Your patient is a 65-year-old woman from Colorado who presents with a chief complaint
of "shortness of breath". She had been well with an unremarkable past history until
10 days prior to admission when she developed flu-like symptoms including fever, headache,
fatigue, myalgias, nausea, vomiting, and diarrhea. Five days after the onset of symptoms
she developed a nonproductive cough and became progressively short of breath.
Your exam reveals an acutely ill woman with a temperature of 38.3°C, a BP of 90/54
mm Hg, a respiratory rate of 20 breaths per minute and a regular pulse rate of 93
beats per minute. Her lips and fingernails are cyanotic. Examination of her lungs
reveals diffuse inspiratory crackles bilaterally. The intensity of the breath sounds
is diminished.
Laboratory studies are positive for leukocytosis, thrombocytopenia, an elevated
AST and ALT, and a prolonged PT/PTT. D-dimers are elevated and an arterial blood gas
analysis reveals a low PaO2 and a metabolic acidosis. A screen test for influenza
A and B is negative. An admission chest x-ray is shown below.
What is your diagnosis, what test(s) would you order to confirm your suspicions,
and what treatment, if any, do you recommend?
In order to receive credit, please email your answers to smithj@etsu.edu