medicbro

Patient DIagnose-Part 1
August 22, 2008 by Von Charlie
AF who was 52 years old came to the doctor one day to complaint about his shortness of breathing and reduced tolerance.Reduced tolerance can also be interpreted as to be easily worn out or exhausted,could be out of the disorder in either his respiratory system or his cardiovascular.Those were the only few early assumption that could be wrong.Too early to make any conclusion here.Further interrogation is needed to dig his history presenting illness.Later AF admitted that he has difficulties in breathing while climbing the stairs and his dyspnea worsen as he climbs only 2 flight of stairs.He also had a chronic cough that produced a lot of sputum,a mixture of saliva and mucus coughed out from the respiratory tract.His wife added that his lips would turn blue following shortness of breath.Aha!here’s the clue.bluish of lips following shortness of breathing.why?refer to the clinical medicine books and you will find that this presents a symptom of cyanosis.Cynosis?That is what could be easily termed as the poor supply of oxygen.This calls for the physical examinationAF admitted that he had befriended with someone who died earlier due to tuberculosis.This is another point that could relate to the shortness of breath he experienced.Why?tuberculosis is infectious.To add, it is a lung infection disease due to bacterial myobacterium tuberculosis.He has the potential to get infected and this calls for the sputum of acid fast bacilli and sputum for culture and sensitivity.PCR and Mantoux test can further confirm his condition.The result was negative to all test.NO myobacterium tuberculosis.He denied prolonged fever.another point here.this shows that there is no infection happened.fever is actually an inflammatory respond of the body to fight antigen such as the myobacterial tuberculosis,if it presents.So,again,no infection.His respiratory system is not compromised by tuberculosis.Lymph nodes,not palpable.this is normal.lymph nodes only becomes palpable in case of cancer or carcinoma.He denied having any chest pain or haemoptysis .Cardiovascular findings shows that there’s no murmur heard.So,no problem there.The first and second heart sound were normal.Further confirms that there is nothing wrong with his heart.However there was a difficulties in palpating his apex of heart at the 5th intercostal space.This is another point for discussion.Problem in palpating.this suggest that there’s increase in the anterior posterior diameter of the thoracic cavity.So the apex of the heart is difficult to be located.What cause the increase in anterior posterior diameter?1)accessory muscles of the respiratory failure.2)size of the lung increased.Xray done on him and revealed that there was increase in his lung volume.So the increased lung size causes the increase in anterior posterior diameter.Further examination revealed that he has no chest tenderness and the chest expansion was reduced.It is also noted that the patient has intercostal retraction.Intercostal retraction is state of the intercostal muscles coming to its original state.At the neck,the sternocleidomastoid muscle noted to be prominent.So this could explain about the increase in the anterior posterior diameter.the sternocleidomastoid is holding the sternum in such position that there’s no more room for the chest cavity to expand.which leads to the shortness of breathing.From the xray,the diaphragm is consistently flat.this will seriously affect the normal mechanism of breathing.the diaphragm was suppose to be flat only during inspiration.consistently being flat will effect the expiration process.the lung cavity will always remain expanded and this is hard for the lung to expel the CO2 .From the lab, the arterial blood gas showed that the pH of the blood is reduced to slightly acidic.pH7.25.normal is pH7.4.this could lead to metabolic acidosis.Partial pressure of O2 is below normal and partial pressure of CO2 is above normal.HCO3 (bicarbonate ion)is higher than normal.Low PO2 further strengthen that AF has poor O2 supply to his tissue.Cyanosis.from his physical examination,he has both central and peripheral cyanosis.central cyanosis can be seen through the bluish of his tongue while the peripheral cyanosis can be seen through his hand.blue that is.

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Diagnoses
AF who was 52 years old came to the doctor one day to complaint about his shortness of breathing and reduced tolerance.Reduced tolerance can also be interpreted as to be easily worn out or exhausted,could be out of the disorder in either his respiratory system or his cardiovascular.Those were the only few early assumption that could be wrong.Too early to make any conclusion here.Further interrogation is needed to dig his history presenting illness.Later AF admitted that he has difficulties in breathing while climbing the stairs and his dyspnea worsen as he climbs only 2 flight of stairs.He also had a chronic cough that produced a lot of sputum,a mixture of saliva and mucus coughed out from the respiratory tract.His wife added that his lips would turn blue following shortness of breath.Aha!here’s the clue.bluish of lips following shortness of breathing.why?refer to the clinical medicine books and you will find that this presents a symptom of cyanosis.Cynosis?That is what could be easily termed as the poor supply of oxygen.This calls for the physical examinationAF admitted that he had befriended with someone who died earlier due to tuberculosis.This is another point that could relate to the shortness of breath he experienced.Why?tuberculosis is infectious.To add, it is a lung infection disease due to bacterial myobacterium tuberculosis.He has the potential to get infected and this calls for the sputum of acid fast bacilli and sputum for culture and sensitivity.PCR and Mantoux test can further confirm his condition.The result was negative to all test.NO myobacterium tuberculosis.He denied prolonged fever.another point here.this shows that there is no infection happened.fever is actually an inflammatory respond of the body to fight antigen such as the myobacterial tuberculosis,if it presents.So,again,no infection.His respiratory system is not compromised by tuberculosis.Lymph nodes,not palpable.this is normal.lymph nodes only becomes palpable in case of cancer or carcinoma.He denied having any chest pain or haemoptysis .Cardiovascular findings shows that there’s no murmur heard.So,no problem there.The first and second heart sound were normal.Further confirms that there is nothing wrong with his heart.However there was a difficulties in palpating his apex of heart at the 5th intercostal space.This is another point for discussion.Problem in palpating.this suggest that there’s increase in the anterior posterior diameter of the thoracic cavity.So the apex of the heart is difficult to be located.What cause the increase in anterior posterior diameter?1)accessory muscles of the respiratory failure.2)size of the lung increased.Xray done on him and revealed that there was increase in his lung volume.So the increased lung size causes the increase in anterior posterior diameter.Further examination revealed that he has no chest tenderness and the chest expansion was reduced.It is also noted that the patient has intercostal retraction.Intercostal retraction is state of the intercostal muscles coming to its original state.At the neck,the sternocleidomastoid muscle noted to be prominent.So this could explain about the increase in the anterior posterior diameter.the sternocleidomastoid is holding the sternum in such position that there’s no more room for the chest cavity to expand.which leads to the shortness of breathing.From the xray,the diaphragm is consistently flat.this will seriously affect the normal mechanism of breathing.the diaphragm was suppose to be flat only during inspiration.consistently being flat will effect the expiration process.the lung cavity will always remain expanded and this is hard for the lung to expel the CO2 .From the lab, the arterial blood gas showed that the pH of the blood is reduced to slightly acidic.pH7.25.normal is pH7.4.this could lead to metabolic acidosis.Partial pressure of O2 is below normal and partial pressure of CO2 is above normal.HCO3 (bicarbonate ion)is higher than normal.Low PO2 further strengthen that AF has poor O2 supply to his tissue.Cyanosis.from his physical examination,he has both central and peripheral cyanosis.central cyanosis can be seen through the bluish of his tongue while the peripheral cyanosis can be seen through his hand.blue that is.

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