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Rs-Case 2a

Mr. X, a 55-year-old male with a history of tuberculosis, presents with a 20-day history of worsening cough with expectoration and progressive breathlessness. Examination reveals signs of chronic parenchymal lung disease, including bilateral upper lobe fibro cavities, likely due to post-TB sequelae. He is not in respiratory failure or cor pulmonale.

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Ram Pradeep
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5 views21 pages

Rs-Case 2a

Mr. X, a 55-year-old male with a history of tuberculosis, presents with a 20-day history of worsening cough with expectoration and progressive breathlessness. Examination reveals signs of chronic parenchymal lung disease, including bilateral upper lobe fibro cavities, likely due to post-TB sequelae. He is not in respiratory failure or cor pulmonale.

Uploaded by

Ram Pradeep
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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RESPIRATORY SYSTEM

CASE 2A
HISTORY
• Name : Mr. X
• Age 55 years
• Gender - Male
• Address - Villupuram
• Occupation - Salesman

CHIEF COMPLAINTS
• Cough with expectoration for 20 days.
• Breathlessness for 20 days.
HISTORY OF PRESENTING ILLNESS
• Patient was apparently normal before 5 years, when he
developed cough with expectoration which has worsened
since 20 days, insidious onset, gradually progressive, no
particular aggravating factor or relieving factor, no diurnal
or seasonal variation. The expectoration white in colour,
mucopurulent, about 10-15ml/day initially and increased
to 20-25ml/day for the past 20 days, not blood stained,
non foul smelling and no postural variation.
• Breathlessness, insidious onset, progressive in nature,
progressed from initial grade 1 (MMRC) to grade 3
(MMRC) at present for the past 20 days, aggravates on
exertion and relieves on taking rest.
• No h/o fever
• No h/o orthopnoea/PND
• No h/o decreased urine output/abdominal distension
• No h/o chest pain
• No h/o wheeze
• No h/o loss of weight or apetite
PAST HISTORY:
•H/o Tuberculosis 5 years back (2017), took ATT for
period of one year.
•Not a known case of DM/SHTN/BA/IHD
•No major surgery history in the past

PERSONAL HISTORY:
•Not a smoker or Alcoholic
•Normal appetite and sleep
•Normal bowel and bladder habits

FAMILY HISTORY:
No H/o contact with tuberculosis
No H/o bronchial asthma or malignancy in the family.
HISTORY SUMMARY
• 55 years old non-smoker male with past history of
tuberculosis presented with chronic history of
progressive breathlessness and productive cough
which has worsened since 20 days.

• Possibility of Chronic parenchymal lung disease


secondary to post TB sequelae with probable
reactivation of tuberculosis.
GENERAL EXAMINATION :
• Conscious, oriented, Afebrile
• Moderately built and poorly nourished.
Weight- 41.2kg, Height- 156cm
BMI-17
VITALS:
• HR : 92/Min, Regular rhythm, Normal volume and
character, All Peripheral pulses Felt, No vessel wall
thickening.
• BP: 110/70 mmHg, measured in the right upper limb in
supine position
• RR: 20 /min, abdominothoracic.
GENERAL EXAMINATION:
• Pallor present
• Pan digital clubbing – Grade III
• No Icterus, Cyanosis, Lymphadenopathy, Pedal
edema
• JVP- not elevated
• No external markers of TB
SYSTEMIC EXAMINATION:
INSPECTION :

Upper Respiratory tract


•Normal
•No flaring of nasal alae,
•No DNS or Nasal polyps
•No sinus tenderness
•Oral Hygiene maintained.
•Oral cavity- Dental filling present in left lower 3 rd molar
•Oropharynx- normal
INSPECTION
Lower Respiratory tract

• Trachea- appears to be in midline


• Apex beat – not visible.
• Chest asymmetry present.
• Flattening of upper chest on left side.
• Drooping of shoulder on left side.
• Spine – scoliosis + with convexity to the left
• Bilateral supraclavicular hollowing present (left>right).
•Chest wall movements - diminished on left side
•Accessory muscles of respiration being used.
•No scars, sinuses, dilated veins or visible pulsations seen
PALPATION
• Trachea- confirmed to be in midline.
• Apical Impulse position - ½ inch medial to the mid
clavicular line in left 5th ICS
• Crowding of ribs – present on left side
• No palpable rhonchi /rub.
• No tactile fremitus
• No bony intercostal tenderness
• No local raise of temperature
CHEST MOVEMENTS

AREA RIGHT LEFT


APICAL normal decreased
ANTERIOR normal decreased
POSTERIOR normal decreased
MEASUREMENTS
• Chest circumference-76 cm,
• On Inspiration expansion - 78.5 cm.
• Total expansion - 2.5 cm
• AP Diameter: 21 cm
• Transverse diameter: 27 cm
• AP: Transverse = 0.78
• HEMITHORAX MEASUREMENTS:

RIGHT LEFT
40 cm 36 cm

On Inspiration- On Inspiration-
42 cm 36.5 cm
Vocal Fremitus Right Left

Supra Clavicular Increased Increased

Infra Clavicular Normal Increased

Mammary Normal Decreased

Axillary Normal Decreased

Infra Axillary Normal Normal

Supra Scapular Increased Increased

Inter Scapular Normal Decreased

Infra Scapular Normal Normal


PERCUSSION
Area Right Left
Direct Percussion- Resonant Impaired
Clavicle

Sternal Percussion
Upper 1/3rd- resonant
Lower 1/3rd- dull
Percussion areas Right Left
Supra Clavicular Impaired Impaired
Infra Clavicular Resonant Impaired
Mammary Resonant Impaired
Axillary Resonant Impaired
Infra Axillary Resonant Resonant
Supra Scapular Impaired Impaired
Inter Scapular Resonant Impaired
Infra Scapular Resonant Resonant
PERCUSSION
• Sternal Percussion
– Upper 1/3rd- resonant
– Lower 1/3rd- dull
• Kronig’s isthmus- Impaired
• Liver dullness starts in the right 6th intercostal space
• Tidal percussion- normal
• Traube’s space- not obliterated
AUSCULTATION
AREA RIGHT LEFT
Supra Cavernous BBS; No Cavernous BBS; No Added
Clavicular Added Sounds Sounds
Infra NVBS , No Added Sounds Cavernous BBS; No Added
Clavicular Sounds
Mammary NVBS , No Added Sounds NVBS, Decreased Air Entry, Fine
crepitations present
Axillary NVBS , No Added Sounds NVBS, Decreased Air Entry, Fine
crepitations present
Infra Axillary NVBS , No Added Sounds NVBS , No Added Sounds

Supra Cavernous BBS; No Cavernous BBS; No Added


Scapular Added Sounds Sounds

Inter Scapular NVBS, No Added Sounds NVBS, Decreased Air Entry, Fine
crepitations present
Infra Scapular NVBS, No Added Sounds NVBS , No Added Sounds
AUSCULTATION
Vocal Resonance Right Left

Supra Clavicular Increased Increased


Infra Clavicular Normal Increased
Mammary Normal Decreased

Axillary Normal Decreased

Infra Axillary Normal Normal

Supra Scapular Increased Increased

Inter Scapular Normal Decreased

Infra Scapular Normal Normal


OTHER SYSTEMS

• CVS: S1S2+, no murmur


• P/A: Soft, BS+, No organomegaly
• CNS: No Flaps
FINAL DIAGNOSIS

• Bilateral chronic parenchymal lung disease


• Bilateral upper lobe Fibro cavity.
• Etiology- Post-TB Sequelae
• Not In Respiratory Failure or Cor - Pulmonale

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