diagnosis.....???...age-25yr male....4 days history of chest pain and generalised weakness....patient is conscious... bp 90/60mmhg..... spo2...80%..... PR 110 M.P. para test-PF weakly positive in mp antigen test widal- O 1:80 I 1:40 S.bil T O.79 D O.18 I. O.61 S.creatinin 1.30 hb 9.9 tlc 3800 poly 64 lymph 35 eocinophils 01 monocyte 0 baso 0 RBC 3.94 platelet 0.34 lac/cumm pcv 30.7 mcv 77.9 mch 25.1 mchc 32..... ESR 20 .. .. auscultation- both chest side...equal...no any added sound present percussion-as normal.....
History of chest pain with Hypotension spO2 - 80% Tachycardia Leukopenia Consolidation involving whole of right lung Pointing towards LRTI possibly Pneumonitis.. But rule out TB and send procal.... The pt can deteriorate , so start with broad spectrum antibiotics and supportive care...
Working diagnosis: Right Pneumonia with sepsis Suggest: Fluid challenge If does not respond to fluids initiate vasopressor support Consider NIV support Send chest secretions,blood and urine for c/s Start Broad spectrum antibiotic as per hospital antibiotic policy Add Nebulisations Supportive management Monitor hrly BP and U/O Regular monitoring of platelets Send samples for: PCT LFT Dengue NS1 Though the possibility is less but send throat swab for H1N1 and Koch’s Routine labs.
X-ray - rt side massive consolidation with shift of trechea to rt side Pltb with pneumonitis Needs further investigation till Higher antibiotic Cbc and esr Ecg sinus tachycardia Treat Malaria at the same time
Jayegi opacity right lung. Tachycardia and leucopenia Broad spectrum antibiotics and supportive care Needs further investigations,evaluation and Constant monitoring.
Hatero opacity right lung. Trachea and mediastinum shifted to right. PTB
Tuberculosis Rt lung Rx Antitubercular drugs for 6mth as per schedule fist 2mths intensive phase & then Continuation phase for next 4mth & Symptomatic treatment as 5
Low spo2 shifting of trachea towards Rt consolidated lung indicating initial stage of fibrosis causing atelectasis.Need spiral ct thorax.
Consolidation Lung.? Rt. Sided pneumonia. Developing septicaemia with MOF. S.creatinine elevated.Low TLC,platelet count 34000/cmm
MASSIVE RT MID AND LOWER ZONE PNEUMONIA. LYCOPODIUM 200 ONCE AND WAIT.
Cases that would interest you
- Login to View the image
7 years female generalised lymphadenopathy 3 months Undocumented fever for first few days No clearcut history of sorethroat One blood transfusion for anemia O/E : Not sick looking, playful Bilateral cervical (anterior and posterior) Bilateral axillary Bilateral inguinal No hepatosplenomegaly Investigations: Pancytopenia Comments are welcomed....
Dr. Atahar Jamal2 Likes15 Answers - Login to View the image
a nine year old girl with history of cough, high grade fever since 4 months with chills and rigor with pain in body with h/o epistaxis with hb- 4 ,platelet count 26000 tlc 17700 chest b/l ronchi . on Att for abdominal Koch's. pallet with tachycardia. ps- anisopoikilocytosis macrocytic anaemia. h/o multiple joint pain. petechiae all over face since 5 days. USG Abdomen shows hepatomegaly. CERVICAL ADENITIS tender. likely d/d and management.
Dr. Abhishek30 Likes59 Answers - Login to View the image
30 yr old male c/O shortness of breath ,vertigo, ghabharat, pain abdomen . h/O fever since 10 days diagnosis and treatment
Dr. Vivek Asthana1 Like6 Answers - Login to View the image
a 27 year old female brought to Ed from outside hospital with complaints of bleeding pv from last 5 days and fever for 3 days..vitals normal,,blood gas ,HB 4.5..rest wnl..GCS E2V2M4..outside repots done same day showing Hb 4.7..platlets 2000.tlc 800...patient in Ed had 2 episodes of seizures...CT brain done....what are the differential diagnosis and how should we proceed for management..
Dr. Muzamil Masoodi0 Like16 Answers - Login to View the image
12yr female ,with decreased platelets and high grade fever every alternate day ,after platelets transfusion no improvement ..pt. is asymptomatic except fever ,dengu test is negative ..plz clear the diagnosis..thanks
Dr. Dileep Pathak1 Like23 Answers
6 Likes