| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer |
>>May be first you want to see how to write a history of COPD.
Elderly gentleman, ill
looking, thin built (with Temporal hollowing, Buccal Hollowing,
Supraclavicular, suprasternal hollowing, Subclavicular hollowing, with thin limbs,
thin skin and prominently visible vessels) lying in semirecumbent position with
IV canula of 20G and nasal prongs delivering 3l of O2/min is conscious,
cooperative and well oriented to time, place and person.
On general physical examination, there is central cyanosis with
peripheral cyanosis.
Bilateral pitting edema extending upto the mid thigh is
present which is non tender with normal overlying skin. Sacral edema is present.
But no clubbing, no pallor, no icterus seen. Hydration status
of the patient is normal. Accessible Lymph nodes are not palpable.
On examination of the vital signs,
Pulse is 70 beats/min taken on right radial artery, regular,
catacrotic, euvolemic, no radio radial and radio femoral delay. All the
peripheral pulses are palpable, and no carotid bruit heard. Condition of the
arterial wall is normal.
Blood pressure measured on the right arm in sitting position
was 130/80 mm of mercury.
Temperature taken on right axilla was 37.2oC.
Temperature taken on right axilla was 37.2oC.
Respiratory rate is 22/min, thoracoabdominal type with nasal flaring, pursed lip breathing and use of accessory muscles of respiration.
JVP was elevated and was 5 cm from the manubriosternal angle
in the semirecumbent position.
On examination of the respiratory system
On Inspection of the upper respiratory tract , no DNS, Polyp,
discharge or congestion present on the nose. Nasal flaring and Pursed lip
breathing present. Use of accessory muscles of respirations seen (with prominent
SCM, Scalene, trapezius. Rectus abdominis, pectoralis). The oral cavity looks grossly normal with no congestion, ulcerations on posterior pharynx and bilateral tonsils looks grossly normal.
On inspection of Lower respiratory system, shape of the chest
is tending to barrel.
Trachea is present in the midline.
Trachea is present in the midline.
Bilateral symmetry of chest wall is seen. Bilateral equal movement with respiration present.
Apical Impulse is not visible.
No other visible pulsation, scar marks and dilated vessels seen.
Presence of Supra and Infrascapular
hollow is present and equal in both side.
Prominent and Horizontal ribs with widened and hollow
intercostal space seen but no intercostal indrawing, no subcostal indrawing and no intercostal fullness.
Spine is centrally placed and no skeletal deformity present.
On palpation, Trachea is centrally placed. Apical impulse is
not palpable.
Chest movement is bilaterally equal.
On measurement of the chest, chest expansion on inspiration was 84.5cm
and expiration was 82cm with inspiratory
expiratory difference of 2.5cm. The Anteropostero Diameter was 35 cm and
Transverse diameter is 40cm and AP to Transverse ratio being 7:8(tending to barrel).
The Right hemithorax is 41 cm and left hemithorax is 41 cm.
The Right hemithorax is 41 cm and left hemithorax is 41 cm.
Increased vocal fremitus palpable in the right
subcostal area.
On percussion, dull note was present over the right sub
mammary region. Resonant sound heard on
the other area all over the chest.
Liver dullness started from 6th right Intercostal
area in the midclavicular line.
Cardiac Dullness was not obliterated.
On Auscultation, Bilaterally decreased air entry with prolonged expiration is present. Bronchial breath sound heard over the right sub mammary region along with Crackles present. Increased vocal fremitus present with aegophony on right sub mammary region.
Provisional diagnosis: COPD with right inframammary consolidation.
| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer |
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