1. Mr. Muthu, a 49-year-old unemployed man presented to a hospital

emergency department complaining of chest pain on the right side

2. which was more severe on deep breathing, and had several recent

episodes of coughing up a small amount of blood mixed with

sputum during the past week.

3. Overall, he had been coughing for

six months

emergency department

• middle age, prone to get infection or disease such as lung disease

• prone to drinking and smoking

• unemployed,limit access to check their health,lower sosioeconomic poor living condition

2. complaining of chest pain on the right side,which was more severe on deep breathing

• disease is not related to heart,more related to repi system

• this type of pain known as pleuritic chest pain that could suggest inflammation or infection of pleura

  3., and had several recent

episodes of coughing up a small amount of blood mixed with sputum during the past week

• hemoptysis

• due to erosion blood vessel in lung area

• due to high pressure in thoracic :lung or heart

  4. Overall, he had been coughing for

six months

• more than 8 week consider chronic

• higher infection,ex; TB,COPD

• might be COPD or TB,astma also included since persistent coughing

DIFFERENTIAL DIAGNOSIS

• related to pulmonary TB

• COPD

• ASTMA

• Lung cancer

• Pneumonia

• Pulmonary embolism

INVESTIGATION

• HOPI (socrates)

• Past medical history

• Social history

• Family history

2.hyposomnia- hypo mean less,somnia mean sleep, reduced or less sleep

cough was more severe in the morning.

2.Apart from coughing, he had been feeling feverish, and having

profuse nocturnal sweating for the last six months.

3.Also, he had

shortness of breath after climbing upstairs for the last one month.

4.Mr. Muthu reported having loss of appetite, loss of weight and

hyposomnia for the past three weeks.

5.Lately, he started getting

tired easily.

6.He denied any leg or abdominal swelling.

7.He denied having contact with patients with chronic coughs.

8.Past medical history

No history of asthma, COPD, heart disease, or history of previous

hospitalisations or trauma.

9.Family history

His family history was unremarkable.

Allergies and medications

Nil of significance.

101.Social history

He had been smoking about 20 cigarettes per day for the past 20

years.

11.He was unable to continue his job and remained unemployed.

No history of drug abuse.

Did not consume alcohol.

No history of recent long air travel

cough was more severe in the morning.

-due to mucus accumulation overnight,morning predoiminant cough is due to copd, could also be consistent with post nasal drip,GERD or TB

2.Apart from coughing, he had been feeling feverish, and having

profuse nocturnal sweating for the last six months.

-feverish, low grade fever which is response to chronic infection

-profuse nocturnal sweat, due to cytokine release response to earlier infection,could also indicate sypmtom for TB

-last 6 nmonth indicate the disease is already chronic

3.Also, he had

shortness of breath after climbing upstairs for the last one month.

-SOB maybe because of sputum accumulation

-smoking habit cause inflammation in the airways

-exertional dyspnea

4.Mr. Muthu reported having loss of appetite, loss of weight and

hyposomnia for the past three weeks.

-common symptom for tb patient

-hyposomnia could be due to few cause, hyperthyroidism, and persistent cough

-unemployment could also cause mental issue (phsycological cond,stress)

5.Lately, he started getting

tired easily.

-hemotypsis could lead to anemia,low blood supply to muscle cause not enough energy

-poor sleep quality

-malnutrition

6.He denied any leg or abdominal swelling.

-no edema

-not related with heart and kidney function

7.He denied having contact with patients with chronic coughs.

-reduced direct contact with patient that have TB

-TB could exist in latent stage

8.Past medical history

No history of asthma, COPD, heart disease, or history of previous

hospitalisations or trauma.

-could be due to medication

9.Family history

His family history was unremarkable.

Allergies and medications

Nil of significance.

101.Social history

He had been smoking about 20 cigarettes per day for the past 20

years.

-heavy smoker

-quantity consider high amount which could cause higher effects

-ciggarates contain carcinogen cause mutation,that lead to not efficient mucus clearance

-could lead to cancer development

-smokes could alter the surfactant

11.He was unable to continue his job and remained unemployed.

-no proper care due to no money

-unactive mean low mobility causing DVT

No history of drug abuse.

Did not consume alcohol.

No history of recent long air travel

DIFFERENTIAL DIAGNOSIIS

pulmonary TB

COPD

lung cancer

Pulmonary embolism

pneumonia

FURTHER INVESTIGATION

check vital sign-respiratory rate,BP

general inspection - anemia sypmtom , finger clubbing

sputum culture- standard for TB test

mantoux test- TB

chest XRAY- checks for lesion

Auscultaion- sound that is abnormal (crackle , wheezing)

FBC-checks for abnormal blood

DIFFERENTIAL DIAGNOSIS

PTB

COPD

lung cancer

FURTHER INVESTIGATIONS

sputum - AFB

chest x ray

HIV test - relate to TB

FBC

Mantoux test or tuberculin skin test

Final diagnosis

Pulmonary TB