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CASE PRESENTATION

CASE PRESENTATION. BY DR AYESHA TAHIR

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CASE PRESENTATION

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  1. CASE PRESENTATION BY DR AYESHA TAHIR PGT MU1, Benazir Bhutto Hospital

  2. Demographic Profile Mr. W 28 year-old male Unmarried Unemployed Resident of Rawalpindi Date of Admission: 15-jan-2018 Mode of Admission: Medical Emergency

  3. Presenting complaints • Fever • Shortness of breath 7 days • Cough

  4. History of Presenting Complaints • Fever Sudden, continuous, up to 104 with rigors and chills • Shortness of breath On mild exertion • Cough Productive, copious sputum, greenish, foul smelling and blood streaked No associated chest pain

  5. Past Medical and Surgical history • Normotensive, normoglycemic and non-smoker • Episodes of fever, cough and difficulty in breathingsince childhood • Multiple admissions in hospital • No history of TB or TB contact No significant surgical history.

  6. Personal History • Uneventful birth, normal milestones • History of missing school days and taking long leaves during academic tenure • Good learner, completed his graduation • Left his job due to illness

  7. Family History • Three siblings • Two siblings with similar complaints • One sibling healthy • Both parents are alive and healthy • Consanguineous marriage • Mother is on anti-depressants

  8. Drug history • Oral and inhaled steroids • Inhaled beta-2 agonist • N-acetyl cysteine sachet • Chest physiotherapy • Advised PEP device (Positive Expiratory Pressure) Gets annual flu vaccine Pneumococcal vaccine advised every five years

  9. Systemic Inquiry

  10. GENERAL PHYSICAL EXAMINATION A young male of normal height, lean, dyspnoeic, sitting on a wheel chair with obvious discomfort, well oriented in time, place and person with vitals as:

  11. GENERAL PHYSICAL EXAMINATION

  12. Differential Diagnosis

  13. MANAGEMENT • Admitted in ward • Supplemental oxygen • Chest Physiotherapy • Nebulization with inj Colomycin and hypertonic saline • N-acetyl cysteine sachet • Inj Piperacillin/Tazobactam4.5g IV QID • IV Steroids • Inhaled beta-2 agonist

  14. INVESTIGATIONS

  15. BLOOD CP

  16. BLOOD BIOCHEMISTRY

  17. SERUM ELECTROLYTES

  18. Urine RE

  19. ARTERIAL BLOOD GASES

  20. SPUTUM EXAMINATION

  21. ECG

  22. CXR (PA VIEW)

  23. HRCT CHEST

  24. CT PNS (coronal view)

  25. CT PNS (axial view)

  26. 2D Echocardiography • Normal sized cardiac chambers with LVEF 60% • Valves appear normal • No regional wall motion abnormality • PAP 30mmHg

  27. Spirometery

  28. GENOTYPING DELTA F508 MUTATION ON CFTR GENE Negative

  29. Immuno assay

  30. SERUM PROTEIN ELECTROPHORESIS

  31. CTDscreening

  32. A REVIEW OF MEDICAL HISTORY OF SIBLINGS

  33. SIBLING ONE • Mr. S, 30-year old male, Unmarried and Unemployed

  34. Fever, productive cough and SOB ever since birth • Multiple admissions in hospital • Severe headache and nasal obstruction • A preterm delivery • A slow learner, studied till 9th grade

  35. Examination • Clubbing • Apex beat palpable at right 5th intercostal space along midclavicular line • Bilateral inspiratory coarse crepitations • Right sided DNS • Left inferior turbinate hypertrophy • Bilateral nasal polyps

  36. INVESTIGATIONS

  37. ECG

  38. CXR (PA view)

  39. CT CHEST

  40. CT PNS (coronal view)

  41. CT PNS (axial view)

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