September 29, 2009

progressive shortness of breath for one week duration


A 55 years old Malay man presented to the clinic with the chief complaint of progressive shortness of breath for one week duration. he is a smoker and smoke for about 20 cigarettes per days for 20 years.


he also complained of cough since three years ago with yellowish sputum.


1) What other question you would like to ask and why?
2) What investigation you would like to perform?
3) what is the most probable diagnosis in this patient?


Good luck

For answer to this question, click [here]
make sure you have tried it out first

7 comments:

  1. 1)-any chest pain.
    -any contact with pulmonary TB
    patient.
    -musical sound during expiration

    2)-sputum culture and sensitivity (to confirm bacteria)
    -full blood count(any infection)
    -chest x-ray(any consolidation in pneumonia)
    -sputum staining(zeihl nelsen staing for Tb)

    3)copd(emphysema)

    ReplyDelete
  2. 1) Have he had any feaver before? - infection
    chest pain? -
    any trauma on the chest?- pneumothorax, pneumonia..
    is there any contact with anyone with tuberculosis?-TB
    how much sputum he coughed each day?
    what makes his difficulty in breathing become worst? onset and so on.

    2)blood test fot total WBC? to indicate if he has any infection.
    chest X-ray.
    Sputum culture and sensitivity to indicate what type of organism causes infection in this patient.

    Because the sputum was yellow, maybe it indicate infection rather than just clear sputum.

    3) It can be COPD from history of smoking with minor infection.

    ~_~, again.. just from my 2nd year knowledge..

    ReplyDelete
  3. to be specific COPD,
    Chronic bronchitis because the production of cough should be in two consecutive years.

    dunno- =p

    ReplyDelete
  4. in order to answer this kind of question, we have to read the answer carefully. for example, the first question require you to justify why you ask certain question for examples. plus, your question must be directed towards your diagnosis or to exclude other diagnosis which resembles the presentation

    for examples, when patient come with SOB as the most prominent complaint. your assesment should be more on resp system and followed by cardiology problem.

    in second phase md in USM, usually we have to ask 3 important question.

    both of you have answer it well but it just not complete in term of explaination.

    for example musical expiration during expiration. you have to reason that you would like to exclude the dignosis of asthma. there will be mark for u even though asthma is not really suggestive based on the onset of the symptom.

    contact with tb patient is important and necessary to elicit in any history taking of respi system. just when u answer it, try to correlate with history.

    respiratory chest pain is more sharp or pleurisy in nature and not confined to left retrosternal area.

    amount of sputum is a good question. certain disease especially bronchiectasis will have more sputum. asthma or copd would rather present with dry cough unless there is underlying infection.

    this patient is more likely to have COPD base on the onset of the cough which is in the middle to late age plus with the history of smoking.

    differentiating between emphysema or chronic bronchitis base in this question statement alone is difficult. but there are severel hint. most of it will present when you do the physical investigation and other investigation like cxr, anti-trypsin level.

    for more explaination, click on the link provided in the article..

    feel free to correct my answer if there is any mistake.. thank you

    ReplyDelete
  5. i see, so emphysema and chronic bronchitis is difficult to differentiate.

    thank you very much..
    ^_^

    ReplyDelete
  6. (MUST READ: HOW I GOT CURED FROM COPD)
    I am Lydia, I was diagnosed of Chronic obstructive pulmonary disease (COPD) in 2014, the doctor told me it has no permanent cure i was given medications to slow down its progress, i constantly felt my health was deteriorating as i constantly go out of breath especially when i walk or talk for long, this continued till a friend told me about how her mother got cured of COPD through herbs she bought from a South African herbal doctor Dr Ejiro, I contacted this herbal doctor via his email and he sent me the herbal medicine through courier service, when i received the herbal medicine i used it for 3 weeks as prescribed and was totally cured of COPD. Contact this herbal doctor via his email ejiroherbalcure@gmail.com or call +27617403481

    ReplyDelete
  7. still don’t know the right words to express my Gratitude to the Great Dr.Lusanda After been diagnosed of Emphysema in 2014, i was given so many health prescription and advice with no improvement, I totally lost hope, until i found testimonies of Great Dr. Lusanda in an online research and on Facebook, Like anybody would be, I was very skeptical about contacting him, but i later did and he opened up to me and told me what was involved and he started the remedies for my health. Thank God, i was cured from hepatitis by the herbal medication I received from him. I never thought that hepatitis can be cured, from the bottom of my heart I’m truly grateful,i pray you have long life so you can help many more people on earth with your herbal medical support. Contact Dr Lusanda today, Email: Drlusandaherbal@gmail.com or www.drlusandaherbal.weebly.com

    ReplyDelete

Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.