Answer
1) Differential diagnosis
a) Acute on chronic heart failure
b) Bronchopneumonia
c) Acute exacerbation of bronchial asthma
d) Viral croup
2) X ray
a) This is an x ray of the chest, PA view
b) There is homogenous opacity mostly at right lung zone.
c) Boot shaped heart with mild cardiomegally.
d) Cardiophrenic angle is obliterated on both sides.
e) Costophrenic angle is not obliterated on both sides.
f) Thymus can be seen.
3) Tetralogy of Fallots and it’s variant (Pulmonary stenosis with MAPCAS)
4) Acute on chronic heart failure secondary to left bronchopneumonia.
5) Management for this patient
a) Prompt up the patient.
b) Gives oxygen via high flow mask 10L/min.
c) Pulse oxymetry
d) BP monitoring.
e) Set an IV access.
f) 12 leads ECG
g) Blood investigation (FBC, BUSE, Cardiac profile, ABG)
h) Admit patient to wards.
i) Restrict fluid intake with 3/4 maintenance if no dehydration.
j) Strict monitoring of urine output.
k) Starts on IV Penicillin antibiotic.
l) loop diuretic (furosemide) and ACE Inhibitors (Captopril)
m) Echocardiography