b'PACEP SCIENTIFIC ASSEMBLY 2025 CPC HIGHLIGHTWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO for organizing this years CPC competition during the PACEP25 Scientific Assembly.Congratulations to this years first place winnersAshley Schultz, MD from St. Lukes University Health Network for submitting the case and being the resident presenter, and Jennifer Spinozzi, MD at Geisinger Medical Center for being the attending discussant.35-year-old G2P2002 female with a recent c-section and bilateralCPC CASE salpingectomy 1 month ago presents with 24 hours of gradually worsening shortness of breath. The SOB is worse with exertionSTUDY and never completely resolves. Associated symptoms include:THE CASEpalpitations, mild headache, generalized weakness and fatigue. The patient is currently breastfeeding.Past Medical History: MVC in 2009 with c5Heart: tachycardic and regular, no rubs, gallops or vertebral fracture, transient tracheostomy andmurmurs resultant paroxysmal vocal cord paralysis andLungs: tachypneic with increased WOB, clear to baseline hoarse voice, GERD, anxiety, chronic lowauscultationback pain Abdomen: soft, nontender, nondistended, Past Surgical History: C-section with bilateralc-section incision c/d/isalpingectomy 1 month ago, tracheostomy 2009 Extremities: no swelling or tenderness to palpationDaily Medications: cyclobenzaprine, prenatalMusculoskeletal: no deformities or swelling, no vitaminstenderness to palpationSkin: No rashes or wounds on exposure No known drug allergies Neuro: CN II- XII intact, strength and sensation in Social History: does not smoke, drink alcohol orb/l UE and LE, grossly intact, coordination intact use drugswith finer to nose, normal mentationVital Signs: HR 150 bpm, RR 26 breaths perPsych: Anxious appearing minute, SpO2 97%, BP 164/90 mmHg, Temp 97.7POCUS: bilateral lung sliding. No obvious B lines deg F or pleural effusions. Grossly normal EF. No RV or LV dilation. No pericardial effusionPhysical Exam:Pertinent Labs: General: well developed, obese, + acute distressWBC 15.12HEENT: MMM, PERRL, oropharynx clear with no Co2 6erythema or edema, uvula midlineAnion Gap 17Neck: supple, normal ROM, no tenderness, no Urinalysis: 100 (2+) nitrites, large ketones, stridor, hoarse voiceprotein/creatinine ratio: 3.22What test will make the diagnosis?What is the final diagnosis?see conclusion on page 30PACEP News | Spring 2025 23'