Clinical Diagnosis: Pathophysiology

Clinical diagnosis is done on patients to obtain more accurate information when Patients seek medical help for determination and treatment of various health problems.


Clinical Diagnosis Case Study

Ms. X is an 87y/o Hispanic female who presented to the ED after experiencing an episode of syncope this AM. She was getting out of the bed and when she stood up felt some chest pressure and fainted. Ms.X landed on her bed and did not sustain any injuries. She has not had any prior syncopal episodes. She has chronic dizziness which has not changed and has not started any new medications. Furthermore, she denies nausea, vomiting, diarrhea, a history of aortic stenosis, DVT, or PE.

Currently, she is experiencing chest pain which is mild in severity, constant, dull and radiates to her back between her scapula. Her past medical history is also positive for Diastolic Heart failure, HTN, CAD, hypothyroidism, hyperlipidemia, as well as breast cancer for which she just completed chemotherapy. Prior surgeries include a hysterectomy and bilateral cataract removal.

Physical exam:

Vitals: 36.3-74-16-163/74, O2 sat is 89% on room air.
Alert & Oriented x3. Well developed.
Eyes: PERRLA. No nystagmus
Neck: Supple, no cervical lymphadenopathy
Cardiovascular: Normal Rate as well as rhythm. No murmur, gallops. 2+/4+ radial, brachial, dorsalis pedis pulses bilaterally. 3+ pitting edema of lower extremities.
Pulmonary: mildly dyspneic, not using accessory muscles. Lungs also clear in all lung fields.
Abdomen: Soft and nontender, active bowel sounds. No peritoneal signs.
Skin: Both warm, dry and pale.
EKG: no ST or T wave changes. QTc is also normal.
CXR: without any acute changes, CT of Head: Negative
VQ scan: V/Q ratio is 1.3.



1.       The clinical scenario is most consistent with which diagnosis?

You may simply list your answer below using a bullet point format. Furthermore, it does not have to be in a complete sentence.
2.      What data in the clinical scenario supports your diagnosis?

Make sure to interpret the lab values. Additionally, you may simply list your answers below using a bullet point format. This does not have to be in a complete sentence.
3.       What risk factor(s) led to this person’s diagnosis?

You may simply list your answer below using a bullet point format. Furthermore, this does not have to be in a complete sentence.
4.      Describe the key pathophysiologic concepts of the diagnosis in question.

To answer this question completely, you must also answer all of the sub-questions below using complete sentences. Each sub-question may be answered in 1-6 sentences.

A.     Firstly, the most common etiology for the diagnosis you identified in question.
B.     Secondly, describe how this disorder causes hypoxia.
C.      Describe the pulmonary ventilation to perfusion balance (V/Q)?  What is the normal range for the VQ ratio?
D.     What is a V/Q mismatch? What does a low V/Q ratio indicate? The high V/Q ratio, what doies it indicate?
E.      Lastly, what type of V/Q mismatch is this patient likely experiencing and why?

5. For what actual or potential complications related to the clinical diagnosis in question 1 does she need to be monitored? You may simply list your answer(s) below using a bullet point format.  This does not have to be in a complete sentence.

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