March 31, 2009

Chest pain in hospitalized patient

30 years old male patient was hospitalized two weeks ago due to fracture of femur bone after involve in MVA. Currently, he complains of progressive right side chest pain which is sharp in nature and aggravated by inspiration. His body temperature is found to be 39.5⁰C. On Physical examination, the lower zone of right lung is dull on percussion and bronchial breath sound is heard on auscultation.

1) What is your provisional diagnosis (1m)
2) Name two causative agent that can cause the current problem (2m)
3) Portal of entry of (2) (1m)
4) List three investigation you want to perform and reason (6m)

Diagnostic approach

When hospitalized patient develop chest pain, think of either pulmonary embolism or hospital acquired pneumonia. Fat embolism is possible due to long bone fracture and prolongs immobilization. However, the nature of chest pain is usually sudden and onset. The physical examination also favor the diagnosis of Hospital acquired Pneumonia. (High grade fever, dull percussion, bronchial breath sound)

HAP usually caused by Pseudomonas aeroginosa and Staphylococcus aureus which enter the body via hematogenous spread from the site of IV line.

Pneumonia have four stages which is congestion, red hepatization, grey hepatization and resolution. This patient possibly in stage of red hepatization (fever, pleuritic chest pain). Chest X-ray may show opacity. Blood culture may yield a positive result. At this time, antibody to the infectious agent is not develop yet, hence immunoassay is not necessary. Full blood count may shows elevated neutrophils.

**Bersama mengembalikan kegemilangan tamadun ilmu Islam**

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