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Demographic information
Name: Master. Arun
Age: 8 years
Sex: Male Date of birth: 18 April 2005 Religion: Hindu Born of non-consanguineous marriage Tharamani, Chennai Socio economic status class 3 Informant : Mother reliable
Chief Complaints
Cough and cold - 4 months.
Breathlessness- 2 months.
back, then he developed Cough and cold Insidious in onset Duration 4 months Progressive Productive cough with copious, yellowish-green in colour, purulent, foul smelling sputum Exacerbated on lying on the left lateral position No diurnal or seasonal variations Relieved by mediations temporarily
Breathlessness Breathlessness for 2 months Insidious in onset, Progressive, no postural variations Class 2 according to NYHA classification No relieving factors. No H/o Paroxysmal nocturnal dyspnea
Negative history
No h/o fever, chest pain, wheeze.
palpitations. No h/o oliguria, abdominal distension, pedal edema. No h/o loss of appetite, loss of weight No h/o hoarseness of voice No h/o foreign body aspiration/known choking spells.
Past history
H/o exanthematous fever probably measles 6
months back. Was admitted in Govt. general hospital and treated. No h/o similar illness in the past. No H/o contact with tuberculosis No H/o oil instillation in the ear No h/o previous hospitalizations. No h/o known allergies, Asthma
Antenatal history
Spontaneously conceived Booked and immunised Trimesters - uneventful
Birth history
Delivered at term by emergency cesarean section
(Indication meconium stained liquor) Birth weight 2.8kgs Cried after birth No H/o jaundice, seizures, feeding difficulties. No H/o discharge or redness of umbilical stump No H/o Ventilatory/Incubatory care, Phototherapy Breast feeding started immediately Meconium and urine passed within 24hrs
Developmental history
Gross motor, fine motor, language, social and
Family history
Pedigree chart
During birth, Maternal age 26 Paternal age 30 Born of a non-consanguineous marriage 1 elder brother -15 years healthy No h/o of asthma, cystic fibrosis in the family
Immunisation
BCG scar present
Dietary history
Exclusively breast fed for 6 months. 24hr dietary recall
Expected Calories Proteins 1700 21 Observed 1121 32.7 Gap 579 -
Socio-economic status
Mother Education 10th Occupation household maid Income Rs.5000/month Class 3 Lower middle Housing condition pacca house, 1 room, 1 kitchen, adequately ventilated Sewage and garbage disposal done properly Water for the children is not boiled before consumption
History Summary
8 year old male child presented with complaints
of chronic cough and breathlessness for the past 4 months. Cough was associated with copious, purulent sputum production. There is past history of an episode of exanthematous fever 6months back which resolved following treatment. This child is most probably suffering from a suppurative lung disease. I would like to proceed with the examination of respiratory system.
Examination
General Examination
The child was Conscious Oriented to time place and person Lethargic Co-operative
Clubbing present grade 1, pan digital No pallor, icterus, cyanosis, lymphadenopathy, pedel
edema
No dysmorphic features No external markers of allergy and Tuberculosis BCG scar present
Vitals
Pulse rate 98 beats/ min. Normal in rate, rhythm
and volume Respiratory rate 31 breaths/ min. Thoracoabdominal. Intercostal retraction present. Blood pressure 100/70mm of Hg Febrile 98.4 F
Anthropometry
observed Weight Height BMI 11 15.1kgs 115cms expected 25kgs 135cms 61% 85% Grade 2 malnutrition Grade 2 stunting
Inspection
Chest wall is symmetrical Trachea appears to be in midline. Apex beat seen in the left fifth intercostal space
1cm medial to MCL. Chest wall moves equally with respiration. Intercostals retractions present No grunt/stridor No drooping of shoulders, bony abnormalities, chest wall deformity seen. No scars, sinuses, engorged veins.
Palpation
Tracheal position and Apex beat confirmed.
Chest expansion 4 cm (during inspiration,
circumference: 57 cm, during expiration circumference: 53 cm) Chest wall moves equally with respiration. No Tactile fremitus, no tenderness No chest wall deformities No kyphosis or scoliosis
VOCAL FREMITUS
RIGHT
SUPRACLAVICULAR INFRACLAVICULAR MAMMARY AXILLARY INFRAXILLARY SUPRASCAPULAR INTERSCAPULAR INFRASCAPULAR NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL NORMAL
LEFT
PERCUSSION
RIGHT SUPRACLAVICULA R INFRACLAVICULAR MAMMARY AXILLARY INFRAXILLARY RESONANT RESONANT DULL RESONANT DULL LEFT RESONANT RESONANT RESONANT RESONANT RESONANT
SUPRASCAPULAR
INTERSCAPULAR INFRASCAPULAR NO PERCSSION
RESONANT
DULL DULL
RESONANT
RESONANT RESONANT
AUSCULTATION
RIGHT SUPRACLAVICULAR INFRACLAVICULAR MAMMARY AXILLARY INFRAXILLARY SUPRASCAPULAR INFRASCAPULAR INTERSCAPULAR NVBS NVBS BRONCHIAL VR NVBS BRONCHIAL VR NVBS NVBS BRONCHIAL VR LEFT NVBS NVBS NVBS NVBS NVBS NVBS NVBS NVBS
well in both lung bases both during inspiration and expiration. No Bronchophony, Aegophony, and Whispering pectoriloquy. No wheeze, pleural rub, pericardial rub.
Summary
8 year old male child presented with complaints if
chronic cough and breathlessness for the past 4 months. Cough was associated with copious, purulent sputum production. There is past history of an episode of exathematous fever 6months back which resolved following treatment. Examination revealed pan digital clubbing and halitosis. On auscultation, bronchial breath sounds and coarse leathery basal crepitations were heard in the right lung.
Diagnosis
Bronchiectasis of the right lung involving the
middle and lower lobe with the probably etiology being post-measles infection with grade 2 malnutrition and grade 2 stunting.
Investigations
Blood Hb%, total count, differential count,
platelet ESR Mantoux test Sputum culture & AFB X-ray chest HR-CT Fibreoptic bronchoscopy Broncho-alveolar lavage Bronchography Sweat chloride test
Management
Medical management Chest physiotherapy and postural drainage Antibiotics and Vaccination support Nutritional support Symptomatic therapy bronchodilators, corticosteroids Long term oxygen therapy Surgical management Segmental or lobar pneumonectomy
Thank you