Makindo Medical Notes

🧑‍⚕️ Case Examples — Acute Dyspnoea

• Case 1 (Acute Severe Asthma): 🌬️ A 25-year-old woman with asthma presents with acute breathlessness, wheeze, and inability to complete sentences. PEFR is 30% of predicted. Diagnosis: Acute severe asthma attack. Teaching point: Always assess severity by PEFR, speech, and O2 sats; treat with high-flow O2, nebulised salbutamol + ipratropium, IV steroids, and escalate if deteriorating.
• Case 2 (Pulmonary Embolism): 🫁 A 40-year-old woman develops sudden onset dyspnoea and pleuritic chest pain after a long-haul flight. She is tachycardic and hypoxic. CTPA confirms PE. Diagnosis: Pulmonary embolism. Teaching point: Sudden unexplained breathlessness + risk factors (immobility, OCP) → PE until proven otherwise; treat with anticoagulation ± thrombolysis if massive PE.
• Case 3 (Pulmonary Oedema from Acute LV Failure): ❤️‍🔥 A 72-year-old man with hypertension and IHD presents with acute severe breathlessness, orthopnoea, and pink frothy sputum. CXR shows bilateral alveolar shadowing (“bat’s wing”). Diagnosis: Acute pulmonary oedema due to left ventricular failure. Teaching point: Manage with high-flow O2, sit upright, IV furosemide, nitrates, and treat underlying cardiac cause.
• Case 4 (Community-Acquired Pneumonia): 🦠 A 55-year-old man presents with fever, productive cough, pleuritic chest pain, and dyspnoea. CXR shows right lower lobe consolidation. Diagnosis: Community-acquired pneumonia. Teaching point: Pneumonia = fever + pleuritic pain + consolidation; severity assessed with CURB-65; treat with antibiotics (e.g. amoxicillin ± macrolide).
• Case 5 (Pneumothorax): ⚡ A 22-year-old tall, slim man develops sudden right-sided chest pain and dyspnoea while playing basketball. Exam shows reduced breath sounds on the right. CXR confirms right-sided pneumothorax. Diagnosis: Primary spontaneous pneumothorax. Teaching point: Acute onset dyspnoea + pleuritic pain in a young man; management depends on size and symptoms (observation vs aspiration vs chest drain).
• Case 6 (Anaphylaxis): 🚨 A 35-year-old woman develops acute breathlessness, throat tightness, and widespread urticaria after eating peanuts. She is hypotensive and stridulous. Diagnosis: Anaphylaxis. Teaching point: Always recognise airway compromise with rash and hypotension; immediate IM adrenaline, call for help, and supportive ABC management.