60 YEARS OLD FEMALE WITH LEFT UPPER LOBE CAVITY OF LUNG SECONDARY TO TUBERCULOSIS WITH DIABETES MELLITUS

LEFT UPPER LOBE CAVITY OF LUNG SECONDARY TO TUBERCULOSIS WITH DIABETES MELLITUS 

January 5,2023

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CHIEF COMPLAINTS 

A 60 years old female patient who is a maid by occupation and resident of Nalgonda, presented to the OPD with chief complaints of 

-: Cough since 15 days

-: Fever since 15 days

HISTORY OF PRESENTING ILLNESS -

Patient was apparently asymptomatic 15 days back after which she developed cough which was insidious on onset. The cough is accompanied with mucous and also blood is noted in the sputum. Blood stained sputum is seen about  4 to 5 episodes which less than 10 ml. There are no aggravating factors and it gets relieved on medication .

Fever is noted since 15 days which is of high grade associated with chills and rigor.

2 episodes of vomiting was also noted which was billious in nature.

Patient also had shortness of breath which is not associated with wheeze, orthopnea, paroxysmal dyspnoea. There is no seasonal or diurnal variation noted.

History of weightloss since 1 month associated with generalised weakness. She also complained of chest tightness.

No history of sweating, palpitations, decrease in urine output 

HISTORY OF PAST ILLNESS -

No history of similar complaints in the past.

- History of cardiac surgery(CABG) which was performed 6 years back and is on medication since then(Tab Acitron,furosemide,ecospirin).

No history of TB in the past 

- patient is a known case of DM and is on oral hypoglycemics i,e. metformin, glimipiride, voglibose since 8 years

No H/o HTN, THYROID OR EPILEPSY.

TREATMENT HISTORY -

She is a known case of DM and is on oral hypoglycemics i.e,metformin, glimipiride, voglibose since 8 years

PAST HISTORY:

No history of similar complaints in the past

No history of of tuberculosis

She underwent cardiac surgery 6 yrs back(CABG) and is following the mentioned medication {(furosemide,aspirin and oral acitrom(vit k epoxide reductase inhibitor)}

Known case of Diabetics since 8 yrs and follows the following regimen of metformin, glimiperide, voglibose( alpha glucosidase inhibitor)

Not history of HTN,ASTHMA,THYROID ABNORMALITIES,EPILEPSY.

History of 4 blood transfusions during cardiacs surgery.

PERSONAL HISTORY:

Sleep adequate 

Appetite normal

Bowel and bladder regular

No allergies

Takes alcohol occasionally  60ml whiskey once a week 

Regular smoker-5 chutta per day.

FAMILY HISTORY - 

Both the parents are diabetic.

-Father had a history of heart attack.

No  history of HTN ASTHMA COPD in the family

MENSTRUAL HISTORY -

MENARCHE  attained at 13 yrs

Age of menopause 40 yrs

OBSTETRIC HISTORY -

Married since 40 yrs.

GENERAL PHYSICAL EXAMINATION - 

Patient is conscious coherent and cooperative well oriented to time, place and person. 

Well nourished and moderately built.

No pallor cyanosis icterus clubbing lymphadenopathy edema

Temp:100.2 F

PR :94bpm

Bp: 100/70

Spo2 :99per

GRBS: 135 mg/ dl.

SYSTEMIC EXAMINATION -

CVS S1 S2 heard,no murmurs.

CNS :No focal neurological deficits 

ABDOMEN:Soft,non tender, no organomegaly 

RESPIRATORY EXAMINATION -

Upper respiratory examination:

No DNS or polyps or post nasal drip or pharyngeal wall inflammation.

Oral cavity shows presence of dental caries.

2 teeth are lost.

Inspection:

Shape of the chest is elliptical.

Chest movements are symmetrical on both sides 

Trachea appears to be central ( trails sign negative)

No crowding of ribs or drooping of shoulders.

No muscle wasting

No accessory muscles usage for respiration. 

Apical pulse is not seen

No kyphosis or scoliosis.

No scars,sinuses seen.

Palpation:

All inspectors findings are confirmed by palpation

No local rise of Temperature 

Anterior posterior diameters is about 16cm

Transverse diameter 23cm

Chest circumference 63 cm 

Chest  circumference after inspiration is 68cm

Trachea is central - 3 finger test

 chest movements are symmetrical with respiration

Tactile vocal fremitus is equal on both sides 

Apical pulse is felt at 5th intercostal space 1 inch medial to MCL

No tenderness over the chest region.

Percussion:

Resonant in all areas of lungs

No tenderness on percussion 

Liver dullness at 5th ics

Cardiac dullness within  normal 

Auscultation:normal breath sounds heard 

INVESTIGATIONS:

X RAY 

2D ECHO

PROVISIONAL DIAGNOSIS:

LEFT UPPER LOBE CAVITY SECONDARY TO TUBERCULOSIS WITH DIABETES MELLITUS 

TREATMENT :

Inj Tranexa 500mg

Tab ethamsylate 250 mg BD

Inj ceftriaxone 1gm

Tab Azee 500mg OD

Tab metformin 

Tab voglibose