rocket Posted July 21, 2006 Posted July 21, 2006 He asks you if you think all the time he spent out in the field on his exercise a couple of weeks ago could have contributed to his illness. ..and I answer "I'm not sure yet. Tell me a little more about what you did on that exercise. And let's hear a little more about the progression of your symptoms. In what sequence did the cough, the tightness, and the abdominal tenderness occur?". Did any of these symptoms seem to begin spontaneously? Also The cough is dry now....has it been wet (productive) at all? If so what did the product look like? Any chills, N/V? How has your eating and drinking been recently? any more or less than usual? Ditto for urination/defecation. I wonder if we have something of a compound problem going on here. -Trevor
MrSpykes Posted July 21, 2006 Posted July 21, 2006 Lets get his shirt off inspect the chest and abdomen. Any bruising or paradoxical movement? Palpate the chest and abdomen. Any crepitus in the chest or any tenderness. Is he ABD soft and non-tender? Are there any pulsating masses or unusual findings. Check lung sounds, heart tones, and bowel sounds. Has he had a bowel movement recently? Any diarrhea? Was there any Hx of trauma on these training exercises. Any tick bites or other insect or other poisonous creature bites. Matter of fact lets expose completely and check back and extremities and scalp for that matter. Also is there any other associated symptoms, ie. headache. Also can we get a BP in each arm. And check pulse in all four extremities and compare quality and strength.
Ace844 Posted July 21, 2006 Posted July 21, 2006 When was the last time this persion voided in all capacities?
chbare Posted July 21, 2006 Author Posted July 21, 2006 Let me try to answer all of the questions. -He has been urinating without any problems and his last BM was this am and he states it was regular. -The chest and back exam is unremarkable with the exception of the findings stated above. -The RUQ of his abd is tender to palp and you do note hepatomegaly with palpation. -No hx of trauma and bowel sounds are noted in all four quads. -No known insect, arachnoid, or animal bites & your exam is unremarkable. -+5 strength and full ROM noted in all extremities, and distal neurovascular status is intact. -The S/S started several days ago and the patient states he has gradually been getting worse. -The patient does C/O occasional chills. -He states his unit spent two weeks in the woods on a bivouac, he is concerned that he did not get enough sleep. Complains about people walking their dogs and the barking keeping hi up all day and night. -no significant change in B/P from arm to arm. -complains of puritus to his arms and legs that comes and goes intermittently in addition to his other complaints. I hope this helps. Take care, chbare.
Mark3743 Posted July 21, 2006 Posted July 21, 2006 Any possibility of Hepatitus? The enlargement of the liver leads me to ask about Jaundice or yellowing of the eyes?
chbare Posted July 21, 2006 Author Posted July 21, 2006 Mark3743, it is possible. No signs of jaundice noted. If we took a turn into the land of OZ are there any tests that you would want to prove/disprove your theory, or is there something in the history that may help? Take care, chbare.
hammerpcp Posted July 22, 2006 Posted July 22, 2006 Any peripheral edema? Pleural effusion or pneumonia or spontaneous pneumo (assuming no trauma) are also on my list of possibilities. Although I think we are being led towards a liver problem at this point. Liver CA and cirrhosis are both possibilities although pt being so young is probably in a low risk category for both. Hepatitis is a good guess.
chbare Posted July 22, 2006 Author Posted July 22, 2006 Hammerpcp, the PA CRX does show a small right sided pleural effusion. No history of trauma. In addition to a negative TB screen during his physical, he was also negative for HEP C & B. (not a normal chapter 2 physical, but we are in the land of Oz after all) Are there any tests or assessments that may help you solve this scenario? Take care, chbare.
AZCEP Posted July 22, 2006 Posted July 22, 2006 Let's check the Liver function while we a sending things to the lab. A CBC would also be in order. While we're at it, how about an abdominal CT with and without contrast.
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