Chief complaints:
- Cough with profuse foul smelling sputum for … days
- Hemoptysis for … days
- Fever for … days
- Chest pain for … days
- Malaise, weakness, loss of weight for … days.
History of present illness: According to the statement of the patient, he was reasonably well … days
back. Since then, he has been suffering from severe cough with production of copious foul smelling
purulent sputum. It is occasionally associated with scanty amount of blood. He also complains of
high grade continuous fever, highest recorded 104°F. The fever is associated with chills and rigors
and profuse sweating, subsides only with paracetamol. The patient also complains of right sided chest
pain, which is compressive in nature, worse with inspiration and during coughing, but there is no
radiation. For the last ... days, he is also suffering from malaise, weakness, anorexia and loss of
approximately 15 kg of body weight. His bowel and bladder habits are normal.
History of past illness: He was suffering from pneumonia 6 months back from which there is complete recovery.
Family history: Nothing significant.
Personal history: He smokes about 25 sticks a day for 25 years. He is also an alcoholic.
Socioeconomic history: He is a day laborer and lives in a slum area with poor sanitation.
Drug history: The patient was treated by local physicians with antibiotics, cough syrup and
paracetamol, but no improvement.
General Examination
The patient looks toxic and emaciated
Generalized clubbing is present in all the fingers and toes
Moderately anemic
No jaundice, cyanosis, koilonychia, leukonychia or edema
No thyromegaly or lymphadenopathy
Vitals:
Pulse: 110/min
BP: 110/75 mm Hg
Temperature: 103ยบ F
Respiratory rate: 28/min.
Systemic Examination
Respiratory System: (Supposing right sided)
Inspection:
- Movement is restricted in the right side of the chest.
Palpation:
- Trachea is central in position
- Apex beat is in the left 5th intercostal space in the midclavicular line
- Vocal fremitus is increased on the right side of the chest
- Chest expansion is reduced on the right side.
Percussion:
- Percussion note is woody dull over right side of chest from … to … intercostal space
- Upper border of the liver dullness is in the right 5th intercostal space in midclavicular line
- Cardiac dullness is normal.
Auscultation:
- Breath sound is bronchial in … intercostal space on the right side. In other places, it is vesicular.
- Vocal resonance is increased over the same area
- There are coarse crepitations over the right side of the chest in … intercostal space, reduces on coughing.
Examination of the other systems reveals no abnormalities.
Provisional diagnosis: Right sided Lung Abscess.
Questions Likely To Be Asked By The Examiner:
Q. What are the differential diagnoses?
A. As follows:
- Consolidation (during resolution stage)
- Bronchiectasis
- Bronchial carcinoma
- Pulmonary TB.
