Slideshow by Kuberan Balakarisnan

References

kamariahjalil — 2025-04-17 02:48:43 UTC

trigger 1

kamariahjalil — 2025-04-17 02:49:45 UTC

TRIGGER 2

kamariahjalil — 2025-04-17 02:50:13 UTC

tRIGGER 3

kamariahjalil — 2025-04-17 02:50:39 UTC

TRIGGER 4

kamariahjalil — 2025-04-17 02:51:06 UTC

LEARNING ISSUES

kamariahjalil — 2025-04-17 02:52:35 UTC

TIRGGER 1(FURTHER QUESTIONING )

2025-04-17 03:42:32 UTC

HISTORY TAKING
- SOCRATES
- site
- onset - is it persistent, all the time, or during night only, or worsening in the morning, is it the first time, berapa episodes dah
- characteristic
- radiation
- associated symptoms - wheezing- COPD, night sweating - TB, dizziness- anemia, cough- TB, pneumonia, hemoptasis -TB,
- time - during exercise or sleeping, morning and night - asthma
- exacurbating factors- relieving factors, apa yang buat untuk relieve, medications ( ex - GTN )
- severity - class 1- blh buat activity lagi, class 2 - buat activity baru sakit - climbing, class 3- biasa biasa pun dah penat, class 4 - berehat pun penat
- past medical history- medical illness-diabetes, hypertension, asthma, COPD, CAD, CKD,
- past surgical history - heart op,
- social history - smoking, alcohol, diet history- strict vegetarian, vege ke tak, pekerjaan- chemicals exposure, dust exposure(asbestos)- risk factor for lung cancer
- fam history - ada tak heart attack,

trigger 2 - difficult term

2025-04-17 03:53:02 UTC

bilateral leg swelling - both of the leg is swollen, due to systemic condition (heart failure, kidney, liver- hypoalbunemia, lung), Pulmonary edema
frothy sputum - mucus that contain bubble and is foamy due to fluid accumulate in the lung
Hyperlipidemia - high level of lipids in the blood including cholesterol and Triglyceride
Hypertension - BP against artery elevated (high BP)
squeezing chest pain - compressing on the chest

trigger 2- key information

2025-04-17 03:56:37 UTC

breathlessness on walking, now breathless even at rest - stable angina led to unstable angina, worsening of the dyspnea from class 3 to class 4
bilateral leg swelling - both of the leg is swollen, due to systemic condition (heart failure, kidney, liver- hypoalbunemia, lung), Pulmonary edema
required three pillows to sleep as his breathlessness becomes worse on lying down - SOB, dyspnea, prop up position
coughing pinkish frothy sputum- sign of pulmonary edema, rule out TB, infection, pneumonia, high hydrostatic pressure causing leakage of blood into alveoli
no squeezing chest pain with radiation - rule out MI
has hypertension and hyperlipidaemia for the past ten years
smokes 20 cigarettes per day for the last 25 years - dust or carbon monoxide exposure
works as a lorry driver - dust or carbon monoxide exposure

trigger 2 - differential diagnosis

2025-04-17 04:13:03 UTC

CARDIOVASCULAR SYSTEM - IHD-MI, ~~angina, ACS~~, heart failure, ~~endocarditis~~
respiratory system - ~~COPD, asthma,~~ ~~pneumonia, PE,~~
endocrine system - ~~hyperthyroidism,~~
blood disorder - ~~anemia~~
others - ~~OSA (obstructive sleep apnea),~~ obesity
metabolic causes - ~~diabetic ketoacidosis (DKA)~~

congestive cardiac failure:

dyspnea

orthopnea

bilateral leg swelling

pinkish frothy sputum

fatigue

underlying hypertension and hyperlipidemia for 10 years

smoking 20 cigarettes per day for 25 years

distressed, high BP, high RR, high HR, pale and sweaty, low O2- restless

Bilateral pitting oedema up to the knees - heart failure
jugular venous pressure was raised at 7 cm- fluid overload right heart failure
apex beat was at the 6th intercostal space at the mid-clavicular
line- cardiomegaly
crepitations heard over the posterior lung bases posteriorly- indicate pulmonary oedema

trigger 2 - further investigation

2025-04-17 04:32:29 UTC

PHYSICAL EXAMINATION

vital sign - high BP, high HR, high RR (tachypnea), low Oxygen saturation (below 95), normal temperature
Examine CVS - palpate jugular vein and pulse, auscultate, listen to S1 S2 and any abnormal sound (murmurs) sign of valvular disease, palpate for edema either pitting or non-pitting
Respiratory system - check for rise of chest either symmetrical or not, palpate for trachea deviation, percussion resonance, Auscultate low part of the lung: reduce breath sound bcs of fluid accumulation
abdominal examination- Palpate for any organomegaly

INVESTIGATION

FBC
liver profile, renal function test
ECG
chest X-Ray - blunted of the lung due to presence fluid bi vessel
Echocardiogram - ejection rate
Angiogram

trigger 3 (difficult term)

2025-04-17 04:36:27 UTC

crepitations- crackle sound- abnormal when heard using stethoscope- present of fluid

trigger 3(key information)

2025-04-17 04:42:42 UTC

1. distressed, high BP, high RR, high HR, pale and sweaty, low O2- restless 4.

Bilateral pitting oedema up to the knees - heart failure
jugular venous pressure was raised at 7 cm- fluid overload right heart failure
apex beat was at the 6th intercostal space at the mid-clavicular
line- cardiomegaly
crepitations heard over the posterior lung bases posteriorly- indicate pulmonary oedema

trigger 4(difficult term)

2025-04-17 04:49:02 UTC

hypokinetic inferior segments- decrease contraction of the inferior wall of the heart

sinus rhythm- heart beating normally

trigger 4 (key Information )

2025-04-17 05:05:07 UTC

low Na+ - dehydrate, fluid accumulation

high TG, high TC, high LDL, - due to hyperlipidemia for the past 10 years

low HDL- cardiovascular disease

left ventricular hypertrophy- wider QRS, ST depression, tall R wave, deep S wave, T wave inversion

Q waves in the inferior leads- indicate previous inferior infarction

left ventricular hypertrophy and hypokinetic inferior segments

(ECHOCARDIORAM) ejection fraction was 41%- low, (Normal men - 52 to 72%)

features of pulmonary oedema, congestive heart

failure secondary to hypertension

previous myocardial infarction

oxygen- short term

diuretics- short term, route of administration IV

vasodilators, nitrates- short term

ACE inhibitors- hypertension

beta-blockers- long term, CCF and Hypertension

fluid and salt restriction of 1 liter a day- long term

reduce of workload of the heart

follow-up in 2 months

Trigger 1

kuberan0508 — 2025-04-17 08:14:56 UTC

No difficult terms

Trigger 1 (Key Information)

kuberan0508 — 2025-04-17 08:30:41 UTC

1) 45 year old man - middle aged citizen, the immune system of the patient is towards weakening condition, have high risk of getting diabetes, hypertension and other medical illness.

2) Admitted to the hospital - Meaning that he has a serious or life-threatening problem. So, the patient needs to stay at the hospital for appropriate care & treatment.Need further investigation in order to diagnosis any possible disease + monitoring patient condition.

3) 2 week increasing shortness of breath (dyspnea) and fatigue - Left sided heart failure, Congested pulmonary vasculature, Fluid enters into alveolar space, O2 interfere 02 exchange (Tissue hypoxia) SOB, Progressive Shortness of breath and cause dyspnoea at rest & lying down, pulmonary oedema