A 45-year-old man presents to the emergency department with progressive shortness of breath and dyspnea on exertion, fever on and off and weight loss for the past month. The patient reports no chest pain, hemoptysis, orthopnea, paroxysmal nocturnal dyspnea, palpitations, or lower-extremity swelling. On physical examination, the patient's temperature is 98.6°F . His pulse rate is 86 beats/min, with a regular rhythm. His blood pressure is 160/100mm Hg. The patient's respiratory rate is 22 breaths/min, with an oxygen saturation of 92% while breathing room air. His chest is nontender on palpation, and expands symmetrically. The abdominal, cardiac and neurologic examinations are unremarkable. The patient has no cyanosis, clubbing, or edema of the extremities. What's the likely diagnosis and treatment?



So chief complain is shortness of breath on ecertion with mild fever and wt loss he is hypertensive as well no other remarkable symptoms. His x-ray chest shows infiltrates rt upper zone with prominentbronchial markings on lt side with hyper inflation on rt side suggests copd heart is tubular he should be investigated for fresh kochs infaction till than should be treated as a pt of copd so also bp shoud be monitored and if needed antihypertensive should be added. Rx tab Amoxyclav625mg 1x2times for5to7days tab pulmoclear 1x2timesfor 7days +nebulisation and cough expectorants

Thank you sir, for detailed explanatory reply. It's very helpful

Please specify present/ past profession,well I will suggest HRCT lung to come to a definite conclusion. There are few calcific opacities in the rt upper zone & on left side the bronchovascular markings are quite prominent. This pt does not have clubbing or cynosis, possibility of fibrosis less likely. Absence of BV markings on rt side with airspace ,an HRCT should give us a diagnosis.

He was musician and singer. Currently unemployed

Rotation ++. Old PTB with COPD.

Sir what is rotation ++ ?

Old PTB with emphysema. Sputum for AFB, CBNAAT if sputum for AFB is negative, CECT Chest, RBS, CBC, RFT, 2D-Echocardiography, Serum Electrolytes, etc

This pt is def having COAD and this can be an acute exacerbation due to new LRTI ...We have to rule out Koch's and othrwise routine treatment with Broad spectrum antibiotics with inhaled steroids .... But he is also showing reticulonodular shadows more on left side... Definitely an HRCT should be done as there is a possibility of ILD

Old c/o PTB, presently COPD with HT, advise Hemogram ESR, sputum for AFB, urine & ECG for further management

Please do sputum afb.if not done .go for blood exam. And blood sugar examination. If sputum is negative for afb.go for antibiotics like cap.moxclave for 7 days with bronchodilators and tablet rca for haemoptysis. Start tab.amlodepine 5 mgm. For hypertension. If no relief than go for c.t.thorax.

Tubular heart. Hyper inflated right lung... flattened dome of diaphragm.. Extensive fibrosis left lung....rule out COPD.

Old calcified lesion rt uz & reticular pattern in lt lung suggest fibrosis & compensatory emphysema rt lung tubular heart restrictive lung d's with HT. Bronchodilator steroid lungs physiotherapy


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