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Final clinical long case 2

Created: 7/4/2004
 

Information given:


59 year old man for transurethral resection of the prostate

Ex-smoker, 20 cigarettes/day

Had 'shadow on lung' 2 years ago

Treated with radiotherapy and drugs - no further information available

Now coughing up blood

Diabetic

Drugs - glibenclamide 5 mg daily

 

On examination:

 

1.75 m 

72 kg

Pulse: 80/min
BP: 150/90 mmHg
Respiratory rate: 20/min

Chest:
- trachea deviated to right

- bronchial breathing and reduced breath sounds heard in the right upper chest

Abdomen:
- 10 cm bladder palapable

 

Investigations:

 

Hb 16.0 g/dl
WBC  7.1 x 109/L
Platelets 271 x 109/L
MCV normal
Differential normal
Na 135 mEq/L
3.5 mEq/L
Urea 14.6 mmol/L
Creatinine 237 umol/L
Glucose 11 mmol/L
CXR

No cardiomegaly

Trachea deviated to right

Right upper zone shadowing and loss of volume on right

 

Lung function tests:

 

  Predicted Measured
FEV1 3.06 L 1.62 L
FVC 4.18 L 3.18 L
FEV1/FVC 69% 51%
PEFR 533 L/min 250 L/min

 

QUESTIONS

 

- Summarise the problems.

- Summarise the positive findings on examination.

- Does a BP of 150/90 mmHg bother you?

- Comment on the investigations.

- How would the raised urea and creatinine affect your management? (Give an example)

- What do you think of a blood glucose of 11 mmol/L?

- What does the CXR show and what is the differential diagnosis?

- Do the lung function tests show a restrictive picture?

- What else would you ask for regarding the lung function tests?

- Would you be happy to anaesthetise this patient now?

- What premedication would you prescribe and why?

- What is your management of his diabetes?

- What anaesthetic would you give and why?

- How would you perform spinal anaesthesia?


ArticleDate:20040407
SiteSection: Article
 
   
    
                                            
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