Summary and Learning Issues!!! Week 5

PCL Week 5: Shamila is Struggling
• Shamila: 45 years old
• Unwell about 2 weeks
• Thinks it’s just a cold
• Shortness of breath > getting worse
• Has endless coughing fits
• Yellow sputum
• FEVER!!!
• Mother> RA
• Father> heavy smoker, resp.failure,dead
• Dull percussion in lower left bases, wide spread crackles
• A wheeze on expiration
• Rest of lung fields >hyperresonant percussion
• 38.8 degree Celcius
• JVP norm
• Prescribed amoxycycilin
• Smoker for over 30 years
Questions to be asked and things to be done:
• Purulent sputum? Blood? Amount?
• Severity of dyspnae
• Alcohol?
• Social Hx: Occupation, travelling, environment
• Medication Hx, past medical>Diabetic?Hypertension? Hyperlipidemia? and surgical Hx
• Allergy, Exercise
• BP, Resp. rate
• Full cardio-resp examination
• X ray> opacity, heart size, ECG, Lung Function Test
• Full Blood count
Diffrential diagnosis:
• Pneumothorax? No pain so eliminated
• Acute Pneumonia
• COPD
• Chronic Bronchitis?
o Is chronic bronchitis under category of COPD?

Learning Issues:
• Definition: COPD and acute pneumonia> Li Tatt
• Diffrential diagnosis: Akmez
o Pneumothorax? No pain so eliminated
o Acute Pneumonia
o COPD
o Chronic Bronchitis?
 Is chronic bronchitis under category of COPD?
• Pathophysiology : Zhi Mei
• Sign and symptoms> Irene
• Causes and risk factors> Meena
• Investigations: x-ray, lung function test(spirometry)> Shuhaiba, Alvin
o Normal, obstructive, restrictive of lung function test
o Why hyperresonant percussion? Why so much of volume> coz obstructed so the vol going in and coming out is diff!
o What is obstructive and restrictive?
• Treatment and management> Ching Mei, Tin Yee
• Complications and prognosis> Hai Sherng
• EFFECTIVE STOP SMOKING campaign!!! > Thermos =)