Lung agenesis
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Shahriar, a 2-year-old boy, presented with neck bending to the left side for 6 months, cough and respiratory distress for 10 days. Examination found restricted chest movement and reduced breath sounds on the left side. Investigations including chest X-ray found opacity on the left side. The final diagnosis was left lung agenesis. The boy was treated supportively and counseled, and is being followed up.
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Support with 1 journals no older than 5 years. H. Pylori infect.docx
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Support with 1 journals no older than 5 years.Week 8GI Case .docx
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Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medic ...
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- 1. Dr. KANTA HALDER Resident (MD;Phase A) BICH
- 2. Particulars of the patient Name: Shahriar Age: 2 years 6 months Sex: Male Informant: Mother Address: keranigonj Date of Admission: 07.06.2015 Date of Examination: 11.06.2015
- 4. Chief Complaints Bending of neck to the left side since 6 months of age Cough for 10 days Respiratory distress for same duration
- 5. History of present illness: According to the statement of informant mother, Shahriar was reasonably well upto his 6 months of age. Then the mother noticed that her child ketp his neck bending to the left side. Now he also developed cough for last 10 days which was dry and non-productive and respiratory distress for same duration. He had h/o contact with TB patient but no h/o foreign body aspiration. With these complaints, he was admitted to Dhaka Shishu Hospital for further evaluation and better management.
- 6. History of Past illness: Shahriar had h/o repeated attack of RTI since his 1 month of age which was usually subsided within 2-3 days with oral medication.
- 7. Birth History: He was delivered by LUCS at term due to maternal oligohydramnios without any postnatal complication. Feeding History: He is on family diet. Immunization History: he is immunized as per EPI schedule.
- 8. Familly History : He is the 2rd issue of his non-consanguinous parents. His grandfather was suffering from pulmonary TB and completed anti-TB treatment. Socio-economic History : He came from a low socio-economic background.
- 9. Treatment History After admission, he was getting nebulization and other injectable medications. Developmental History He is developmentaly age appropriate.
- 10. General Examination : Appearance: Well, alert Anaemia: Jaundice: Cyanosis: Clubbing: Absent Oedema: Dehydration:
- 11. Cont.. Skin: BCG mark present Spine: Normal Lymphnode: Not palpable Signs of meningeal irritation: Absent Neck Vein: Not engorged Ear: Nose: Normal Throat:
- 12. Cont.. Vital Signs: Heart Rate: 110/min Respiratory Rate: 28/min Temperature: 98°F Blood Pressure: 90/50 mmHg
- 13. Anthropometry: Cont.. Weight: 10.5 kg Height: 71.5 cm MUAC: 14.5 cm HAZ: -4.08 (severely stunted) WHZ: 2.0 (normal)
- 14. Systemic Examination Respiratory system : Inspection : Respiratory rate: 28/min Shape of the chest : Flat on left side Movement of the chest : Restricted in left side
- 15. Cont.. Palpation : Trachea is shifted to the left side. Chest expansibility is reduced in left side. Vocal fremitus is reduced in left side in mid- clavicular, midaxillary and post-scapular line, normal in right side. Apex beat lies in left 5th intercostal space, lateral to the midclavicular line
- 16. Cont.. Percussion : Percussion note is dull over left lung field in midclavicular, midaxillary and post-scapular line, normal in right lung field.
- 17. Cont.. Auscultation : Breath sound is vesicular, but diminished in left lung in midclavicular , midaxillary and post-scapular line, vesicular in right lung field. Vocal resonance is reduced in left lung field, normal in right lung field. There is no added sound.
- 18. Cont.. Cardiovascular system : 1st & 2nd heart sounds are audible in all 4 areas. There is no added sound. Alimentary system : No organomegaly. No ascitis. Other Systemic examination: No abnormality
- 19. Salient feature Shahriar, 2 years 6 months old immunized boy, 1st issue of his non- consanguineous parents, was admitted with the complaints of bending of neck to left side since 6 months of age, dry, non-productive cough and respiratory distress for last 10 days. Shahriar had h/o repeated attack of RTI since his 1 month of age which usually subsided within 2-3 days with oral medication. He had h/o contact with TB patient as his grandfather was suffering from
- 20. Cont.. pulmonary TB and completed treatment.He had no h/o foreign body aspiration. Shahriar was well, alert, afebrile. Vitals are within normal limit. Chest movement was restricted in left side. Trachea was shifted to the left side, chest expansibility and vocal fremitus was reduced in left side. Percussion note was dull and breath and vocal resonance was diminished on left side. Other systemic examination revealed no abnormality.
- 21. Provisional Diagnosis: Left sided collapse due to tuberculosis
- 22. Differential Diagnosis: Left sided collapse due to pneumonia Left sided collapse due to foreign body aspiration
- 23. Investigations Complete Blood Count : • Hb: 10.5 gm/dl • WBC: Total count: 12,700/cumm Differential count: o Neutrophil: 48% o Lymphocyte: 47% o Monocyte: 03% o Eosinophil: 02% o Basophil : 00%
- 24. Cont.. o RBC:Normocytic normochromic o WBC:Mature with above distribution o Platelet: Adequate • Platelet : 318,000/cumm • PBF:
- 25. Cont.. Blood grouping & cross matching : A positive Mantoux test : 00 mm Chest X-ray:
- 27. Cont.. USG of chest : No free fluid is noted in left costophrenic angle. Opacity in chest X-ray was due to consolidation. CT scan of chest :
- 30. Final Diagnosis: Left lung agenesis
- 31. Management • Counseling • Supportive treatment : Maintenance of nutrition • Follow up
- 32. Thank You