Worsening edema – a diagnostic puzzle
70-something woman admitted to our service with worsening lower extremity edema. She is “billed” as worsening CHF. We know the following things about this woman:
COPD – but not on home oxygen
Systolic dysfunction – last left ventricular ejection fraction 25%
Type II Diabetes Mellitus for approximately 4 years
history of hypertension
Medications include
Insulin
carvdelilol
amlodipine
furosemide 40 mg daily
She has spent 2 weeks in a nursing home. Does not complain about dyspnea, only about lower leg edema.
Examination slows the patient is afebrile, pulse 68, BP 130/90, respirations 18
lungs are clear except bibasilar rales
heart without murmurs, regular rate and rhythm
extremities – increased painful lower extremity edema (the intern had seen the patient 2 weeks previously)
The question for you – provide a differential diagnosis and order diagnostic tests – I will give the test results and then you should explain what happened to this woman
Source: DB's Medical Rants - Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
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