Case of the Week
A 58-year-old woman with a history of smoking complains of days of worsening
shortness of breath, now worsening today.  She has associated chest pain that appears to be constant, without waxing or waning; she has no other associated symptoms.

On examination, vital signs show: T 100.1 HR 88 BP 130/80 RR 22 SpO2 87% on room air that increases to 96% on oxygen. She has rales heard in both lung bases and seemingly distant heart sounds.  She exhibits some lower extremity edema.  When you sit her up to perform a better lung examination, she becomes very uncomfortable and has worsening shortness of breath – her oxygen saturation decreases to 75%.

Your patient asks you in a panic to bring the head of the bed back down, where she
feels more comfortable, and her oxygen saturation on supplemental oxygen  improves.

Based on what we know this far, which is the MOST likely etiology:

    A. Congestive heart failure
    B. Pneumonia
    C. Pulmonary embolism
    D. Chronic obstructive pulmonary disease 

In the meantime, a quote – 

A man is a poor physician who has not two or three remedies ready for use in every
case of illness.

– Asclepiades, 1st century BC; Greek-born Roman physician


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