History taking

A 65 years old lady with no previous medical illness, was admitted from the casualty with complaint of fever of one week duration associated with cough, shortness of breath on mild exertion and bilateral lower limbs swelling. Clinically, she was breathless with signs of heart failure.

This first thing I did before proceeding further was to look at her CXR. There was cardiomegaly with mild pulmonary congestion. In addition, there seemed to be some ?"cannon-ball" lesions/?consolidation. I looked at her blood counts (done earlier), Hb 7.0, TWBC 21, Plt 225. Renal profile was normal.

I then proceeded to a full and "thorough" history taking to find out what was the cause of her anaemia and CCF.

Then, I did a complete physical examination, including per rectal examination. Her vital signs were normal, she was febrile and there were signs of heart failure. Her ECG was normal.

I then came to a diagnosis of CCF precipitated by bronchopneumonia and severe anaemia.

But, what was the cause of the anaemia?

In fact, I had missed out one very important part of the history taking. That was the gynaecology history!

The nurse in charge informed us she noted that the patient had PV bleed in her diaper. No doubt, we did a PS and VE and found that she had a cervical carcinoma.

Though she might be way beyond her menstruation age, we should not miss out on history of PV bleed.

The above CT scan, confirmed she had lung metastasis.