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Pneumonia- let me guess, the patient died? I have heard of a case locally just like that. Rasied WBC found on FBC so patient telephoned to return to AMU but died in the two hours before the perfectly sensible ST 1 phoned again to find out where she was. On 23/02/2010, Julian Bradley <[log in to unmask]> wrote: > Based (loosely) on an actual case (with patient consent), where I am > not the GP. > The story is fictionalized or embelished wherever I wanted to. > > Middle aged female patient presents with a couple of weeks history of > illness. > Includes 2 x 24 hour episodes of headache with vomiting and diarrhoea. > More persistently some lethargy, some myalgia, some low grade fever, > ie 37.5 - 38C, some sore throat / neck pain and discomfort with > swallowing. Noted to have a slight cough, and noted to be mildly > tachypnoeic at times. Also complained of ear discomfort and > sometimes crackling, nasal bleeding. > > No known relevant PMH except uses Beconase for allergic rhinitis. > Normally on no medication, but has used ibuprofen and paracetamol for > fever and myalgia with some benefit. > > Clinical examination > Throat NAD > Ears - wax + 0 > No cervical adenopathy > Chest clear > Tachypnoea not confirmed > Tachycardia 115 at rest - and some suggestion this may have persisted > through illness > Low grade fever confirmed > > > Any thoughts on diagnosis or if relevant investigation? > > > More will follow in due course.... > > > Julian > -- Dr John Glasspool Barge House, Timsbury, Romsey, Hampshire SO51 0NG UK