Karthik Radiology

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    RADIOLOGYPOSTING

    CASEPRESENTATION PRESENTER : KAARTHIGAN

    RAMAIAH ID NO. : 06- 201204-00011 LECTURER :

    DR.AZMAN

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    1. History taking

    2. Physical examination

    3. Provisional diagnosis

    4. Diferential diagnosis 5. Investigation

    6. anagement !lan

    ". Disc#ssion and learning o#tcomes

    $. %e&erences

    '()*+)*

    2

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    Pati!t"# $tai%#

     )ame , -an Dayang emi

     ge , 4/ years o ld

     %ace , alay

     0ender, emale

     ddress, *an#ng 0ading #ar

     (cc#!ation, Ho#sei&e

     Date o& admission, 26/42/16

     Date o& clerking, 2$/42/16

    'hie& com!laint

     hortness o& 7reath &or 3 eeks

    Hi#t&'( &) *'#!ti!+ i%%!##:

    Patient is a knon case o& hy!ertension and !le#ral

    t#8erc#losis. Patient started to have shortness o& 8reath 3 eeks ago. he claimed that it is orsening on sitting and aking 8#t not at rest. Patient also !resented ith ortho!noea and !aroxysmal noct#rnal dys!noea since 3 eeks ago. he needs to slee! #sing 3 !illos. Patient also added that she also had decreased efort tolerance since 3 eeks ago. he said it started to orsen 2 eeks ago in hich !atient claimed that she started &eeling lethargy a&ter alking aro#nd 3/ metres.

    HI*(%9 *:I)0

    3

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    Patient also !resented ith on and of giddiness. Patient said that she starts to vomit and &eels na#seated only a&ter taking

    anti;*7 dr#gs. Patient said that she lose $/kg to 4/kg in this 3 years time. (therise !atient denied 8l#rring o& vision &ever co#gh chest !ain and !al!itation.

    Pa#t ,$ia% i#t&'(

      *#8erc#losis

     Diagnosed 6 months ago

     Patient is having rec#rrent !le#ral ef#sion.

     he has done !le#ral ta!!ing &or 16 times d#e to this.

     Patient as !laced #nder a

    treatment regimen &or 6 monthsatest 8lood !ress#re reading is 1"6?/ mmHg

      *aking medi cations &o r it

     'om!liant

     o &ar no com!lication &rom hy!ertension like headache !al!itation or 8l#rring o& vision

     )o :non edical Illness

    4

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    Pa#t #/'+ia% i#t&'(   >oer segment caesarean

    section

     Done in 2//$ and 2/13 to !revent com!lications as !atient had !revio#s history 5 miscaria ge histo ry.

     (ther than that no other s#rgeries ere done.

    D'/+ i#t&'( a!$ a%%'+(   *. 'alci#m car8onate 5//mg *D

      *. Pyra@inamide 5//mg +(D

      *. mlodi!ine 5mg (D   *. e rro#s #marate 2//mg (D

     olic acid 5mg (D

     Aitamin 7 11 (D

      *. Isonia@id 3// mg (D

      *. %i&am!icin 3// mg (D

      *. Pyridoxine 5/ mg (D

      *. +tham8#tol H'l 4//mg +(D

    a,i%( i#t&'(  ather !assed aay at the age o& 63

    d#e to myocardial in&arct ion.

     other is st i l l a l ive and is 62 years old ith h istory o& d ia8etes mel l i t#s

    and hy!ertension.  $ si8 l ings 5 males and 3 &emales

    ith )o :non edical I l lness.

    S&ia% i#t&'(  Pat ient l ives in v i l lage area.

     Pat ient c la imed that o!en 8#rning ha!!ens constantly.

     Pat ient gets a clean ater s#!!ly.

     Pat ient has no &ood al lergy and o8serves a normal 8alanced diet .

     Pat ient h#s8and is a smoker 8#t doesnBt smoke in & ront o& !at ient . Pat ient is not an alcohol ic.

     Pat ient also cla imed that there is no !ets in her ho#se

     Pat ient c la imed that no one in her

    &ami ly has *7 and also her & r iends. 5

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    Patient as alert !ink and thin and eak there as a cann#la inserted on the le&t hand.

    ita% #i+!# ,  *em!erat#re, a&e8rile

     7lood !ress#re, 1"6?/

     P#lse rate, $5 8!m reg#lar rhythm ith normal character and vol#me.

     %es!iratory rate, 16 8!m

    I!#*ti&!

    )o !eri!heral cyanosis no (slerCs node no ane ayBs lesion. *he !eri!hery as cold. )o con#nctival !allor and scleral  a#ndice oral hygiene acce!ta8le no central cyanosis.

     A not distended. )o any visi8le !#lsation o& neck.

    'hest, no any chest de&ormities no any s#rgical scars and no visi8le !#lsation

    PH9I'> +EI)*I()

    6

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    Pa%*ati&!

     *rachea is not deviated

     *he cricosternal distance is 3 Fnger 8readths

    !ex 8eat is &elt at 5th intercostal s!ace along mid;

    clavic#lar line 'hest ex!ansion as good

     *actile vocal &remit#s; increased on the right area

    P'/##i&! 

    nterior  D#ll so#nd heard on right loer @one

     Posterior  D#ll so#nd heard on right loer @one

    "

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    A/#/%tati&!  7ronchial 8reathing as heard

     Decreased air entry on the right com!artment

     )o rhonchi or 8asal cre!itation

     *actile vocal &remit#s; increased on the right area  +nd ith P+% #rine di!stick

    $

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    P%/'a% T/'/%i#

    Positive Fndings

     Previo#s history o& !le#ral ef#sions  shortness o& 8reath

     decreased efort tolerance

     lethargy

     loss o& eight

     Perc#ssion revealed d#ll so#nd heard on right loer @one on 8oth anterior and !osterior chest all

     #sc#ltation revealed 8ronchial 8reathing decreased air entry on the le&t com!artment and tactile vocal &remit#s; increased on the right area

    P%(AII()> DI0)(I

    ?

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    1. Pne#monia

    • igns o& lo8ar or aty!ical !ne#monia s#ch as dys!noea. 0enerally shorter d#ration o& sym!toms com!ared ith *7.

    2. arcoidosis

    • (ther &eat#res o& sarcoidosis s#ch as intrathoracic lym!hadeno!athy and arthralgias may 8e !resent.

    3. #ngal in&ection

    • Potential ngi incl#de histo!lasmosis coccidioidomycosis and 8lastomycosis. *ravel history may hel! narro the

    diferential diagnosis

    DI+%+)*I> DI0)(I

    1/

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    7lood investigations

    I)A+*I0*I()

    )ormal 7' Fnding.

    Patient is slightly anemic.

    ULL 3LOOD

    COUNT

    RESULT REERENCE RANGE

    H 1/.3gd> 11.5;15.5

    TR3C 3.6 x 1/6#> 3.$;5.$

    PC 31.$ G 3";4"

    MC $$.$ &> "6;?6

    MCH 2$.6 !g 2";32

    MCHC 32.2 gd> 3/;35

    PLT 2$4 x1/3#> 15/;4//

    T3C $.1 x 1/ 3

    #> 4;11

    N/t'&*i% 63.6 G 5.15G 2;".5

    L(,*&(t 24.2 G 1.?6G 1.5;4

    M&!&(t 5.5 G /.45G 2;1/

    Ei!&*i% 5." G /.46G 1;6

    3a#&*i% 1./G /./$G /./2;/.1

    11

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    )ormal res#lts o& >iver #nction *est.

    LIER UNCTION

    TEST

    RESULT REERENCE

    RANGE

    TOTAL PROTEIN "3 g> 65;$5

    AL3UMIN 3? g> 35;5/

    GLO3ULIN 34 g> 2/;35

    A5G RATIO 1.1 g> 1./;2.2

    TOTAL 3ILIRU3IN " #moll P *( 22.2

    ALKALINE

    PHOSPHATASE

    $4 > 3/;12/

    ALANINE

    TRANSAMINASE

    15 > P *( 32

    RENAL

    PROILE

    RESULT REERENCE

    RANGESERUM

    CREATININE

    "/ #moll 53;1//

    UREA $ mmoll 2.5;$.3

    SODIUM 134

    mmoll

    135;145

    POTASSIUM 4./

    mmoll

    3.5;5./

    CHLORIDE ?5 mmoll ?$;1/$

    )ormal res#lts o& %enal ProFle.

    12

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    >DH is slightly high. (ther than that normal 'ardiac +n@ymes val#es.

    CARDIAC ENZYMES RESULT REERENCE

    RANGE

    CREATINE KINASE 53 > 25;2// LACTATE

    DEHYDROGENASE

    254 > 11/;24$

    ASPARTATE

    TRANSAMINASE

    13 > P *( 4/

    CALCIUM 2.16 mmoll 2.1;2.6 INORGANIC

    PHOSPHATE

    1./ mmoll /.$";1.45

    COAGULATION RESULT REERENCE

    RANGE PT 11."/ ?.56  1