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Case of the Month - July 2011


Case 1:

A 74 yr old woman consults four weeks after an extended visit to her family in the UK. Three days prior to consultation, she experienced an acute shortness of breath on getting into bed, on a background of minimal breathless on exertion, which was slowly increasing. She had no other respiratory symptoms or chest pain.

During her trip, she developed moderately severe lumbar backache with nerve root pain. She was treated by a chiropractor and given amitriptyline 10 mg nocte, but she continued to feel some minor pain.

She had an internal fixation following a fracture of her left ankle in 1999, but had been otherwise well and was not on any chronic medication. She is physically active, walking 5km three times a week and playing tennis twice a week. She was not overweight. She had never smoked and had no history of obstructive airways disease.

On examination she was not distressed but was slightly tachypnoeic on walking through to the examination room, which settled immediately one at rest. She showed no signs of anaemia and had a normal BMI. There was no evidence of cardiac failure, BP 160/80 mmHg, PR 78 in sinus rhythm, with normal heart sounds and a clear chest. Lymphadenopathy and organomegaly was absent.

Question 1: What is the differential diagnosis

Continue to Answer 1