Acute exacerbation of bronchial asthma with type 2 diabetes mellitus

-

This is an online E logbook to discuss our patients' de-identified health data shared after taking his/her/guardian's signed informed consent. 

Here we discuss our individual patient's problems through a series of inputs from the available global online community of experts intending to solve those patients' clinical problems with the collective current best evidence-based inputs. 

This e-log book also reflects my patient-centered online learning portfolio and your valuable inputs.


 I have been given this case to solve in an attempt to understand the topic of " Patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, and investigations, and come up with a diagnosis and treatment plan.

This is a case of 70 year old female resident of miryalaguda came with the 

Chief Complaints:

Shortness of breath since 2 months

HOPI:
   The patient was apparently asymptomatic 2 months back then she developed shortness of breath which was insidious in onset and gradually progessive associated with wheeze when exposed to cold and dust aggrevated on lying down in bed and relieved on sitting

Patient also had a complaint of dry cough occasionally which last for 1 week and with no aggrevating and relieving factors.
No h/o of fever, chest pain ,chest tightness,hemoptysis, sweating and palpitations .

Past history:-

K/c/o asthma , diabetes mellitus -2,
No history of tb, htn , epilepsy, thyroid disorders.

Family History: elder sister- k/c/o Asthma since childhood

Personal history:-
Diet:- mixed
Appetite :-normal
Bowel and bladder :- regular and normal
Addictions:- none

Treatment history:- patient was using Rota haler (fluticasone) , medication for diabetes.


General examination: -
The patient is conscious, coherent, cooperative and well oriented to time place and person.

Vitals:-
Pulse rate : 110beats /mim
Rr: 20 cpm
Bp: 130/80mmhg.
Temp: afebrile 
Spo2:96

No pallor
No icterus
No cyanosis
No clubbing
No palpable lymphnodes
Edema:- bilateral pitting type of edema upto ankles





Systemic examination:

Rs:
Inspection: 
Shape of the chest -Barrel shaped
Trachea position is central
Symmetrical movements of the chest with 
respiration.
No presence of any sinuses , scars, engorged veins

Palpation:
No rise if temperature and no tenderness
All inspiratory findings are confirmed

Percussion:
Resonant note is Heard

Ascultation:
Vesicular breath sounds heard
Bilateral basal crepitations and wheese are heard.

CVS:
S1 s2 heard with no murmers

CNS: all higher mental functions,cranial nerves,motorsystem and sensory system are intact.
Normal speech observed.

Perabdomen:
Abdomen is obese
No palpable spleen ,liver, lymphnodes.



Investigations:-





Provisional Diagnosis:-

Acute exacerbation of asthma with diabetes mellitus type 2

Treatment:-
Budesonide nebulizer suspension
Inj augmentin iv /tid
Inj pan 40mg iv/od
Inj lasix 40mg iv/bd
Inj hydrocortisone 100mg iv/bd
Insulin subcutaneous/tid
Inj noh s/c bd
Tab azithromycin
Tab prednisolone












Comments

Post a Comment

Popular posts from this blog

Prefinal practical Osce and learning points

-
Blog: https://146venkatameghanabadam.blogspot.com/2023/12/this-is-online-e-logbook-to-discuss-our.html   OSCE: 1.How do you differentiate between bronchial asthma and COPD? For Asthma: Variation in symptoms over hours ,days , minutes . Symptoms worse during the night and early morning,during cold Symptoms triggered by excercise,emotions induced by laughter, exposure to dust or allergens  Disease course is stable with exacerbations For COPD: Persistence of symptoms despite  treatment  Good and bad days but always daily symptoms and exertional dyspnea  Chronic cough with sputum unrelated to triggergens. Disease course progressive worsening .      2.What are the complications of diabetes? Acute complications   1.diabetic ketoacidosis 2.hypoglycemia 3.lactic acidosis Chronic complications 1.microvascular   Diabetic retinopathy   Diabetic neuropathy   Diabetic nephropathy 2.macrivascular    Coronary artery disease    Peripheral vascular disease    Cerebrovascular disease Others   Dermatolog
Read more

BIMONTHLY GENERAL MEDICINE ASSESSMENT

-
Name - Venkata Meghana Badam Roll no - 146 3rd semester   QUESTION 1: LONG CASE:   This is primarily a case of Acute glomerulonephritis, likely due to Secondary Amyloidosis due to Chronic Poorly Treated Seronegative Erosive Rheumatoid Arthritis . The patient presented with bilateral, symmetric, pitting type of edema which was extending upto the middle of his leg. The patient also had chronic pain in the joints leading to restriction of movement since 2011. Upon previous hospital visits, the RA factor was negative. Therefore, the patient was prescribed analgesics and sent home. Chronic use of analgesic drugs was seen from 2011-2019, the details of which were undocumented. Hyperuricemia was also observed in one of his recent visits during last year and Febuxostat was prescribed as it has proven to be more effective than Allopurinol in recent studies. Anasarca was the chief complaint of this visit for which through testing and examinations were done. Liver and cardiac causes were ruled ou
Read more