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CPC Jan 16 Yawqna PDF
CPC Jan 16 Yawqna PDF
38 year old
Male, from Cavite,
D I FnoF known
I C U LT Y
O F comorbidities
BREATHING
H I S T O R Y O F P R E S E N T
I L L N E S S
15 MOS. PTA
9 MOS. PTA
5 MOS. PTA
4 MOS. PTA
• Inc. H I S T O R
freq. of coughY • OCough
F P+ R E S phlegm
whitish E N T
•
I L L assoc.
Fever and back pain N E S with
S night sweats
• No hemoptysis • No hemoptysis or fever
• X-ray: Pleural effusion • Px self-medicated with
• Treated as Pneumonia Carbocisteine, did not relieve
15 MOS. PTA
• Given antibiotics, was compliant
symptoms
9 MOS. PTA
• Relief of fever and dec. freq. of
cough • Recurrence of fever 5 MOS. PTA
• Persistent productive cough, whitish
4•MOS. PTAdone
CT scan phlegm, bloody streaks
• Biopsy requested Weight loss (20%)
•
3 MOS. PTA
2 MOS. PTA
1 MONTH PTA
H I S T O R Y O F P R E S E N T
I L L N E S S
• Px was on regular follow-up
• Started on anti-tuberculosis
• FNAB was done:
• Still had cough assoc. with Chest pain & Dyspnea1.5 MOS. PTA
• Admitted for 10 days
1 MONTH PTA • Improvement of symptoms
• O2 support given
• Steroids were tapered
• CT-guided lung mass biopsy was requested
• Mild improvement of dyspnea
• Patient was discharged on O2 support at home
H I S T O R Y O F P R E S E N T
I L L N E S S
No history of hypertension
Pulmonary Tuberculosis
Mother
Pneumonia
Sibling
P E R S O N A L & S O C I A L
H I S T O R Y
P E R S O N A L & S O C I A L
H I S T O R Y
Unemployed, former Factory worker,
regularly exposed to paint thinner
4 pack-year smoker
Weakness Cough
Abdominal pain
Dysuria
Bowel
Movement
Changes
P H Y S I C A L E X A M
Drowsy
Cardiorespiratory
distress
P H Y S I C A L E X A M
Constitutional
BLOOD
PRESSURE 130/90 mmHg
HEART
RATE 140 bpm
RESPIRATORY
RATE 32 cpm
BODY
TEMP. 37.3C
O2 SAT. 92%
P •HUnequal
Y S chest
I C expansion
A L E X A M
• Chest lag on the Right
• Anicteric sclerae
• Dullness on percussion on R lung field
CBC
Result Int.
MCH
N = 12.0 - 31.0 pg
29.4 N
MCHC
N = 320 - 360 g/L
338 N
Platelet
N = 150 - 450
360 N
D I A G N O S T I C S
CBC
Result Int.
Lymphocytes
N = 0.200 - 0.500
0.129
Neutrophils
N = 0.500 - 0.700
0.767
Monocytes
N = 0.020 - 0.090
0.045 N
Eosinophils
N = 0.000 - 0.060
0.000 N
Basophils
N = 0.000 - 0.020
0.001 N
D I A G N O S T I C S
CHEM
1st HD 2nd HD Int.
Crea
N = 53 - 115 umol/L
69 N
Na
N = 136 - 145 mmol/L
118 120
K
N = 3.50 - 5.10 mmol/L
2.0
Cl
N = 98 - 107 mmol/L
76
Albumin
N = 38 - 51 g/L
36
Ca
N = 2.12 - 2.75 mmol/L
2.22 N
D I A G N O S T I C S
ABG
1st HD 3rd HD 4th HD
pH
N = 7.35 - 7.45
7.557 7.312 7.308
PCO2
N = 35 - 45
23.2 51.2 35
PO2 58 45 57.2
HCO3
N = 22 - 28
20.5 26.3 21
O2Sat 93.8% 75.2% 89.3%
Partially Uncompensated Partially
compensated respiratory compensated
respiratory alkalosis acidosis metabolic acidosis
D I A G N O S T I C S
SPUTUM:
PMN <25
Squamous Epithelial cells >25
D I A G N O S T I C S
ECG:
Sinus tachycardia
Normal axis
R E V I E W O F S Y S T E M S
C O U R S E
I N
T H E
WA R D
C O U R S E I N T H E W A R D
ADMISSION
Admitted under Gen. Medicine Service
Put under NPO
Hooked to IVF: PNSS 1L x 12 hrs.
Requested CBC, Blood chem, Sputum
GS/CS, Chest CT
Tx: Anti-TB meds, Vit. B complex,
Ipatropium + Salbutamol nebulization
Vital signs monitored hourly.
C O U R S E I N T H E W A R D
Back pain
Night sweats
Fever
Productive cough (whitish
phlegm + blood streaks)
20% weight loss
Chest pain
Severe dyspnea
D I F F E R E N T I A L D I A G N O S I S
PULMONARY MASS
Infection Neoplasm
PULMONARY TUBERCULOSIS
(Tuberculoma)
with
Recurrent Pneumonia
PATHOPHYSIOLOGY
38 y/o, Male, former factory worker
4 pack-year smoker
Respiratory Compromise
Respiratory Compromise
Decreasing O2 Sat.
Cyanosis
Tight air entry
RESPIRATORY FAILURE
DEATH
Cause of Death
C A U S E O F D E AT H
UNDERLYING CAUSE
Pulmonary Tuberculosis
(Tuberculoma)
ANTECEDENT CAUSE
Atelectasis
IMMEDIATE CAUSE
Respiratory Failure