A 60YearOld Woman With Fever, Cough and Low Back Pain Chapter 8

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A 60-Year-Old Woman With Fever, Cough and Low
Back Pain Chapter 8

• Based upon LABORATORY MEDICINE CASEBOOK. An
  introduction to clinical reasoning
• Jana Raskova, MD Professor of Pathology
  Laboratory MedicineStephen Shea, MD
  Professor of Pathology Laboratory
  MedicineFrederick Skvara, MD Associate
  Professor of Pathology Laboratory MedicineNagy
  Mikhail, MD Assistant Professor of Pathology
  Laboratory MedicineUMDNJ-Robert Wood Johnson
  Medical SchoolPiscataway, NJ

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History and Physical Exam

• A 60 y.o. ?
• Chief complaing fever and productive cough for
  approximately two months
• Fatigue and low back pain
• Physical Exam
• Alert ?, oriented
• BP 120/90
• HR 90 bpm RR 23
• Temp. 102.2 oF
• Bilateral rales
• Rest of exam - unremarkable

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• Differential diagnosis?
• Tests?

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CBC
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CHEMISTRY
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Electrolytes
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Two weeks later

• Fever gone, chest clear
• Back pain worse

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• Differential diagnosis?
• Tests?

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HEMATOLOGY 2 weeks later
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CHEMISTRY 2 Weeks later
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Urinalysis