Tuesday, March 12, 2019
Hillcrest Medical Essay
Chief Complaint Tightness in the chest, shortness of breath, fast shopping centre rate. HISTORY OF PRESENT ILLINESS Mr. Barua is a 42 year old military man from Bangladesh who presents with chest tightness, shortness of breath, and tachycardia. Dr. J.K McClean of cardiology is evaluating his heart jibe. The patient has had the recent onset of hemoptysis. He was interact for terabyte in Bangladesh 15 years ago. This has prompted the fretfulness of go his treatment of tuberculosis was adequate or if weather t here(predicate) is another(prenominal) cause of his hemoptysis. The duration of his tuberculosis treatment was apparently adequate, according to his wife. scarcely no records are available. In addition, the patient had thrombosis of the axially artery treated drop dead year at Hillcrest. He had an embolectomy and has been on Coumadin since. INR is significantly elevated at 16.None the less, because of the cavitary lesions that are seen in the right and go away(p) upper lobes, the possibility of tuberculosis has been raised. Ancillary history was been given by the wife, Nupaul, with the patient translating for her from the Indie language. PAST HISTORY Tuberculosis is the past. Embolectomy at Hillcrest last year. SOCIAL HISTORY Married with two daughters. Patient has been in the the States for 10 years. The patient has no recent history of smoking he smoked in the past. But the amount is unclear. He is a eating place manager for the Marriot hotel chain. FAMILY HISTORY No known family history of diabetes, heart disease, or cancer. Mother died of a stroke and father was killed in a MVA in Bangladesh. REVIEW OF SYSTEMS Negative other than as stated in HPI.PHYSCIAL interrogation Vital signs are WNL. Apparently he has had no fever, chills or night sweats. Generalized malaise and the lack of energy has been the main concern. HEART invariable rate a rhythm with S1 and S2. No S3 or S4 is heard at this time. LUNGS Bilateral bronchi. No significant eupho ric sounds were noted. ABDOMEN Soft non tender. No hepatosplenomegagaly detected. RESTAL Prostate smooth and firm, no stool present of Hemoccult test. DIAGNOSIS hemoptysis with history of tuberculosis.PLAN I have reviewed the chest x-rays available here and agree with the finding of bleb formation in the right and left upper lobes. Despite the patient has had a high INR, because of his history of hempotysis and tuberculosis I believe obtaining sputum for TB is very, very important. We should rule disclose any other endobronchial lesions are the cause of his bleeding. I have discussed this liaison with the patient and his wife. I told them that there is a possibility of observing the condition via x-rays and repeated tested of sputum. They understand that this is an option However, they have decided because of the concern regarding of his repeating hemoptysis, they would consent to bronchoscopy. We will arrange for the patient to have a bronchoscopy done. The patient is off Coumadi n. We will recheck the prothrombin time and INR tomorrow. Depending on those results we will proceed with bronchoscopy and further evaluation.