CASE 3

Clinical Profile Physical Findings

 Male
 23 years old
 Construction worker
 Family history of asthma
 One sibling diagnosed with TB
 Diagnosed Asthmatic
 Smoker (9 pack years)
 Occasional alcoholic beverage
drinker
 Productive cough
 Worsening dyspnea
 Body malaise
 Fever
 Anorexia
 Headache
 Chest pain
 Hypotensive
 Tachycardic
 Tachypnea
 Hyperthermia
 O2 saturation: 88% at room air
 (+) subcostal retraction
 (+) impaired tactile fremitus on
the right lung fields
 (+) dullness on percussion on both
lower lung fields
 (+) bibasal crackles
 
 Cough and Dyspnea

COPD Tuberculosis COVID 19 Asthma

COPD Tuberculosis COVID 19 Asthma

Rule in Rule out

 Smoker  No signs of hyperinflation –
 Asthmatic barrel chest, hyperresonance on
 Wheezing percussion
 Occupation – exposure to dust,  No tripod sign
etc.  Acute cough
 Most common symptom –
cough, sputum, dyspnea
 
 COPD Tuberculosis COVID 19 Asthma

Rule in Rule out

 Cough  Cough is acute
 Dyspnea  Needs sputum exam and chest
 Fever x-ray to confirm
 Anorexia  No hemoptysis
 Sibling with TB  No night sweats
 Chest Pain
 
 COPD Tuberculosis COVID 19 Asthma

Rule in Rule out

 Male  No history of travel or exposure
 Dyspnea to COVID-19 positive patient
 Fever  Cough
 Headache  Sore throat
   Loss of appetite
 Rash
 PC-RT test for confirmation
COPD Tuberculosis COVID 19 Asthma

Rule in Rule out 

 History of asthma (2004)  Productive cough
 Smoker  Fever
 Dyspnea  Bibasal crackles
 Chest pain
 Wheezing
 Admitting Diagnosis:
Community Acquired Pneumonia
 Inhaled droplets of microbial
pathogens

Gag and cough reflex +

mucociliary clearance

Pathogens overcome barriers

Microorganisms in alveoli

Alveolar macrophages opsonize and phagocytose

pathogens

Inflammatory Alveolar capillary

Chemokines Bronchospasm
response leak

IL-1 and TNF IL-8 and G-CSF ARDS Pleuritic Dyspnea,

chest pain, Hypoxemia
Crackles
Neutrophils
Fever Tachypnea,
Hypotension,
Headache,
Thank you for
listening!