1. what is the most probable diagnosis. explain 2. should any additional diagnostic tests be performed to confirm the diagnosis? 3. suggest the treatment strategy

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1. what is the most probable diagnosis. explain
2. should any additional diagnostic tests be performed to confirm the diagnosis?
3. suggest the treatment strategy

Patient L., a 25-year-old female, a
painter
Complaints: dyspnea attacks during
physical exercises daily.
Medical history: suffers from episodes
of suffocation since 14 years old. These
attacks were usually provoked by
strenuous exercises and sometimes
occurred at night (1-2 times per month).
She used was administrated short-acting
beta2 agonists as required to alleviate her
symptoms. Current exacerbation since
last week (after a meticulous inquiry, she
remembered that she have purchased
new primer for her art workshop at this
very time), when dyspnea attacks
became daily and nocturnal symptoms
appeared.
Family history: her mother suffers from
polypose rhinosinusitis.
Allergy history: penicillin, mold and
pollen cause a runny nose, cough, and
attacks of dyspnea.
Transcribed Image Text:Patient L., a 25-year-old female, a painter Complaints: dyspnea attacks during physical exercises daily. Medical history: suffers from episodes of suffocation since 14 years old. These attacks were usually provoked by strenuous exercises and sometimes occurred at night (1-2 times per month). She used was administrated short-acting beta2 agonists as required to alleviate her symptoms. Current exacerbation since last week (after a meticulous inquiry, she remembered that she have purchased new primer for her art workshop at this very time), when dyspnea attacks became daily and nocturnal symptoms appeared. Family history: her mother suffers from polypose rhinosinusitis. Allergy history: penicillin, mold and pollen cause a runny nose, cough, and attacks of dyspnea.
Physical examination:
Lungs auscultation: respiration rate - 16
per min, vesicular breathing, singular dry
and whistling rales increasing on forced
expiration.
HR - 68 per min. BP - 110/60 mm Hg.
Laboratory tests:
Full blood count: WBC - 5 x109/L (N 4 - 10
x109/L); Hb – 13.5 (N 12 to 18 gm/dL);
RBC – 4,7x1012/L (N 3.6-4.85x1012/L);
bands – 1% (N 2%), segments - 65% (N
36-75%), lymphocytes - 22% (N 10-50%),
monocytes - 5% (3-8%), eosinophils -
7% (0-5%); platelets 240 (N 150 – 450
x10 x10°/L); ESR – 9 mm/h (N 10 mm/h).
Ig E- 200 IU (0-100 IU).
Sputum analysis: leucocytes - 20-40 in
I/p/f, eosinophils - 40-60-80 in I/p/f,
Curschmann's spirals and Charcot-
Leyden crystals are found.
Transcribed Image Text:Physical examination: Lungs auscultation: respiration rate - 16 per min, vesicular breathing, singular dry and whistling rales increasing on forced expiration. HR - 68 per min. BP - 110/60 mm Hg. Laboratory tests: Full blood count: WBC - 5 x109/L (N 4 - 10 x109/L); Hb – 13.5 (N 12 to 18 gm/dL); RBC – 4,7x1012/L (N 3.6-4.85x1012/L); bands – 1% (N 2%), segments - 65% (N 36-75%), lymphocytes - 22% (N 10-50%), monocytes - 5% (3-8%), eosinophils - 7% (0-5%); platelets 240 (N 150 – 450 x10 x10°/L); ESR – 9 mm/h (N 10 mm/h). Ig E- 200 IU (0-100 IU). Sputum analysis: leucocytes - 20-40 in I/p/f, eosinophils - 40-60-80 in I/p/f, Curschmann's spirals and Charcot- Leyden crystals are found.
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