80Y male Chronic smoker since childhood stopped 10yrs back. K/c/o HTN, CAD - S/P PCTA to RCA(10yrs back), COPD - Chronic bronchitis with H/O breathlessness since 1year presented with fever since 3days. Patient is on Nitrolong 2.6, Clopivas AP 75. ECG & CXR attached. Kindly discuss..

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X-ray shows slight broadening of the superior mediastinum with a small suspicious shadow in the left hilar area.. Scattered area of fibrotic strands more in the left lung.. Consider it a case of AECB... Treat with antibiotics and nebulisations.. Perform pre and post bronchodialator spirometry to assess the degree of airway obstruction.. Breathlessness may be explained by loss of lung function in spirometry Cect thorax may be needed if Patient doesn't respond to above management..

Any chance of PTB sir. But his sputum AFB negative previously..
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Ecg shows of q wave in 2,3 avf suggestive of old inf wall mi with premature complexes likely to be atrial.early repolarisation in lateral leads of chest. cxray s/o- bronchitis with bronchiectasis. with hilar prominence more on rt than lt slightly deviated lt main bronchus on rt. with ? radiopaque shadow silhouette with aorta deviating lt main bronchus. if present could localised in lt upper lobe. ct chest to ruled out mass. 2D echo to ruled out depress lv function sec CAD. antibiotic bronchodilator oxygen therapy hydration

You r right.
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It seems to be acute exacerbation of chronic Bronchitis. He already has CAD ,therefore his CAD treatment must continue as before. For his respiratory problem, he should be put on DUPHILL 400 1/2 BD along with Cepoodem 200 BD and Seretide autohaler 2 puffs twice a day along with cetirizine 10 mg at bedtime. Rule out CCF bcz of HTN and cardiac problem. If having CCF then put him on diuretics and steroids for some time till he recovers

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ECG shows prominent Q waves in inferior leads with T wave inversions. Old inferior mi CXR shows increased Bronchovascular markings. kindly provide detailed examination findings. History as given is suggestive of acute exacerbation of COPD.

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X ray shows- increased bronchovascular markings characteristic copd chest , hilar b/l increase thickness, diffuse patchy inhomogenous opacity with airbronchograms is suggestive of bronchopneumonia. ecg - inferior wall old mi

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Old Inf wall MI Xray is typical COPD Emphysema Symptomatic treatment If no response proceed with CECT chest and Bronchoscopy with wash for C/S, AFB, Malignant cells Cardiac treatment to continue

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I am seeing lot of cases which ultimately have lung pathology. Rule out bronchiectasis, interstitial lung disease., rule out cysticercosis

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Ecg shows old inferior wall mi with LAD From cxr it's acute exacerbation of COPD Recent complains is due to lung pathology rule out that

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old inferior wall mi cxr suggestive of bronchitis echo to rule out cor pulmonale

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ECG old inferior wall infarct. X ray chest suggestive of bronchopneumonia.

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