Wednesday, January 14, 2015

Short Case with Dr. Khairul Azhar

Patient 1

A Malay teenager, thin-built, presented with pallor of hands, hepatomegaly 5cm below costal margin and splenomegaly. No stigmata of chronic liver disease.

1. How would you like to complete your examination with?
I would like to examine genitalia (for testicular atrophy) and per rectal examination.

2. Causes of hepatosplenomegaly?

Haematological
  • Myeloproliferative - Myelofibrosis, CML, PCV, Essential thrombocytosis
  • Lymphoproliferative - ALL, CLL, lymphoma, myeloma
  • Haemolytic anaemia
Infection
  • Infective hepatitis
  • Infective mononucleosis
  • Leptospirosis
  • Malaria
  • Toxoplasmosis
  • Leishmaniasis
Portal hypertension

Others
  • Sarcoidosis
  • Amyloidosis

Patient 2

A middle-aged cachexic Malay man, looked tachypneic and in respiratory distress, presented with finger clubbing and bilateral lung crepitations.

1. Clinical features of bronchiectasis?
  • Chronic cough with copious, purulent sputum
  • Recurrent haemoptysis
  • Recurrent lung infection

2. Causes of bronchiectasis?

Postinfectious
  • Measles
  • Pertussis
  • TB
  • Aspergillosis
Endobronchial obstruction
  • Bronchial adenoma
  • Bronchial carcinoma
Congenital
  • Kartagener's syndrome
  • Hypogammaglobulinemia

3. Complications of bronchiectasis?
  • Haemoptysis
  • Pneumonia
  • Cerebral abscess
  • Amyloidosis

4. Investigations in bronchiectasis?
  • Sputum AFB / fungal culture
  • Sputum C&S - H. influenzae, P. aeruginosa, Str. pneumoniae
  • CXR - Ring-like shadows, tram lines, focal opacities
  • High-resolution CT - detects airway dilatation not visible on CXR 

No comments:

Post a Comment