Medicine: Bronchiectasis-Mr sivan tu rasanye..Soalan dr..

what is ur diagnosis, what

other respi cause of clubbing, cause of bronchiectasis

Short cases (dr wan haniza (respi), dr. akmal, prof rashid, Mr. A (kalau x silap), ext
examiner pompuan)
- Medicine: patient come with SOB, do respi examination.
ade clubbing grade 4,
time tgh examine, dr interupt gak mcm td..
prof rashid: what r u looking at the neck? to cek whether JVP raised or not.
which vein are u looking for? external jugular v. Are u sure? internal kot...ntah
tell me the landmark?
why do u feel for apex beat?
dah abis cek anterior chest, dr. wan suruh percuss and auscultate posteriorly.
spnjg auscultate tu, x taw nk conclude apa bnde la yg encik ni ada..redha je la. x leh
bygkn nk ckp apa.
so, bila present, nk describe nma, tp, x taw nme apa...so, dr wan pun ckp, ok..this is
Mr. Sivan....
oh...ni ke mr. sivan nya.. Alhamdulillah sgt.. ptolongan Allah tu dtg tanpa disangka.
prof rasyid tnye, tell me ur positive finding during respi examination. this patient
has inspiratory crackles bilaterally.
so what do u think he has? dipendekkan crite, korang tau la
jwpnnya..Bronchiectasis.

2.

Medicine: Bronchiectasis

clubbing+generalized coarse crepts+ronchi. dr tengku tnye ddx sekali. tu jek

1. Medicine: Bronchiectasis
Bronchiectasis-ade clubbing ,leuconychia n generalised coarse crepitation
-Question:instruction:do general then proceed wth respi.what type of
crepitation?,causes bronchiectasis?,causes impalpable apex beat?,what u look for in
sputum pot?

LONG CASE: Medicine - Bronchiectasis

Examiner: PROF ROKIAH main examiner(very nice,smiling all da time even when
asking q's)/PROF HAFIL/DR PHILIP/DR FOO

CASE: 23 y/o Malay Sabahan guy,with background hx of post-tb bronchiectasis

complicated with fungal infection not responding to meds necessitate left upper
lobe lobectomy. Also had redu...ced effort tolerance so another cx is pulmonary
hypertension. LOW and LOA as well. Admitted to HSB last 2/52 because of
haemoptysis again,a/w SOB. **this guy is soo haemoptysis..initial presentation for
tb also haemoptysis,while on tb meds also haemop,completed anti-tb also
haemopt,until they did angiogram and found dat main blood vessel to da lung is
bocor oredi so tampal la tempat bocor tuh. 1 year later (mid 2011),haemop
again.CT and bronchoscopy done showed fungal infection on Lt lung.put on
antifungal for 6/12. still haemop,so dr wan haniza referred him to serdang for
op.serdang referred him to IJN.did Lt upper lobe lobectomy in IJN Jan
2012,complicated with pleural effusion (need 3 chest drain) and lung didn't
expand.so stay for 1/12 in IJN. Basically,haemoptysis is what his daily living is all
about,hee.

FINDINGS & DISCUSSION:

1. On left UZ/MZ: reduced expansion/reduced VF/dull percussion note/reduced air
entry/reduced VR/and got 3 scars for chest tube as well as 1 thoracotomy scar at da
back.
2.Trachea is not shifted,but in this man we expect it to shifts to da left right. why?
--> ans: consolidation collapse
3. We remove da left lobe,what happen there? does nature allow a vacuum there?
--> no,coz there'll be compensatory hyperexpansion (they all laughed i don't know
why). but she mention this ans also T__T
4. Why you think he has pulmonary HT?
-->ans:history wise he got reduced effort tolerance and orthopnoea (even i did
abdominal exam 45 degree) but no PND, leg oedema. on PE, he got palpable P2 and
auscultation got loud P2. But no graham-steel and functional TR pun..
5. Correlate between his initial haemoptysis and fungal infection (need a lot of hint
here aigoo)
--> ans: post-tb > healing by fibrosis > but once bronchiec settle in,continous
inflammation will cause rupture and cavitation (her ans) > got cavity there,so fungal
come in and take place la..@--@
6. Invx and mx as usual.

7. lastly,barulah prof hafil ask to look for cx of surgery: examine la for serratus
anterior and latissimus dorsi.

1. Medicine: bronchiectasis/ AEBA(ad rhonci ngan coarse crept)- dr tengku

3. Medicine: Bronchiectasis
-

Feature of CO2 retentation

Ddx for upper lung dullness

Antibiotics of bronchiectesis

Cephalosporin- which one can gibe by oral and only IV