Case scenario to be discussed on 21-9-2020
HISTORY
Mr X a 52 year old male resident of Panambur, a carpenter by occupation has come to OPD with chief complaints:
--- Content provided by FirstRanker.com ---
Breathlessness x 2 years
Cough with expectoration x 2 years
Generalised weakness for 6 months
Pedal edema x 1 month
HISTORY OF PRESENTING ILLNESS
--- Content provided by FirstRanker.com ---
BREATHLESSNESS
Duration x 2 years, gradual in onset, progressive in nature, MMRC class 3 now
- Relieved by rest and medications
- No orthopnoea/PND
COUGH
--- Content provided by FirstRanker.com ---
Cough with expectoration, not associated with blood, No diurnal variation of cough, No postural variation of cough
SPUTUM
Minimal quantity, Whitish in colour, on foul smelling
Not associated with blood
Generalised weakness since 6months
--- Content provided by FirstRanker.com ---
History of pedal edema present for the past 1 month, No h/o fever,
No history of wheezing,
No h/o chest pain,
No h/o Hemoptysis
No h/o Decreased urine output, abdominal distension
--- Content provided by FirstRanker.com ---
PAST HISTORY
- H/o of pulmonary tuberculosis twenty years back, completed treatment and cured.
- Not a diabetic, asthmatic, cardiac ailments, no history of exposure to occupational hazards
PERSONAL HISTORY
- Non-smoker,
- Occasional alcohol consumption
- No loss of Appetite
- No loss of weight
- Normal sleep, bowel and bladder habits
--- Content provided by FirstRanker.com ---
FAMILY HISTORY
--- Content provided by FirstRanker.com ---
No history of tuberculosis in the family and no respiratory illness in the family members
TREATMENT HISTORY
Treated for pulmonary TB twenty years back. On and off bronchodilators for the last two years
GENERAL EXAMINATION
- Conscious, oriented
- Tachypnoeic
- Afebrile
- No pallor
- No icterus
- digital Clubbing +(Grade 3)
- No cyanosis, no lymphadenopathy
- Bilateral Pedal edema +
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
Vitals
- Pulse: 90/min
- Sinus rhythm
- Normal volume and character
- All peripheral pulses are felt well
- No radio radial/radiofemoral delay
- No vessel wall thickening
- Blood pressure: 130/90 mm Hg in right upper limb in supine posture
- Respiratory rate: 28/min, abdominothoracic
- JVP: Elevated
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
RESPIRATORY SYSTEM EXAMINATION
- Upper respiratory system normal
Examination of chest
--- Content provided by FirstRanker.com ---
Inspection
- Flattening of the chest on left side
- Trachea appears to be deviated to left
- Apical impulse not visualised
- Accessory muscles of respiration are used
- Drooping of shoulder to left
- Bilateral supraclavicular hollowing present (left > right)
- Left infraclavicular hollowing present
- Respiratory movements appear diminished on left hemithorax
- Vertebral border of scapula is prominent on left side
- No scars, sinuses, dilated veins over chest wall
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
Palpation
- Trachea confirmed to be shifted to left
- Apex beat could not be localised
- Diminished anterior, posterior, upper thoracic movements on left side
- No localised tenderness
- VF reduced on the left side
--- Content provided by FirstRanker.com ---
Measurements
- Total chest circumference: 82 cms
- Right hemithorax: 44 cms
- Left hemithorax: 38 cms
- Chest expansion: 2 cms
- Hemithorax expansion reduced on the left side
- Anterio posterior diameter: 22 cms
- Transverse diameter: 34 cms
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
PERCUSSION
Impaired note on the left side, Resonant note on the right side
Liver dullness is pushed down
Traubes space not obliterated
AUSCULTATION
--- Content provided by FirstRanker.com ---
decreased intensity of breath sounds on the left side
Left suprascapular and interscapular bronchial breathing heard
Left supraclavicular, infraclavicular, axillary, cavernous bronchial breathing
Harsh vesicular breath sound heard in all other areas on the right
VR reduced on the left side
--- Content provided by FirstRanker.com ---
Added sounds- Fine inspiratory crackles present in left mammary, axillary, infrascapular areas
CVS-S1S2 present
ABDOMEN- Soft, no organomegaly
CNS- No flaps, no deficits
- What are the causes for chronic breathlessness?
- Describe MMRC grading of breathlessness?
- What are the causes for chronic cough?
- What is the significance of taking history of sputum quantity and color?
- How does the past history and personal history contribute in diagnosis of this case?
- What are the long term complications of pulmonary tuberculosis?
- What is the significance of occupation in this case?
- What is the possible cause for pedal edema in this case?
- What is your DD s for this case?
- What are the causes of clubbing?
- What do the inspection findings suggest?
- What are the conditions causing dull note on percussion?
- Where do you get stony dull note on percussion?
- Where do you get hyper resonant note on percussion?
- What are the causes for decreased breath sounds?
- Enumerate conditions causing bronchial breath sounds?
- Name conditions where VF/VR are decreased?
- What are fine and coarse crepitations, give causes for each?
- What would you like to look for in other system examination?
- What is your diagnosis at the end of examination?
- What investigations you would like to order?
- What are the possible etiologies for this condition?
- What are the chest X-ray findings in such a case?
- What are PFT findings in such a case?
- What is the role of sputum examination?
- What is the role of CT chest in this condition?
- What are the possible complications in this lung condition?
- What are the treatment goals for this patient?
- Any role for surgical intervention for this patient?
- What is pulmonary rehabilitation?
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
--- Content provided by FirstRanker.com ---
Visit FirstRanker.com for more information.
--- Content provided by FirstRanker.com ---
This download link is referred from the post: MBBS All Subjects Clinical Case Scenarios (Clinical Case Studies)
--- Content provided by FirstRanker.com ---