Tuesday, February 10, 2015

Short Case with Dr. Nik Fatnoon

Patient 1

A tachypneic middle-aged lady on nasal prong. She had occasional chesty cough. Inhaler noted on side table. No clubbing, pallor or peripheral cyanosis. No flapping tremor. BCG scar noted at left deltoid. No conjunctival pallor, cervical lymphadenopathy or pedal edema.

On respiratory examination, there was no surgical scar, dilated veins, visible pulsations or barrel chest noted. Trachea was centrally located. Apex beat not displaced. Chest expansion was equal bilaterally. Tactile vocal fremitus normal. 

On auscultation, air entry equal bilaterally - vesicular breath sounds heard. Vocal fremitus normal. Generalised crepitations were heard. 

1. Provisional diagnosis?
Acute exacerbation of Chronic Obstructive Pulmonary Disease

2. Clinical signs of AECOPD?
  • Nicotine stains on fingers
  • Barrel chest
  • Wheezing
  • Hyperresonance
  • Generalised rhonchi

Patient 2

16-year-old boy with central and peripheral cyanosis as well as clubbing of fingers and toes. No polycythemia, AF, raised JVP or pedal edema. 

Apex beat was displaced. Pansystolic murmur heard at tricuspid area with thrill felt - moderate intensity, grade 4/5, not accentuated by expiration or inspiration. Loud P2 heard at pulmonary area. No hepatomegaly or lung crepitations.

1. Provisional diagnosis?
Ventral Septal Defect

2. What happens in VSD?
Taken from this website

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