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(-) Stroke
(-) Cardiovascular disease
(-) Asthma
(-) PTB
(-) Thyroid diseases
(-) Cancer
(-) Lung diseaseses
Personal and Social
Musculoskeletal: (-) pain, (-) warmth, (-) swelling, (-) limitation of movement
Endocrinologic: (-) polydipsia, (-) polyphagia, (-) polyuria, (-) heat/cold intolerance, (-)
irritability,
(-) tremors, (-) palpitations, (-) nervousness
Hematologic: (-) pallor, (-) easy bruisability, (-) bleeding
Neuropsychiatric: (-) tremors, (-) seizures, (-) weakness, (-) numbness, (-) memory loss,
(-) depression, (-) mood changes, (-) delusions, (-) hallucinations
Physical Examination
Heart: adynamic precordium, normal rate, regular rhythm, apex beat at 5th LICS
MCL, no murmurs
Abdomen: flabby abdomen, normoactive bowel sounds, tympanitic, soft, non-
tender
DRE: no skin tags, no external hemorrhoids, no fissures, tight anal sphincteric
tone, no masses, no blood/stool on tactating finger
Genitourinary: no CVA tenderness
Extremities: pulses full and equal, CRT <2 secs, no edema, no joint
swelling/tenderness, no limitation of movement
Neurologic Examination
Salient Features
SUBJECTIVES
OBJECTIVES
● 67/M
● Not in cardiorespiratory distress
● CC: DOB
● RR: 23 cpm O2 sat: 93%
● Progressive dyspnea, Productive cough, with whitish sputum
● (+) barrel chest, hyperresonant upon
● Easy fatigability
percussion, decreased breath sounds, (+)
● Difficulty sleeping wheeze
● Loss of appetite
● Weight loss
● No fever, chest pain, orthopnea, PND nor edema
● Smoker - 37 pack years; occasional alcoholic beverage drinker
● (+) Exposure to smoke from burning of biomass in their area
● HTN (2014) - Losartan 50mg OD, Amlodipine 5mg OD
(compliant)
● Cholecystectomy (2008, VMMC)
Clinical Impression
Chronic Cough
Sputum production
Exertional Dyspnea
Diagnosis
SPIROMETRY
● standard confirmatory diagnostic tool
● used for classification of disease severity
● Provide additional
information about alveolar
ventilation and acid base
status by measuring pH and
Pc02
Treatment
Stable Phase
Beta Agonists
● Short-acting beta agonists ease symptoms with acute
improvements in lung function.
● Long-acting agents (LABA) provide symptomatic
benefit and reduce exacerbations
Pulmonary Rehabilitation
● This refers to a comprehensive treatment program that
Non-pharmacologic incorporates exercise, education, and psychosocial and
nutritional counseling
Lung Transplantation
● COPD is currently the second leading indication for lung
transplantation