Take a look at this case study and see how well you think you would do with the evaluation and diagnosis.
This case study involves a 60-year-old patient with no history of heart or lung disease. Up until six months ago, he had been pretty active. He took regular walks with the dog and swam at the gym a couple of times a week. For the past six months though, he has been experiencing shortness of breath. The problem has been progressive, and now he’s unable to even walk to the end of the block without taking a break to catch his breath. He’s also experiencing frequent dizzy spells, but has not actually lost consciousness. He’s had no chest tightness or other red flags for heart disease. The patient had been a smoker, but claims to have quit several years ago. And, his medical history includings nothing to give you a clue as to the cause of his symptoms.
This is the course of action that was taken to diagnose the patient.
Can you spot where the missteps occurred?
Tar stains on the patient’s fingers were noted, but he continued to insist that he was no longer a smoker, and hadn’t been for at least a couple of years.
His pulse at rest was weak but not dangerously low The patient’s blood pressure was within normal ranges, and chest auscultation revealed a few crepitations.
Doctors expected a respiratory disorder was the cause of the patient’s problems. They suspected lung cancer or COPD due to his history of smoking. Based on these assumptions, the patient underwent a chest x-ray, FBC and spirometry immediately. The doctors felt that time was of the essence because of the progressive nature of the problem and their belief that cancer was likely the culprit. Test results surprised them all. No cancer was found. There was no evidence that any of their initial concerns were the cause of the patient’s symptoms.
Back to the Drawing Board
Upon further research, including praecordium examination and an abdominal tenderness test, a second theory of aortic stenosis was agreed upon. Doctors urgently ordered a carotid doppler which revealed mild stenosis. Upon further evaluation, they added left ventricular systolic dysfunction to the stenosis diagnosis. This turned out to be the correct diagnosis.
The patient underwent a valve replacement and made a fairly textbook recovery. He took a regimen of drugs following the surgery and participated in standard followups.
What was your diagnosis?
The one big mistake that was made here is that doctors assumed that there was an underlying respiratory issue related to smoking. Because of that, they simply ignored the dizziness and the low pulse, both of which were much stronger indications that the problem was cardiovascular in nature. Would you have caught that?
No one is perfect, not even doctors. But we can all do better. And sometimes the best way to do better is to use the latest tools available to us. In your case, that’s the Xebra Pro Clinical Diagnostic App. It is the best medical school app you’ll find, and it is available free to download. The app can go a long way in helping you better diagnose symptoms and develop more effective treatment plans. It’s a great learning tool at every stage of your education, from first year through residency. Don’t struggle more than you have to. Download the XebraPro App from iTunes or Google Play. It is free for students.