GENERAL MEDICINE E- LOG


Hi, I am Aziza Ferdose 3rd sem medical student. this is an online elog book to discuss our patients health data after taking his consent.This also reflects my patient centered online learning portfolio.


A 66 YEAR OLD MALE PATIENT CAME WITH COMPLAINTS OF SHORTNESS OF  BREATH

A 66 yr old male patient farmer by occupation came to casualty with complains of shortness of breath since 1 day and abdominal discomfort

HISTORY OF PRESENT ILLNESS

Patient was apparently asymptomatic 1 day back then he developed breathlessness sudden in onset MMRC grade 3 increased on exertion no relieving factors present 

no orthopnea, palpitations, no seasonal or diurnal variation

no complain of cough, chest pain , chest tightness, fever

complain of abdominal discomfort since 3 days 

PAST HISTORY

no similar complaints in the past 

no past history of TB, HTN,  DM,  Epilepsy, asthma 

past history of covid 19 1 yr back got admitted at local hospital for 15 days 

patient is a known case of CAD since 10 yrs on Tab clopitab A 150 mg , tab rantac 150 mg 

PERSONAL HISTORY 

diet : mixed 

bowel : regular

micturition : normal 

known allergies : no

 VITALS 

temperature : Afebrile

pulse rate : 102 bpm

Bp :140/100 mmHg

Respiratory rate : 20 /min

GENERAL EXAMINATION 

no pallor , icterus , clubbing of fingers , lymphadenopathy, malnutrition , oedema

CNS : concious,coherent and  cooperative 

CVS :s1 s2 heard

RESPIRATORY SYSTEM :  BAE +, dyspnoea , no wheeze , central position of trachea, vesicular breath sounds 

Inspection 

shape of chest - elliptical

B/L symmetrical chest 

trachea appears to be central 

expansion of chest - equal on both sides

no drooping of shoulders 

no crowding of ribs

no wasting of muscles

spinoscapular distance equal on both sides 

Palpation

no local rise of temperature

no tenderness

chest movements equal on both sides

apex beat left 5th ICS

TVF equal in all areas

Percussion 

direct - hyperresonant

indirect - hyperresonant 

Auscultation 

BAE +, VBS

decreased breath sound right ICA, MA, ISA, Infra SA 

INVESTIGATIONS 

















PROVISIONAL DIAGNOSIS

Right sided hydropneumothorax secondary to TB with CAD 

TREATMENT
 
Patient on ICD for 4 days 
oxygen inhalation 2-4 lit/min
tab azee 500 mg
inj tramadol
diclofenac patch
tab clopitab A 150 mg 
tab ramipril 5mg 
inj pan 40mg
inj augmentin
neb with duolin , budecort








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