case presentation ppt of respiratory systems

Pleural effusion

1. Case presentation PRESENTER: DR SACHIN PATIL

2. Name : Basavantraya Age: 40  yrs Gender: Male Place: Nariboli , jewargi tq Occupation: cable operator Date of admission : 6/9/ 2024 Date of examination: 8/9/  2024

3. Fever since 2 weeks Breathlessness since   2 weeks Cough  since 7 days Chest pain since 3 days Chief complaints

4. Patient was apparently asymptomatic 2 weeks back, later he started complaining of fever, which was insidious in onset,  low grade , continuous type , not associated with chills and rigor, associated with evening rise of temperature , fever used to get relieved on medication C/o breathlessness since 2 weeks, insidious in onset, progressive in nature, initially patient used to get breathlessness on strenuous activity, and it increased to breathlessness after walking for 100 meters(MMRC grade 0 to III)no positional variation C/o cough since 7 days, insidious in onset, progressive in nature,not associated with expectoration,no diurnal variation, no positional variation.no aggrevating or relieving factors.no h/o blood after coughing History of present illness

5. c/o chest pain since 3 days in left side of the chest on lower lateral part,which is sharp stabbing type worsens on deep inspiration and coughing,non radiating,it aggrevates on lying on right side relives on lying on left side. H/o reduced appetite since 15 days (initially patient used to have 3  rotis per meal, now he has only 1 roti per meal) h/o weight loss , undocumented, noticed in the form of loosening of clothes in the past 2 months No h/o palpitations No h/o orthopnea or PND No h/o b/l lower limb swelling No h/o any chest trauma No h/o halitosis No h/o of joint pain or rash No h/o hoarseness of voice

6. Patient was admitted in ESIC hospital 8 months back with complaints Of generalized weakness and breathlessness on exertion and was told to have severe anemia for which he was transfused 2 pint pcv and was discharged. Not a known case of hypertension, diabetes,TB in past Past history:

7. Born out of a non-consanguineous marriage 3 rd out of  5 siblings and has 1 son to himself All family are keeping good health No history of tb contact in family,htn , dm Family history:

8. Diet: pred veg Sleep: normal Appetite: Decreased Bowel and bladder habits: Regular Habits: alcoholic since 10 years ,1 quarter whisky per day ( 42 units per week) Smoker since 10 years , 4 cigarettes per day ( Smoking index: 40 ) Tobacco chewer since 10 years ,5 packets per day Personal history:

9. Breakfast Cup of tea: 2 kcal Lunch 1 roti : ~100 kcal, 2 cups of rice: ~400 kcal (200 kcal per cup), 1 cup of dal : ~200 kcal Total for Lunch: 100 + 400 + 200 = 700 kcal Dinner 2 roti : ~200 kcal, 1 cup of rice: ~200 kcal, 1 cup of dal : ~200 kcal Total for Dinner: 200 + 200 + 200 = 600 kcal Daily Calorie Requirement (Moderately Active): 2,400 kcal Daily Caloric Intake: 1,302 kcal Daily Caloric Deficit: 1,098 kcal Nutritional history:

10. Here is a  40 year old male patient, chronic alcoholic,smoker,tobacco chewer came with complaints of fever and breathlessness since 2 weeks and cough since 7days , chest pain since 3 days . I would like to consider the involvement of respiratory system. Probable aetiologies like : 1.Chronic bronchitis 2.pneumonia 3.Pleural effusion Summary:

11. General examination: Patient is conscious , cooperative Oriented to time, place and person Moderately built and nourished Vitals: PR: 8 beats /minute, normal in volume and character, no radio-radial delay, no radio-femoral delay BP: 120/80 mmHg, measured in right arm in supine position RR:20 breaths per minute, abdominothoracic type Temperature: 98 O F

12. SpO 2 : 99% at RA No Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema Height: 174cms Weight: 48 kg BMI: 15.8 kg/M 2

13. Upper airway: Nose - no DNS Ear - Normal Throat - Normal Oral cavity - hygiene not maintained, tobacco staining of teeth present Systemic examination: Respiratory system examination:

14. Lower airway: Inspection: Shape of chest : Normal in shape , bilaterally symmetrical Position of trachea : appears to be central Apex beat: could not be visualised

15. Chest movements Areas Right Left Supraclavicular Normal Normal Infraclavicular Normal Normal Mammary Normal decreased Axillary Normal Normal Infraaxillary Normal decreased Supra scapular Normal Normal Interscapular normal normal Infra scapular Normal decreased

16. No dilated veins, scars, sinuses No Supraclavicular hallowing No Infra clavicular flattening No Drooping of shoulder No usage of accessory muscles of respiration No alar flaring No intercostal indrawing Spine :normal

17. Palpation: All inspiratory findings are confirmed. No local rise of temperature No tenderness. Position of trachea : central . Trail sign : negative Apex beat felt at 5th ICS   , 1 cm medial to MCL.

18. Chest movements

19. Chest measurements: AP: 18 cms , Transverse : 30 cms Chest expansion Inspiration Expiration 80 cms 78 cms Hemithorax: Right side 42 cms 40 cms Left side 40 cms 40 cms Right side Left side Spino scapular distance 10cms 11 cms Spino acromian distance 15 cms 15 cms

20. Tactile vocal fremitus: Right side Left side Supraclavicular normal normal Infraclavicular normal normal Mammary normal decreased Axillary normal Normal Infra-axillary normal decreased Supra scapular Normal Normal Inter scapular normal Normal Infra scapular normal decreased

21. percussion : Right side Left side clavicular resonant resonant Supraclavicular Resonant resonant Infraclavicular Resonant resonant Mammary resonant Stony dull Axillary resonant Resonant Infra-axillary resonant Stony dull Supra scapular Resonant Resonant Inter scapular resonant Resonant Infra scapular resonant Stony dull

22. Liver dullness : upper border at right 5 th intercostal space, liver span 14 cms Tidal percussion: Negative Traubes space:dull

23. Auscultation: decreased air entry present on left side Breath sounds: Normal vesicular breath sounds on right side on left side decreased breath sounds in mammary, infraxillary and infrascapular areas No Added sounds

24. Other systems examination: CVS : S1,S2 heard, no murmurs heard Per abdomen : Soft non tender, no organomegaly CNS : Conscious, oriented to time place and person.

25. Provisional diagnosis: left sided moderate pleural effusion probably tubercular etiology not in respiratory failure

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