Tutor profile: Maria M.
Please translate the following conversation to Portuguese: A: Good morning. How are you? B: Hi. I am good, what about you? A: I am also doing well. I just started my own catering company. B: Really? Congratulations. A: Thanks. Here is my card. You should stop by sometime. B: Great. Thank you. I will definitely do that. I have to run. Bye. A: Bye. Have a nice day.
A: Bom dia. Como estás? B: Olá. Estou bem, e tu? A: Também estou bem. Acabei de criar a minha própria empresa de catering. B: A sério? Parabéns. A: Obrigada. Fica com o meu cartão. Tens de lá passar um dia destes. B: Óptimo. Obrigado. Sem dúvida que passo lá. Tenho de ir. Adeus. A: Adeus. Tem um bom dia.
Subject: Health and Medicine
How do you differentiate a transudate from an exudate pleural effusion?
Using Light's criteria: 1. Pleural fluid protein/serum protein ratio > 0.5 OR 2. Pleural fluid LDH/serum LDH ratio > 0.6 OR 3. Pleural fluid LDH > 2/3 the upper limits of the normal serum LDH However these criteria sometimes misclassify a transudate as an exudate. So if there is a clinical suspicion of a transudate the difference between the serum protein and the pleural effusion protein should be calculated. If it is >3.1g/dL, it is most likely a transudate.
A 55 year old male, with diabetes, hypertension, current smoker, with a history of a myocardial infarction 3 years ago, is sent to your consultation for dyspnea and lower limb edema. What is your first diagnostic option? What tests would you ask for on the first consultation?
My first diagnostic option would be heart failure, since he has cardiovascular risk factors and a history of MI. However he is also a smoker, so the dyspnea can be a consequence of that (although it wouldn't explain the peripheral edema). Also the dyspnea could be an "anginal equivalent" given the previous MI history. I would collect a complete anamnesis, do a physical examination and ask for blood tests (CBC, liver and kidney function, thyroid function, serum electrolytes, fasting blood glucose and A1c, pro-NT-BNP, iron studies, lipid panel, urine spot), EKG, chest X-ray, echocardiogram with doppler. Because of the smoking history I would also ask for pulmonary function tests. If the history suggested an anginal equivalent I would also consider asking for a cardiopulmonary exercise test.
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