A Case presentation of post TB sequelae.pptx

Ppt on tb sequle

1. Case presentation Dr Sk Nadim

2. I am presenting a case of Lallan , 60 years old male resident of sidhauli dist-sitapur , Hindu by religion and plumber by occupation. History is given by patient himself. Chief complaints Breathlessness since 2 years Cough since 3 months Weight loss since 2 months

3. History of presenting illness Patient was apparently asymptomatic 2 year back when he developed breathlessness , Which is insidious in onset ,Gradually progressive, initially patient had breathlessness on walking upstairs but now has breathlessness even while walking a certain distance. Aggravates on exertion and relieved on taking rest

4. Patient also complains of Cough with expectoration since 3 months, which was insidious in onset, gradually progressive and associated with greenish colored , mucopurulent, and profuse in amount ,initially used to produced around 50ml/day later the quantity increases to about 100-120ml/day, more in morning with no postural or seasonal variation, non blood stained, Not associated with wheeze . Patient also complains of weight loss since 2 month , patient loss 6kg weight over period of 2 month, by himself noticing his clothes are becoming loose, and decrease appetite. initially he used eat 8-10 chapatti per day now he takes2-3 chapatti per day

5. No h/o fever, night sweats No h/o paroxysmal nocturnal dyspnea or orthopnea , chest pain , palpitations No h/o swelling in the legs, syncope, puffiness of face or reduced urine output No h/o skin rashes or joint pain No h/o change in voice or difficulty in swallowing . No h/o neck swellings

6. Past history History of pulmonary tuberculosis 4 years back for which he took ATT For 8-9 months, h/o haemoptysis of 3 years back Not a known case of diabetes mellitus/ hypertension/ bronchial asthma/ COPD/ ischemic heart disease No h/o prior surgeries in the past No history of allergies. Family History No similar complaints in the family

7. Personal history Married & 2 childrens Patient consumes non vegetarian diet Appetite : decreased Addictions: smoking since 10 years ( 7 bidi /day, 3.5 pack year) Bowel and bladder : Regular and Normal Sleep : Normal

8. Summary 60 years old male presented with breathlessness since 2 years and cough since 3 month and weight loss since 2 month with past history pulmonary tuberculosis Provisional D/D Post tubercular bronchiectasis Aspergilloma Bronchogenic carcinoma Open negative syndrome

9. General Physical Examination Patient is conscious ,cooperative and oriented to time , place and person . Poorly built and nourished Height- 157 cm Weight -33kg BMI – 13.4 No pallor , icterus , cyanosis , clubbing , lymphadenopathy , edema No external markers of TB.

10. Vitals Temperature : 97.2 F Pulse : 78bpm , regular rhythm , normal character and volume , no radio radial delay , no radio femoral delay , all peripheral pulses are palpable and equal bilaterally Blood pressure : 110/70 mm hg measured in the right upper limb in supine position Respiratory rate : 18/min ,abdaminothorasic Saturation: 97% No engorged neck vein

11. Upper respiratory examination Nose : Normal , septum is central , no secretions or polyp Paranasal sinuses : no tenderness Oral cavity : Hygiene adequate , no dental carries , tonsils normal , posterior pharyngeal wall shows no exudates or erythema

12. Inspection Trachea – central Shape of chest - normal Both side of chest wall moving equally with respiration Bilateral supraclavicular and infraclavicular hollowing present No drooping of shoulder No crowding of ribs No visible pulsation seen No scars/sinuses/dilated veins over chest Spine – normal

13. Palpation Trachea present centrally Apex beat – felt in 5 th intercostal space just medial to left midclavicular line No tenderness over chest wall Total chest circumference – on Inspiration – 77cm on expiration- 74 cm chest expansion 3cm AP diameter 18cm ,transverse diameter 25cm ,AP to transverse ratio 5:7cm No crowding or widening of ribs Vocal fremitus is decreased in right supraclavicular, infraclavicular, mammary, axillary areas of chest

14. Percussion Direct percussion over right and left clavicle is resonant percussion over right supraclavicular , infraclavicular, mammary is dull left supraclavicular & infraclavicular, mammary – resonant Percussion over right axillary is dull right infraaxillary – resonant left axillary and infraaxillary - resonant Percussion over right suprascapular , interscapular is dull right infrascapular – resonant left suprascapular , interscapular , infrascapular - resonant Traube’s space – resonant No shifting dullness No succussion splash

15. Auscultation Auscultation Right Supraclavicular , infraclavicular- brochial sound heard Lt Supraclavicular,infraclavicular - normal vesicular sound heard Auscultation over right mammary - brochial sound heard right inframammary - normal vesicular sound heard left mammary & inframammary - normal vesicular sound heard Auscultation over right axillary - brochial sound heard right infraaxillary – normal vesicular sound heard left axillary & infraaxillary - normal vesicular sound heard Auscultation over right suprascapular , interscapular- brochial sound heard right infrascapular – normal vesicular sound heard left suprascapular , interscapular , infrascapular - normal vesicular sound heard

16. Other system examination Cardiovascular system : S1 S2 present Central Nervous system : Patient is conscious , oriented and cooperative to time ,place and person no focal neurological deficit Gastrointestinal system: Soft , non tender , no organomegaly.

17. Diagnosis Post tubercular bronchiectasis