COPD With Pneumonic Consolidation by DR Mim New-2

WELCOME TO THE
MORNING SESSION
Academic case Presentation
Dr. Tanjina Salam Mim
Intern Doctor
Department of Medicine
Tairunnessa Memorial Medical College and
Hospital
Case - COPD with
Pneumonic
Consolidation
Particulars of the Patient:
Name: Chitto Ronjon Das
Age: 72 years
Sex: Male
Occupation : Farmer
Present and Permanent Address: Pubail, Gazipur
Religion: Hindu
Marital Status: Married.
Date & Time of Admission: 29/11/23 @12:30 PM
Date & Time of Examination: 30/11/2023 @ 10.00
AM
Chief Complaints:
1. Shortness of breath for 3-4 days
2. Cough for 5-6 days
3. Chest pain for 3-4 days
4. Fever for 3-4 days.
History of Present Illness:
According to the statement of the patient, he was reasonably 4 days
back then he developed shortness of breath. It was gradual in onset.
Initially it was mild to moderate in nature which is subsided by
taking broncho dialators. But for the last 4 days it increased in
severity. He also complaints of frequent attack of cough with
sputum production for last 5 days. Cough is present throughout the
day and night more marked in morning. He also suffering from high
grade fever which was continuous in nature.
Continue…
Highest recorded temperature was 102̊ F. The fever is associated
with chills and rigor. Fever was subsided by taking paracetamol. He
also complaints of right sided chest pain, which was sharp, stabbing
in nature for last 3 days. There is no radiation of pain. There is no
history of haemoptysis or contact with TB patient. His bowel and
bladder habit are normal. He is hypertensive, non-diabetic and he
was diagnosed case of Chronic obstructive pulmonary disease. Now
he is admitted to our hospital for better management.
Continue.....
•Past History: 2 years back, he was admitted in the hospital
due to severe attack of cough and breathlessness.
•Family History: All the members of his family are at good
health.
•Drugs History: For cough and fever he took some drugs, but he
cannot mention any specific drugs name.
•Personal History: He takes 20 sticks per day for last 25 years.
Continue...
•Allergic History: He has no allergy to food or drugs
•Immunization History: He was partially immunized. He has
also been immunized against Covid 19.
• Socioeconomic History: He belongs to middle class family
& lives in flat house with good water supply & well
sanitation.
GENERAL EXAMINATION:
•Appearance: Ill-looking.
•Body Build & Nutrition: Average.
•Decubitus: On choice.
•Co-operation: Co-operative.
•Pulse: 88 beats/min
•Blood Pressure: 130/70 mmHg
•Respiratory Rate: 26 breaths/min
•Temperature: 99°F
CONTINUE...
•Anaemia: Absent.
•Jaundice: Absent.
•Cyanosis: Absent.
•Clubbing: Absent.
•Koilonychia: Absent
•Leukonychia: Absent
•Oedema: Absent
•Dehydration: Absent.
CONTINUE...
•Jugular venous pressure: Not Raised
•Neck Vein: Not engorged.
•Thyroid Gland: Not enlarged.
•Lymph Nodes: Not palpable
•Bony Tenderness: No bony-tenderness.
•Skin pigmentation: Normal
Systemic Examination:
Respiratory system:
•Inspection:
Chest shape was normal
Chest movement was restricted on right side.
Respiratory rate was 26 breaths/mint
No use of accessory muscle & no intercostal recession present.
•Palpation:
Trachea was centrally placed
Apex beat is situated in left 5th intercostal space just medial to midclavicular
line
Chest expansion was reduced on right side.
Vocal fremitus is increased on right side.
Respiratory system: continue…
•Percussion: Percussion note is woody dull.
•Auscultation:
On auscultation
Rhonchi present in both lung field.
Bronchial breath sound present in right lung in middle and
lower zone.
Vocal resonance Increased &
Crepitation present on the right side.
Cardiovascular System:
•Inspection: There is no visible carotid & epigastric pulsation and no
cardiac impulse were seen.
•Palpation:
Apex beat was found at left 5th intercostal space just medial to
midclavicular line. There is no left parasternal heave, no thrill.
•Auscultation: 1st & 2nd heart sounds are audible at all four cardiac area.
No added sound present.
Other systemic examinations were performed and revealed
nothing abnormality
Salient Feature
My patient Mr. Chitto Ronjon Das, 72 years old, farmer,
hypertensive, non-diabetic, smoker hailing from Pubail, Gazipur,
admitted to our hospital on 29 November 2023. Presented with
shortness of breath for last 4 days. It was gradual in onset. Initially
it was mild to moderate in nature which was subsided by taking
broncho dialators. But for the last 4 days it increased in severity.
He also complaints of frequent attack of cough with sputum
production for last 5 days. Cough is present throughout the day and
night more marked in morning.
Continue…
He also suffering from high grade fever which was continuous in
nature. Highest recorded temperature was 102̊ F. The fever is
associated with chills and rigor. Fever was subsided by taking
paracetamol. He also complaints of right sided chest pain, which
was sharp, stabbing in nature for last 3 days. There is no radiation
of pain. There is no history of haemoptysis or contact with TB
patient. His bowel and bladder habit are normal. He is
hypertensive, non-diabetic and he was diagnosed case of Chronic
obstructive pulmonary disease.
Continue…
For cough and fever he took some drugs, but he cannot mention
any specific drugs name. On general examination Pulse: 88
beats/min, Blood Pressure: 130/70 mmHg, Respiratory Rate: 26
breaths/min, Temperature: 99°F. On respiratory system
examination Chest shape was normal. Chest movement was
restricted on right side. Respiratory rate was 26 breaths/mint. No
use of accessory muscle & no intercostal recession present
Continue…
Trachea was centrally placed. Apex beat is situated in left 5 th
intercostal space just medial to mid-clavicular line. Chest
expansion was reduced on right side. Vocal fremitus is increased
on right side. Percussion note is woody dull. On auscultation
Rhonchi present in both lung field. Bronchial breath sound
present in right lung in middle and lower zone. Vocal resonance
Increased & Crepitation present on the right side. Other systemic
examinations were performed and revealed nothing abnormalities.
Provisional Diagnosis:
Acute exacerbation of COPD with Right

sided pneumonic consolidation.
Differential Diagnosis
1. Pulmonary Tuberculosis
2. Bronchial carcinoma
Investigations
Chest x-ray P/A view
ECG
CBC with ESR
CRP
Serum electrolytes
Sputum for AFB
Sputum for Gene xpert
Dengue NS1
RBS
Serum creatinine
Blood culture & sensitivity.
CBC:
★ HB%:- 10.7 gm/dl
★ ESR:- 58;mm (1st hour)
★ Total WBC:- 21,930/cumm
★ Platelet count:- 191000/cumm
★ RBC count: 3.81×106 /uL
Chest X-ray P/A view
Serum creatinine
1.42 mg/dl
FBS and 2HAPP
HbA1c
CRP
Sputum for AFB
S.electrolytes:
• –Sodium: 136.86 mmol/L
• –Potassium: 3.90 mmol/L
• –Chloride: 98.85 mmol/L
Confirmatory Diagnosis:
Acute exacerbation of COPD with Right sided pneumonic
consolidation with mild Anaemia.
Treatment & Management at ward:
• Bed rest. • Inj. Pansec 40mg(Omeprazole)
• Diet: Normal. 1 vial I/V – BD
• Nebulization with Salbutamol (1ml)+ • Inj. Emistat (8mg)(ondansetron)
Ipra(2ml) + N/S (3ml)-6hourly 1 amp IV - TDS
• Oxygen inhalation : 2L/min – SOS • Tab. Arokast (10 mg) (montelukast)
• Inj. Cotson (100 mg) 0+0+1
2 vial iv – TDS • Tab. Doxiva (200 mg) (doxofylline)
• Inj. Moxaclav 1.2 gm 1+0+1
(Amoxicillin+clavulanic acid) • Syp. Ambrox
1 vial I/V –TDS 2TSF - TDS
• Tab. Clarex(500mg)(Clarithromycin)
1+0+1
Treatment during discharge
Tab. Clarex( 500mg) Tab. Amdocard (5mg)
1+0+1-----------10 days 0+0+1---------continue
Tab. Moxaclav (625mg)  Tab. Dilator (10 mg)
0+0+1-----------1 month
1+1+1-----------10 days Cap. Dextac (30mg)
Tab. Arokast (10mg) 1+0+0---------before meal ---1 month
0+0+1-----------2 months
Tab. Rivotril (0.5mg)
0+0+1-----------7 days
Advice:
• Take medicines regularly
•To take good nutritious diet.
• To take rest.
• Avoid smoking
•Follow up at regular interval
THANK YOU

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Acute exacerbation of COPD with Right

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