after the treatment were 125/250 and ausculation revealed loud expiratory wheezing and better airflow. 20 minutes later a second treatment was given with the above meds. Peak flows before and after showed improvements of 230/360 and on ausculation there was clearing of breath sounds and much improved airflow. RR was 24 at this time and HR 108. Symptoms resolved and patient was givenprescription for inhaled steroids to be used with current home meds. Instruction was given for use of inhaled steroids and the patient was sent home.
This case is an example of what many people with asthma experience. The following discussion will cover the etiology, pathogenesis, signs and symptoms, diagnosis, and treatment of asthma. Complete the following sections and take the quiz to check...