Patient with Blurred Vision and Bilateral Leg Pain
Rahul's Noteblog
Notes on USMLE facts, Exam Tips, and USMLE Lab Values
Patient with Blurred Vision and Bilateral Leg Pain
NOTE: incomplete file
Chief complaint:
A 56 y.o. African American male presents to the ER with blurred vision, bilateral leg pain and respiratory distress.
Patient History:
Diabetes Mellitus.
Differential dx:
Acute asthma bronchitis.
COPD.
CHF.
Final dx:
Acute asthma bronchitis.
COPD.
CHF.
Cardiomegaly.
Tests:
Venous Doppler is normal.
D-Dimer (fibrin degradation product used to diagnose DVT); (results are due).
Comprehensive metabolic panel (repeat daily).
Patient refused V/Q scan (can't lie flat).
X-ray reveals cardiomegaly.
Physical Examination:
Peripheral edema.
Blurry vision present.
Current Medications:
Lasix/Furosemide/loop diuretic (Ordered by ER physician).
Ecotrin/Aspirin/acetylsalicylic acid (Ordered by ER physician).
Morphine (Ordered by ER physician).
Atrovent/Ipratropium (anticholinergic drug that blocks muscarinic cholinergic receptors) (Ordered by ER physician).
Insulin (Ordered by ER physician).
Captopril (ACE inhibitor) (Ordered by FP physician).
Digoxin/cardiac glycoside (cardiac action potential and decreased K+ conductance) (Ordered by FP physician).
Dopamine/vasopressor agent (to increase cardiac output and organ perfusion) (Ordered by FP physician).
Lasix (Ordered by FP physician).
Actos/pioglitazone (to improve glycemic control) (Ordered by FP physician).
Glucotrol/glipizide (sulfonylurea used to improve glycemic control) (Ordered by FP physician).
Protomix (proton pump inhibitors used to reduce gastric acid production) (Ordered by FP physician).
Spironolactone (K-saving diuretic) (Ordered by FP physician).
Vasotec/Enalapril (ACE inhibitor) (Ordered by FP physician).
Heparin (Ordered by FP physician).
Avelox/Moxifloxacin (a fluoroquinolone that blocks DNA unwinding and replication) (Ordered by FP physician).
Albuterol (short-acting alpha agonist used for acute asthma) (Ordered by FP physician).
Bactroban (mupirocin; used to treat skin infections) ointment to nares (Ordered by FP physician).
Miscellaneous Notes:
Cardiomegaly due to opioid abuse.
Pericardial Effusion.
Can't lie still.
CMP results improving.
Additional Reading:
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1. Patient with Blurred Vision and Bilateral Leg Pain
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