PACES Channel (HELPING HANDS MEDICAL EDUCATION CENTRE)

If this CA breast patient on chemo, >>confusion for 4 days >>preceeding problems with back pain for 1 months >>also became constipated more thirsty and increased urine amount >>PE - GCS 13/15 no neuro deficit dehydration (+) tenderness over T10 and T11 👉What is the most likely cause of confusion?

Acute confusion or delirium has a long list of possible causes. Among the following lists, try to link with underlying CA breast on chemotherapy. Confusion is always acute to subacute onset and so assessing onset won't help much in differentiating causes like in breathlessness complaint. We need to collect *OTHER CLUES* (both symps and signs) to make a sensible guess to Dx.

Thank you very much for answers. 😊 My apology for delay in uploading answers and further discussion. 🙏

Case 5 If CA breast patient on chemotherapy presented to you with acute confusion, what are likely differentials?

I hope you all can see how we should approach a case to get a correct and sensible diagnosis. 😊

Another important point is When RA patients presenting with SOB, not only RA related SOB causes but also non-RA related SOB causes must be considered. (eg RA patient can also be breathless due to pulmonary embolism, DKA or lung cancer, ect...)

Approach Among all the possible causes, to reach to the correct cause of SOB in this RA patient, a good history taking and physical examination will help you. *ONSET* and *NATURE* of breathlessness is very important. eg 1. chr SOB worse with exertion associated with dry cough --- is definately due to pulmonary fibrosis (either RA itself or methotrexate induced) which will be supported further by physical examination findings eg 2. chr SOB on exertion with clinically pallor - may be due to anaemia (either NSAID induced occult GI bleed or methotrexate induced BM suppression) eg 3. acute onset of SOB which worse on lying flat for 2 day - more in favour of ht failure ---- definately not caused by pulmonary fibrosis (even though there are physical signs of plmonary fibrosis, need to search the cause of why sudden SOB)

Thank you very much for a complete list of possible causes of SOB in RA patient. 😍 I won't repeat the list again.

Case 4 If this patient presented with shortness of breath, what are possible causes?

Thanks a lot! Please check answers in comment.

When you assess this patient, -history of recurrent haemotypsis with no constituitional symp -examination findings of mild clubbing, trachea shift to left, BBS and increased vocal resonance in left upper zone with few fine crepitations ✍️What is the most likely cause of haemotypsis?

When you assess this patient, -history of productive yellow sputum off and on and haemotypsis -examination findings of clubbing, coarse crepitations in left upper zone that change in character after coughing ✍️What is the most likely cause of haemotypsis?

So, likely causes are 1. Reactivation of TB 2. Post TB bronchiectasis 3. Cavitation with mycetoma or aspergilloma 4. Cavitation with pseudoaneurysm formation (Rasmussen aneurysm) 5. Scar cancer

Good Job! Thanks for your answers.

Case 3 If a 52 year old patient with old Koch's lung presented to you with recurrent haemoptysis, ..... What are likely causes?

1. Acute left heart failure dt scleroderma renal crisis 2. Rising creatinine CBC - microangiopathic haemolytic A with schistocytes on blood film and thrombocytopenia Anti RNP polymerase III Renal Bx 3. Early use of ACEI and Tx of acute left heart failure

What a perfect answer! Thanks for that. 😃

If this systemic sclerosis patient presented with acute onset of breathlessness for 2 days which worse on lying flat and physical signs of bilat basal crepitations and high BP, 1. What is the likeliest cause of breathlessness? 2. What investigation will support this Dx? 3. What Tx will you give?

This is a case of systemic sclerosis. Most common causes of SOB in this patient would be 1. pulmonary fibrosis 2. pulmonary hypertension 3. anaemia We have to check nature of patient's breathlessness fit in with our presumptive Dx or not. These causes will present with gradual onset of breathlessness and other specific symptoms and signs. (eg. dry cough + bilat basal fine crepts in pulmonary fibrosis)