Ppt on tb sequle

1. Case presentation
Dr Sk Nadim

2. I am presenting a case of Lallan, 60 years old male resident of sidhauli
dist-sitapur, Hindu by religion and plumber by occupation. History is
given by patient himself.
Chief complaints
• Breathlessness since 2 years
• Cough since 3 months
• Weight loss since 2 months

3. History of presenting illness
• Patient was apparently asymptomatic 2 year back when he developed
breathlessness ,
• Which is insidious in onset ,Gradually progressive, initially patient had
breathlessness on walking upstairs but now has breathlessness even
while walking a certain distance.
• Aggravates on exertion and relieved on taking rest

4. • Patient also complains of Cough with expectoration since 3 months,
which was insidious in onset, gradually progressive and associated
with greenish colored, mucopurulent, and profuse in amount ,initially
used to produced around 50ml/day later the quantity increases to
about 100-120ml/day, more in morning with no postural or seasonal
variation, non blood stained, Not associated with wheeze.
• Patient also complains of weight loss since 2 month , patient loss 6kg
weight over period of 2 month, by himself noticing his clothes are
becoming loose, and decrease appetite. initially he used eat 8-10
chapatti per day now he takes2-3 chapatti per day

5. • No h/o fever, night sweats
• No h/o paroxysmal nocturnal dyspnea or orthopnea, chest pain ,
palpitations
• No h/o swelling in the legs, syncope, puffiness of face or reduced
urine output
• No h/o skin rashes or joint pain
• No h/o change in voice or difficulty in swallowing .
• No h/o neck swellings

6. Past history
• History of pulmonary tuberculosis 4 years back for which he took ATT For
8-9 months,
• h/o haemoptysis of 3 years back
• Not a known case of diabetes mellitus/ hypertension/ bronchial asthma/
COPD/ ischemic heart disease
• No h/o prior surgeries in the past
• No history of allergies.
Family History
• No similar complaints in the family

7. Personal history
• Married & 2 childrens
• Patient consumes non vegetarian diet
• Appetite : decreased
• Addictions: smoking since 10 years ( 7 bidi /day, 3.5 pack year)
• Bowel and bladder : Regular and Normal
• Sleep : Normal

8. Summary
• 60 years old male presented with breathlessness since 2 years and
cough since 3 month and weight loss since 2 month with past history
pulmonary tuberculosis
Provisional D/D
• Post tubercular bronchiectasis
• Aspergilloma
• Bronchogenic carcinoma
• Open negative syndrome

9. General Physical Examination
• Patient is conscious ,cooperative and oriented to time , place and
person .
• Poorly built and nourished
• Height- 157 cm
• Weight -33kg
• BMI – 13.4
• No pallor , icterus , cyanosis , clubbing , lymphadenopathy , edema
• No external markers of TB.

10. Vitals
• Temperature : 97.2 F
• Pulse : 78bpm , regular rhythm , normal character and volume , no
radio radial delay , no radio femoral delay , all peripheral pulses are
palpable and equal bilaterally
• Blood pressure : 110/70 mm hg measured in the right upper limb in
supine position
• Respiratory rate : 18/min ,abdaminothorasic
• Saturation: 97%
• No engorged neck vein

11. Upper respiratory examination
• Nose : Normal , septum is central , no secretions or polyp
• Paranasal sinuses : no tenderness
• Oral cavity : Hygiene adequate , no dental carries , tonsils normal ,
posterior pharyngeal wall shows no exudates or erythema

12. Inspection
• Trachea – central
• Shape of chest - normal
• Both side of chest wall moving equally with respiration
• Bilateral supraclavicular and infraclavicular hollowing present
• No drooping of shoulder
• No crowding of ribs
• No visible pulsation seen
• No scars/sinuses/dilated veins over chest
• Spine – normal

13. Palpation
• Trachea present centrally
• Apex beat – felt in 5th intercostal space just medial to left midclavicular line
• No tenderness over chest wall
• Total chest circumference – on Inspiration – 77cm
on expiration- 74 cm
• chest expansion 3cm
• AP diameter 18cm ,transverse diameter 25cm ,AP to transverse ratio 5:7cm
• No crowding or widening of ribs
• Vocal fremitus is decreased in right supraclavicular, infraclavicular,
mammary, axillary areas of chest

14. Percussion
• Direct percussion over right and left clavicle is resonant
• percussion over right supraclavicular, infraclavicular, mammary is dull
left supraclavicular & infraclavicular, mammary – resonant
• Percussion over right axillary is dull
• right infraaxillary – resonant
• left axillary and infraaxillary - resonant
• Percussion over right suprascapular, interscapular is dull
• right infrascapular – resonant
• left suprascapular, interscapular, infrascapular - resonant
• Traube’s space – resonant
• No shifting dullness
• No succussion splash

15. Auscultation
• Auscultation Right Supraclavicular , infraclavicular- brochial sound heard
Lt Supraclavicular,infraclavicular- normal vesicular sound heard
• Auscultation over right mammary -brochial sound heard
right inframammary - normal vesicular sound heard
left mammary & inframammary -normal vesicular sound heard
• Auscultation over right axillary -brochial sound heard
right infraaxillary – normal vesicular sound heard
left axillary & infraaxillary - normal vesicular sound heard
• Auscultation over right suprascapular, interscapular-brochial sound heard
• right infrascapular – normal vesicular sound heard
• left suprascapular, interscapular, infrascapular - normal vesicular sound heard

16. Other system examination
• Cardiovascular system : S1 S2 present
• Central Nervous system :
• Patient is conscious , oriented and cooperative to time ,place and person
• no focal neurological deficit
• Gastrointestinal system:
• Soft , non tender , no organomegaly.

17. Diagnosis
• Post tubercular bronchiectasis