Final exam

February 09, 2022

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A 67 yr old male patient presented to the opd with the chief complaints of shortness of breath since 2-3 days, bilateral pedal edema since 3 days, orthopnea,PND

History of present illness: patient was apparently normal 20 yrs Back then he developed severe cough with sputum and also shortness of breath.then he was diagnosed with TB.he used ATT course for 9 months and relieved. Now patient again developed shortness of breath of grade 2-3, grade-2 pedal edema of pitting type.

Past history: known case of TB. Not a known case of diabetes, hypertension, asthama , epilepsy.

Personal history: patient follows a mixed diet.patient complaints of decreased appetite since 1 yr.normal bowel and bladder movements. Patient is a chronic alcoholic since 50 yrs(180-360ml) three times a week.he also have a habbit of smoking since 50 yrs (18beedis per day) .

Family history : no relevant family history

Drug history : not allergic to any of the known drugs.

Vitals: pulse rate: 98BPM, temperature: afebrile, BP: 110/80, respiratory rate: 26 cycles per min, spo2: 83, GRBS:111mg/dl

Systemic examination:

Cvs: bilaterally symmetric chest wall .no precordial bulge .no thrills and no murmurs. s1 and s2 heard

Respiratory system: bilateral air entery present , wheeze present, Position of trachea- central,

CNS: patient is concious .reflexs are normal

Abdomen: distended

Investigations to be done: x- ray, echocardiogram.

Provisional diagnosis: cor pulmonale, with history of TB 20 yrs back.

Differential diagnosis: pulmonary hypertension

Treatment plan: