2. • Mrs. Muthammal, a 40 year old female hailing from villupuram who is
a agricultural labourer by occupation presented with complaints of
• Cough with expectoration for 6 years
• Breathlessness for 2 years
3. History of presenting illness
The patient was apparently normal 5 years back after which she
developed
• Cough with expectoration
• 5 years
• Insidious onset
• Persistent and progressive
• Increased in last 2 months
• Productive in nature
• Aggravated during early morning and in left lateral position
• Not associated with chest pain, syncope .
4. • Sputum production
• Quantity- 50 ml per day
• Yellowish in colour
• Thick in consistency
• Mucopurulent in nature
• Not foul smelling
• Not blood stained
• Aggravated during morning and in left lateral position
• H/o hemoptysis
• On and off for past 5 years
• 4 episodes in the past year
• Frank blood of 50-100 ml during each episode
• Not associated with sputum or food particles
5. • Breathlessness
• Insidious in onset
• Gradually progresdive
• Progressed from Grade 1 to Grade 2 according to mMRC grading
• Aggravated by cough
• Relieved with rest
• No H/o PND and orthopnea
• No diurnal variation
• H/o loss of weight
• H/o loss of appetite
6. • No h/o wheeze
• No h/o chest pain
• No h/o fever with evening rise of temperature
• No h/o night sweats
• No h/o leg swelling, abdominal distension and right hypochondriac
pain
• No h/o palpitations
• No h/o syncope
• No h/o hoarseness of voice
• No h/o dysphagia
7. Past history
• H/o fever with breathing difficulty 5 years ago which required
hospitalisation
• H/o recurrent respiratory infection
• No h/o pulmonary TB
• No h/o contact with tuberculosis
• Not a k/c/o DM, HTN , bronchial asthma, epilepsy
• No h/o any known allergies
• No h/o tooth extraction, exanthematous fever, exposure to STDs.
8. • Family history
• No h/o similar complaints in the family
• Married for 15 years
• No h/o TB in family members
• No h/o asthma, allergies in the family
• Personal history
• Consumes mixed diet
• Normal bowel and bladder habits
• Normal sleep cycle
• H/o passive smoking for the past 15 years . Her husband is a smoker.
9. • Treatment history
• Took medications for fever and cough 1 month back
• Occupational history
• She is a agricultural labourer by occupation but currently not working from 2
months back.
SUMMARY
Mrs. Muthammal, 40 years old female who is a passive smoker for the
past 15 years, presented with complaints of cough with mucopurulent
expectoration with occasional hemoptysis for past 5 years , Grade 2
dyspnea for past 2 years not associated with PND or orthopnea.
Probable system involved is Respiratory system.
10. General Examination
The patient was conscious, comfortable , well oriented to time, place and
person.
Moderately built and nourished.
Mild pallor
No icterus, cyanosis, generalised lymphadenopathy and pedal edema.
Grade II clubbing seen
No external markers of tuberculosis seen.
No markers of HIV
No markers of Horner’s syndrome .
11. • Vitals
• Pulse- 70 beats/ min, regular in rhythm, normal volume, no radio-radial or
radio-femoral delay, all peripheral pulses are equally felt.
• Blood pressure – 110/70 mm Hg in right upper limb sitting position.
• Respiratory rate – 16/min, Thoraco-abdominal type, regular in rhythm.
• Temperature – 37.6℃
• JVP – not elevated
12. Systemic Examination
Examination of Respiratory System
• Upper Respiratory Tract Examination
• Contour of nose – Normal
• No nasal septum deviation
• No nasal polyp
• No sinus tenderness
• Examination of Oral cavity
• No staining of teeth , no dental caries
• No oral thrush, halitosis
• No tonsillar enlargement
• No post nasal drip
13. Lower respiratory tract examination
• INSPECTION
• Chest wall appears to be symmetrical.
• No kyphosis or scoliosis.
• No supra or infraclavicular fullness or hollowness.
• No drooping of shoulder or intercostal in drawing.
• Trachea appears to be in midline .
• Apical impulse seen in left 5th intercostal space half an inch medial to mid
clavicular line.
• Respiratory movements appears to be decreased on right side.
• No abnormal pulsations, dilated veins , scars or sinuses.
14. • PALPATION
• Tracheal position is confirmed to be in midline.
• Apex beat felt at left 5th intercostal space half an inch medial to mid clavicular
line.
• Respiratory movements decreased on right side and normal on left side.
• Chest expansion – 3 cm
• Hemithorax expansion: Right – 1 cm; Left – 2 cm
• Vocal fremitus – Increased in Mammary, Infra axillary and Infrascapular areas
of the right lung.
• Normal in supraclavicular, infraclavicular, axillary, suprascapular,
interscapular areas of right lung.
• Normal in all areas of the left lung.
16. • AUSCULATATION
• Breath sounds-
• Right: Tubular bronchial breath sounds in Mammary, Infra axillary and
infrascapular areas.
Normal vesicular breaths sounds in Supraclavicular, Infraclavicular,
Axillary, Suprascapular and Interscapular areas.
• Left: Normal vesicular breath sounds in all areas.
• Coarse leathery crepitations heard in mid-inspiratory phase on the right
side.
• Vocal Resonance-
• Right: Increased in Mammary, infraaxillary and infrascapular areas.
Normal in Supraclavicular, Infraclavicular, Axillary, Suprascapular and
Interscapular areas.
• Left : Normal in all areas.
17. Examination of other systems
• CVS : S1 , S2 heard. No murmurs.
• ABDOMEN: Soft , non- tender. No organomegaly. Normal bowel
sounds heard.
• CNS: No focal neurological deficit.
