57 year old mail, with chronic cough, old pt. of Tb he completed his DOTS OF 6 MONTH.

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You must rule out obstructive airway disease by doing a pre and post bronchodialator spirometry.. There is a possibility of COPD in this patient.. Treatment depends on the diagnosis.. Also add PPI to treat associated GERD.. post tubercular bronchiectasis needs exclusion by doing a HRCT thorax if spirometry is inconclusive...

Chest xray Is suggestive of old ptb changes with fibrosis of b.l upper zone more of left than rt.. with copd changes. first sputum examination for afb if negative then spirometry for seeing obstruction.. treat pt with bronchodilator mucolytics and cough syp expectorant and mdi to be added as per spirometry report.. chest physiotherapy and breathing exercise are important for this pt.. ecg.. and 2 d echo to see cor pulm and pah... baseline abg.. and later hrct thorax can be planned if amount of expectations is too much. high protein diet..

Chest X-ray is suggestive of tuberculosis. Do sputum analysis atleast twice to detect tuberculosis reactivation or MDR. Cect chest, Esr, lung function tests are other tests needed at present. In the meantime, while the tests results are awaited, treat with bronchodilator, cough suppressants, and antibiotics for secondary infection.

some hyperinflation is there in bilateral lung fields with haziness of bilateral upper lung fields. a cyst like lesion can be seen in the left upper lobe. the best plan of treatment for the patient would be. 1. do routine blood examination . sputum for gram stain and culture, afb stain. start patient on anti histaminics MDI with levosalbutamol and ipratropium sos. give anti biotics for a week.preferably coamoxyclav with azithromycin. avoid linezolid. fluoroquinolones. after a week check for radiological resolution with a repeat chest xray and check for sputum for afb. if no improovement then go for a hrct thorax. and if still no clue the go for a bronchoscopy and a lavage.

Do sp gene expert it looks like relapse of tb do spirometry pre and post hrct thorax

should we not wait for the infection or haziness to settle before we do a spirometry... it may be highly misleading
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x-ray chest shows B/l upper lobe fibrocavitory lesions .Adv sputam for AFB ,if negative then go for CT chest to rule out Bronchiectasis. manage initially by antibiotics, bronchodilator, mucolytics .

sputum AFB or hrct lung .... it's reactivation of tb

post tb squalene

spirometry should be in plan after the haziness settles.. there is some active disease in bilateral upper lobes

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