Short case of COPD (example )

Mrs/mr A, is an elderly indian/malay/Chinese( race) who appear to be alert at rest.

His/ her vital sign as pulse rate 80 beat/min regular and not bounding. He/she looks
to be in respiratory distress as evidence by tachypnea with respiratory rate of 24
breath/min, on oxygen supplement with nasal prong connected to 2L /min and use
of accessory muscle for breathing. Then look surrounding of patient n said ( I notice
the presence/absence of sputum pot, bronchodilator and iv drip of antibiotic
indicates the presence of ongoing infection.
On peripheral examination, there is presence/no digital clubbing, tar stain (bkn
nicotine deh nanti dr hilmi tegur), wasting of intrinsic hand muscle, tenderness,
crt<2s, not appeared/ appear to be cyanosed or presence of flapping tremor ( co2
retention), fine tremor ( side effect of chronic use of beta agonist),BCG scar on
deltoid. There is no jaundice and conjunctiva is pink/pale. There is presence/no
central cyanosis, oral hygience status, coated tongue or not. The JVP raised or not
( if raised indicated cor pulmonale)
On examination of the chest ( consist of inspection, palpation, percussion and
auscultation)
On inspection, there is presence/no surgical scar and chest deformities, barrel chest.
On palpation, reduced chest expansion at which zone ( upper zone, mid zone, lower
zone )
On percussion, presence of resonant percussion note and loss of cardiac and liver
dullness
On auscultation, reduced air entry associated with expiratory wheezhing and
prolong expiratory phase and decrease vocal resonance/fremitus
There is no/presence of cervical lymphadenopathy, sacral edema and bilateral leg
swelling.
I would like to finish my examination by checking the fever chart, peak expiratory
flow rate, sputum chart and (x ingat sow lg rse mcm ade 4)
My provisional diagnosis is acute exacerbation of chronic obstructive pulmonary
disease (COPD) because of the evidence of hyperinflation of lung such as barrel
chest, the ongoing infection that cause it, decrease air entry, expiratory wheezing
and prolong expiratory phase.
My differential are acute exacerbation of bronchial asthma and bronchiectasis
How to diagnose COPD?
-the air flow limitation ( FEV1/FVC <70%) that is not fully reversible (post
bronchodilator FEV1 <80% of predicted value.
-
Ix
PEFR
Chest x-ray-hyperinflation, bullous changes, pulmonary hypertension, cardiac
failure, lobar pneumonia and pneumothorax
ECG-cor pulmonale (peaked P waves at lead II,III and aVF
ABG-screening for respiratory faulure
Sputum culture and sensitivity

Mx
-Oxygen
-nebulised of bronchodilator
-antibiotic
-steroids
-chest x-ray ( to exclude pneumothorax)