A 66-year-old female presents with fatigue, shortness of breath ...

[javeds]

A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for hypertension.
 
  On physical examination, vital signs are 98 degrees, 18 resps/min, pulse 56, and BP 100/60. Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These signs and symptoms are characteristic of:
  A. Chronic renal failure
  B. Congestive heart failure
  C. Metabolic syndrome
  D. Liver failure

Question 2

A 45-year-old female patient complains of nausea, vomiting, fatigue, and weakness. She admits to a history of heroin abuse for 11 years. She quit using the drug after rehabilitation last year and denies current use of the drug.
 
  Habits include use of alcohol daily, 4-5 drinks a day, and tobacco use of 60-pack years. On physical examination, she is non-febrile, has a blood pressure of 148/98, pulse 78, and resps 16/min. The patient has periorbital edema. Lungs are clear to auscultation. Abdomen is non-tender and distended w/ mild hepatomegaly. No neurologic deficits. Laboratory testing reveals Hgb 10, BUN of 60, potassium 6.1, and serum creatinine 2.9 mg/dL. These findings are characteristic of:
  A. Chronic renal failure
  B. Dehydration
  C. Congestive heart failure
  D. Liver failure

[vickybb89]

Answer to Question 1

ANS: B
CHF, commonly occurring in the elderly or in patients with past myocardial infarctions or cardiomyopathy, can often present with complaints of fatigue, decreased activity tolerance, and/or shortness of breath. A patient with a history of hypertension and hyperlipidemia indicates cardiovascular disease that predisposes to heart failure with age. The signs of heart failure include cough, shortness of breath with exertion, S3 and S4 heart sounds, pulmonary crackles, ascites, hepatomegaly and ankle edema.

Answer to Question 2

ANS: A
Patients with mild renal dysfunction are generally asymptomatic, but as the disease progresses, vague symptoms appear. Fatigue and weakness are early signs, as are decreased cognitive functioning and irritability. Patients may complain of nocturia, which is due to the kidney not concentrating the urine at night. Many of these early signs are nonspecific, and patients often pass them off as a normal part of aging. GI complaints, such as nausea, vomiting, and anorexia, are common and contribute to the muscle wasting and fatigue. Patients may complain of a metallic taste in the mouth. Hypertension may develop from fluid overload and can result in CHF. Pericarditis may develop, producing a friction rub. Neurological symptoms include muscle cramps and twitching, peripheral neuropathy, difficulty concentrating, and sleep disturbances.

[javeds]

Excellent

[bimper21]

TYSM