¿Qué hay en tu mochila? (Choose the appropriate response)
Questions
¿Qué hаy en tu mоchilа? (Chооse the аppropriate response)
Pаtient Prоfile: Nаme: Mr. RC Age: 55 yeаrs Sex: Male Occupatiоn: Retired Medical Histоry: Hypertension Type 2 Diabetes Mellitus Asthma Current Medications: Atorvastatin 20mg once daily Clenil Modulite 100microgram inhaler 1 puff twice a day Losartan 100mg once daily Metformin 1g twice a day Salbutamol 100microgram inhaler 2 puffs when required No known drug allergies. Presenting Complaint: Mr. RC presents to the outpatient clinic with complaints of persistent fatigue, weakness, and shortness of breath over the past few months. He reports a gradual onset of symptoms and notes that they seemed to be worsening despite adequate rest and a seemingly healthy lifestyle. He denies any recent illnesses, fever, or significant weight changes. No specific triggers or patterns for his symptoms are identified. History of Present Illness: Mr. RC reports that breathlessness has become more pronounced recently and is interfering with his daily life. He denies any chest pain, palpitations, cough, sputum, or fever but he has started to notice some loss of sensation in his feet. Physical Examination: General Appearance: Mr. RC appears fatigued and pale. Conjunctival pallor noted. Vital Signs: Blood pressure 130/80mmHg, heart rate 80 bpm, respiratory rate 18 bpm, temperature 37°C. Cardiovascular Examination: Regular rhythm, no murmurs, rubs, or gallops. Peripheral pulses were palpable. No peripheral/sacral oedema. Respiratory Examination: Normal breath sounds on auscultation, no wheezing, or crackles. Abdominal Examination: Soft, non-tender abdomen, no organomegaly. Blood results: Blood Test Result Normal Range Haemoglobin (Hb) 82 g/L g/L (120–155) Hematocrit 0.25 0.36–0.47 Mean Corpuscular Volume (MCV) 110 fL 80-96 fL Red Cell Count 3.6 x 1012/L x 1012/L (3.5–5.0) White Cell Count 6.5 x 109/L x 109/L (3.0–10.0) Platelet Count 220 x 109/L x 109/L (150–400) eGFR 62 mL/min/1.73 m2 mL/min/1.73 m2 (>60) Serum Folate 6 microgram/L microgram/L (2.0 – 11.0) Serum Vitamin B12 42 ng/L ng/L (160–760) a. Suggest 4 potential differential diagnoses based on Mr RC’s presenting symptoms. (2 marks) b. Based on the results of Mr RC’s physical examination and investigations, discuss which differential diagnosis is the MOST LIKELY, and your rationale for reaching that decision? (7 marks) c. Discuss any other investigations or assessments you would want to undertake to confirm the diagnosis, including your rationale. (3 marks) d. Based on your diagnosis, outline a treatment plan for Mr RC, including dose(s), specific counselling points and monitoring required. (3 marks)