Common Long Cases

History Taking
NSTEMI
ACS
Pneumonia

COPD

Physical
Examination

Investigations

Management /
Treatment

- Fever ,
Chest X-ray
tachycardia ,
- Bronchopneumonia
tachypnoea
- Lobar pneumonia
- Reduced chest
expansion
- Dullness to
percussion
- Bronchial
breath sounds +/coarse
crepitations
- Increased vocal
resonance
- Pleural friction
rub

Chest X-ray
- Hyperinflation
- Cor pulmonale
ECG
- right atrial hypertrophy P-pulmonale
- right ventricular
hypertrophy
- right axus deviation
- right bundle branch
block
Arterial blood gas
FBC - infection
Sputum examination
Spirometry

Controlled oxygen
therapy - nasal prong or
face mask
IV hydrocortisone
IV aminophylline
IV antibiotics
Nebulisation with beta-2
agonists alternating
with steroids
Nebulisation with
sodium bicarbonate
nebulising solution - to
liquefy tracheobronchial
secretions
CPAP
BiPAP
Home management
Long-term Oxygen
therapy

Oral theophylline
B2 agonists (terbutaline
or salbutamol) ,
administered orally or
via metered dose
inhalers
Steroids
Pulmonary
rehabilitation
DVT
DKA

Symptomatic
anaemia
Atrial fibrillation
Nephrotic
syndrome

- Nausea , vomiting
- Thirst , polyuria
- Abdominal pain
- Shortness of breath

Tachycardia
Dehydration
Hypotension
Tachypnoiec /
Kussmaul
Infection (e.g cough , respiration /
fever) to rule out
respiratory
pneumonia , UTI ,
distress
gastroenteritis ,
Abdominal
sepsis
tenderness
Lethargy

- Serum urea
- Serum electrolytes
(Na+ , K+)
- Fasting blood glucose
- Full blood count
- Arterial blood gas
- Blood culture , urine
culture
- Chest X-ray
- ECG

HOPI
Facial puffiness
Leg swelling
Urine

- Urinalysis - proteinuria
glycosuria , absence of
red (cell) casts X
glomerulonephritis
- 24-hour urinary protein
- Serum total protein ,
serum albumin and A: G
ratio (hypoalbuminemia)
Serum lipid profile (high
cholesterol , high TG)
- Blood glucose , serum
electrolytes , urea and
creatinine (renal profile)

Breathlessness

Pleural effusion
Pulmonary
oedema
Ascites (shifting
dullness and fluid
thrill)

PMH
Pitting oedema
- diabetes (diabetic
nephropathy)
- malignancy
(lymphoma ,
leukemia)
- drugs : captopril ,
NSAIDs ,
penicillinamine , gold
Chronic kidney
disease
Stroke

Fluid and salt restriction

Diuretics
ACE inhibitors
High protein diet

- To look for underlying

cause :

Carotid endarterectomy
Antiplatelet therapy
Anticoagulant
Antihypertensives

Statin
Modification of risk
factors (smoking
cessation , exercise ,
glycaemic control)
Seizures