1 / 18

Approach to a patient with cough

Approach to a patient with cough. B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon , Gaspar, Gatchalian , Gaw , Geraldoy , Geronimo, Geronimo Geronimo , Go, Go, Go, Go, Go, Go December 4, 2009. General Data. Name: RM Age: 60 Sex: Male Status: Married Address: Quiapo, Manila

ryo
Download Presentation

Approach to a patient with cough

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Approach to a patient with cough B4 – Dr. Remedios Coronel Garcia, Garcia, Garzon, Gaspar, Gatchalian, Gaw, Geraldoy, Geronimo, Geronimo Geronimo, Go, Go, Go, Go, Go, Go December 4, 2009

  2. General Data • Name: RM • Age: 60 • Sex: Male • Status: Married • Address: Quiapo, Manila • Religion: Roman Catholic • Race: Filipino

  3. History of Present Illness • CC: Productive Cough

  4. Past Medical History • HTN (2005) - Highest BP 200/160; Usual BP – 120/80 • Nifedipine, Metoprolol, and Aspirin - unrecalled dosage • Non-complaint (?) • LVH, possible MI (2005) • “ Food poisoning” – UST Hospital (2005) • External Hemorrhoids (2005) • Claims to have complete immunizations • No history of surgery • (-) DM • (-) Bronchial asthma • (-) PTB • (-) Blood transfusion • (-) Allergies • (-) Trauma/ accident

  5. Family History • (+) HTN – parents and siblings • (+) Heart disease – parents and siblings • (-) DM • (-) Cancer • (-) Allergy • (-) Asthma • (-) PTB • (-) Thyroid diseases

  6. Personal/Social History • Drinks a lot of soft drinks (each meals) • (+) Smoking pack/year • Occasional alcohol drinker amt • Mixed diet, preference to salty foods • Used to work for customs as a “checker” for 2O years and retired in 2009 • Currently sells candles in Quiapo church with his wife. • Married with 8 kids • Currently lives with his 20-year old son in a small apartment located in Abad Santos • Joined a marathon as his form of exercise

  7. Review of Systems • (-) anorexia, (+) weight loss (8kg loss in a month) • (-) itchiness • (-) headache, (-) blurring of vision • (+) dizziness • (-) colds • (-) chest pain, (-) palpitations • (-) abdominal pain • (-) vomiting, (-) diarrhea, (-) constipation • (-) dysuria, (-) hematuria, (-)flank pain

  8. Review of Systems • (-) bleeding, (-) easy bruisability • (-) polyuria, (-) polydipsia, (-) polyphagia • (-) heat / cold intolerance • (-) muscle pain • (-) edema • (+) asterixis

  9. Physical Examination on Interview • Conscious, coherent, ambulatory, not in CP distress • BP: 160/100mmHg PR: 92bpm, regular RR: 21cpm, regular T: 37.5 °C Ht=160 cm Wt=45 kg BMI=18 • Warm dry skin, no active dermatoses • Pale palpebral conjunctivae, anicteric sclera, pupils 2-3mm ERTL • Septum midline, no nasoaural discharge • No tragal tenderness, non-hyperemic, no pain on mastoid area

  10. Physical Examination on Interview • Neck not rigid, no palpable cervical lymphadenopathy • No chest wall deformity, symmetric chest expansion, no retractions, equal vocal and tactile fremiti, clear breath sounds • Adynamicprecordium, AB at 6th LICS AAL, (-) parasternal heave, (-) thrills, S2>S1 at base, loud P2, S1>S2 and (+) S3 at apex, (+) hemic murmur, carotid artery: rapid uptsroke, gradual downstroke, JVP 3cm at 30 angle • Flat abdomen, NABS, soft, no mass, no tenderness, 8 cm liver span midclavicular line, traube’s space not obliterated, (-) hepatojugular reflux • No palpable inguinal nodes, no CVA tenderness • Pulses full and equal, (-) cyanosis

  11. Physical Examination on Interview • Conscious, coherent, oriented to 3 spheres GCS 15 • Sense of smell intact • Isocoric pupils: , 2-3mm ERTL, no visual field cuts • Fundoscopy: (+) ROR, no papilledema, no hemorrhages, clear disc margins • EOMs full and equal, (+) conjugate eye movements • Intact V1-V3 • Can clench teeth, raise eyebrows, frown, no gross facial asymmetry • Gross hearing intact, (-) lateralization on Weber • Uvula midline on phonation

  12. Physical Examination on Interview • Can shrug shoulders, turn head side to side against resistance • Tongue midline on protrusion • MMT: 5/5 on all extremities • No sensory deficits • No atrophy, no fasciculations, no spasticity • Cerebellar functions intact • DTRs: (++) on all limbs • No Babinski, no chaddocks, no oppenheims • No nuchal rigidity, no Brudzinski, no Kernigs

  13. Salient Subjective Features

  14. Salient Objective Features

  15. Etiology of Cough

  16. Differential Diagnosis • (-) orthopnea, PND • JVP 3cm at 30 angle • AB at 6th LICS AAL • S3 at apex • (-) hepatojugularreflux • (-) edema • Dyspnea • 8 cm liver span MCL • Weight loss • Dyspnea, • (-) chest pain • (-) syncope • (-) tachycardia • (-) cyanosis • (-) hypotension • Fever • Cough • Dyspnea • (-) colds • Septum midline • (-) nasoaural discharge • (-) palpable cervical lymphadenopathy

  17. Clinical Impression • Community-Acquired Pneumonia

More Related