The Wiggle Baron wrote:sounds like good times de-fi!
...ahem
I finally had an exam go well today, which is nice...but i still got a question for you de-fi (and other medical types) if you fancied having a look and seeing what youd have thought!
"A group of 4 gentleman who appear to be slightly intoxicated and enjoying each other's company (laughing alot). Suddenly one of them (a middle aged over weight Caucasian male) has difficulty speaking, seems to panic and struggles desperately to breathe. The restaurant owner calls for an embulance but is informed that it will take 6 mins to arrive.
Initially the middle aged man looks very anxious and has difficulty speaking. He is clutching his throat with both hands, starts becoming cyanotic and sweaty. He develops insipratory stridot and high-pitched expiratory sounds. Following a few minutes his level of conciousness appears to deteriorate and subsequently becomes floppy. His pupils appear to be dilated"
A) Critically reflect upon this scenario, comment on the presenting signs and symptoms and give a justified list of events (differential diagnoses) in progress. (10 marks)
B) Which further investigative procedures (in an ambulance/hospital) would be most relevant in view of your differentials given above? (5 marks)
Aint gonna say what I put yet (dont think I did too well) but dead interested to see what y'all might think
Ok, definitely don't take it as the final word (i'm only a fresher!
) . Also, i'm not entirely sure how to approach the question. Anyway - my take is;
A. )
Man is in the resteraunt, therefore you can assume he's eating. The sudden onset of symptoms kind of narrows down the possible causes.
My guess would be anaphylactic shock. Ingestion of an allergen causes an acute immunilogical reaction. Release of histamine and prostaglandins by mast cells cause systemic vasodilatation. Systemic vasodilation causes an acute drop in blood pressure - reduced perhipheral perfusion hence the pallor and clammy skin.
The histamine and prostaglandins also cause bronchoconstriction which explains the mans difficulty in breathing and subsequent cyanosis. The anxiety, inspiratory stridor can also be explained by this. It could be possible that he has a piece of food stuck in his trachea, blocking his breathing, although he wasn't described as choking.
Lack of oxygen to the brain causes the eventual loss of consciousness (and therefore pupil dilation) and floppyness, although alcohol can cause pupil diation as well, and vasodilation - accounting for or potentiating symptoms.
He's overweight so some cardiac causes could be considered. Stroke can account for a lot of his symptoms, but not really in the order of presentation - and don't really account for initial presentation of respiratory crisis. His weight could also indicate for diabetes (type II most likely) and so the loss of consciousness could be explained by a hypo / hyperglycaemic coma. He's been drinking (most alcoholic drinks high in sugar) and eating recently, so that's a possibility. Although again it doesn't account for initial presentation of respiratory distress.
B.) (assuming the above)
BP monitoring and HR monitoring in the ambulance is standard, BP might reveal drop in BP caused by vasodilation.
Blood work to check for levels of the histamines and prostaglandins. O2 sats.
Skin tests to check for specific allergy
Additional Tests -->
Blood glucose
Platelets & coagulation factors
Blood gasses
I dunno man, not sure if that's answered it in the right way - or even what I've written is 100% correct.
What did you put?