In this podcast we discuss the case of:

34 year male brought in by ambulance feeling unwell. He had had a recent history (of about 48hrs) suggestive of upper respiratory tract infection (URTI) - runny nose, productive cough, sore throat etc. However, in the last 12 hours or so she had started to feel much more unwell. He felt more washed out and lightheaded, developed nausea and had vomited once or twice. He also felt that there was a slight increase in the cough.

He complained of a mild headache. He denied urinary symptoms although said the urine was darker than normal. There was no chest or abdominal pain or loose stool.He denied rashes, photophobia or neck stiffness.

Past Medical History:   Well controlled Crohn’s disease - didn’t feel like a flare

Drug History:      Budesonide 3mg TDS,  NKDA

Social History:       Independent. Lives with partner. Accountant. A non-smoker.

Examination

He looked unwell, was mildly shocked - BP 89/53 and HR 118. Currently afebrile.

A – Patent

B – Talking in full sentences. Sp02 100% (15L NRBM). RR 23. A few crackles LEFT base. Calves SNT. No chest wall tenderness.

C – HR 118. BP 89/53. Heart sounds normal. Warm peripheries.

D – GCS 15/15. No facial weakness. No limb weakness. Making co-ordinated movements. No photophobia. Freely moving neck. Kernig’s neg.

E – Temperature 38.1. Abdomen - Not distended. Soft. Mild non-tenderness. No guarding. Bowel sounds normal. No rashes.

ENT - Mildly red throat. Normal voice. Mildly red ears. No lymphadenopathy

Have a listen to the podcast for the differential diagnoses and to find out what happened.

Music by BenSound.