CONSOLIDATION

Presenter: S. Poorani
Moderator: Dr. N.Ramya
NAME : Mr.Sakthivel
AGE : 45
SEX : Male
ADDRESS : Samayapuram
OCCUPATION: Farmer
CHIEF COMPLAINTS

• Fever for past 7 days

• Pain on right side of chest for past 5 days
• Cough for past 5 days
• Breathlessness for past 3 days
HISTORY OF PRESENT ILLNESS

• Patient was apparently normal before 7 days. Since then, he has been suffering
from high grade continued fever which is subsided on taking paracetamol. It is
associated with chills and rigor and also associated with generalized body ache
and weakness.
• H/o right sided chest pain for past 5 days which is sharp, stabbing in nature, more
marked on coughing and deep inspiration.
• H/o cough for the past 5 days which was initially dry, but for the past 2 days it
was productive with purulent sputum.
• H/o breathlessness for past 3 days which was insidious in onset non progressive
worsen on walking improved after taking rest. No diurnal variation.
• No H/o hemoptysis
• No H/o contact with TB patient
PAST HISTORY
No H/o similar complaints in the past.
Not a known case of Diabetes mellitus, Hypertension, bronchial asthma,
Tuberculosis, epilepsy and coronary artery disease.
TREATMENT HISTORY
H/o taking antipyretics for fever
PERSONAL HISTORY
He consumes mixed diet
Not a smoker, not an alcoholic
Normal sleep pattern
Normal bowel and bladder habits
FAMILY HISTORY
Nil relevant

GENERAL PHYSICAL EXAMINATION

Patient is ill looking, toxic but conscious and cooperative
No pallor, icterus, cyanosis, clubbing, lymphadenopathy and pedal edema.
No external markers of Tuberculosis
VITALS
PULSE: 102/min, regular rhythm, normal volume, no specific character,
condition of the vessel wall normal, no radio radial delay, no radio femoral delay,
all peripheral pulses are felt equally on both sides.

BLOOD PRESSURE: 110/70 mm Hg

RESPIRATORY RATE: 30/min

TEMPERATURE: 104⸰ C
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
After getting consent from the patient, patient is exposed till umbilicus.
INSPECTION
UPPER RESPIRATORY TRACT : Normal
LOWER RESPIRATORY TRACT:
Position of trachea appears to be normal.
Position of the apex beat appears to be normal.
Movement of the chest is diminished on right side of the chest mainly the
lower and lateral part of the chest.
No supraclavicular hollowness or fullness.
No fullness or flattening of chest wall.
No drooping of shoulder.
PALPATION
• Trachea in midline.
• Apical impulse felt in the left 5th intercostal space ½ inch medial to midclavicular
line.
• Chest movement reduced on lower part of right side of chest
• Vocal fremitus increased over right infra axillary, inter scapular and infra scapular
region.
• Chest expansion- 4 cm.
• AP diameter- 20 cm, Transverse diameter- 29 cm.
VOCAL FREMITUS

AREAS RIGHT LEFT

Supraclavicular Normal Normal
Infraclavicular Normal Normal
Mammary Normal Normal
Axillary Normal Normal
Infra-axillary Increased Normal
Suprascapular Normal Normal
Interscapular Normal Normal
Infrascapular Increased Normal
PERCUSSION
AREAS RIGHT LEFT
Percussion directly on clavicle Resonant Resonant
Supraclavicular Resonant Resonant
Infraclavicular Resonant Resonant

Mammary Resonant Resonant

Axillary Resonant Resonant

Infra-axillary Woody dull Resonant

Suprascapular Resonant Resonant

Interscapular Resonant Resonant

Infrascapular Woody dull Resonant

AUSCULTATION: Vocal Resonance

AREAS RIGHT LEFT

Supraclavicular Normal Normal
Infraclavicular Normal Normal
Mammary Normal Normal
Axillary Normal Normal
Infra-axillary Increased Normal
Suprascapular Normal Normal
Interscapular Normal Normal
Infrascapular Increased Normal
BREATH SOUNDS

AREAS RIGHT LEFT

Supraclavicular NVBS NVBS

Infraclavicular NVBS NVBS

Mammary NVBS NVBS

Axillary NVBS NVBS

Infra-axillary Tubular bronchial breath NVBS

sounds
Suprascapular NVBS NVBS

Interscapular NVBS NVBS

Infrascapular Tubular bronchial breath NVBS

sounds
Bronchophony, aegophony and Whispering pectoriloquy heard Right side
on
OTHER SYSTEM EXAMINATION
CARDIOVASCULAR SYSTEM:
S1, S2 Heard
No murmur heard
CENTRAL NERVOUS SYSTEM:
No focal neurological deficit
ABDOMEN:
Soft, non tender
No organomegaly
SUMMARY
45 year old male patient present with high grade fever for 7 days,
right sided chest pain for 5 days, more marked on coughing, cough for 5
days, breathlessness for 3 days. No h/o contact with Tb patient. No
previous illness in the past.
O/E Chest movement reduced on infraaxillary areas, Vocal
fremitus increased in infra-axillary, interscapular, infrascapular areas.
Vocal resonance- woody dullness in infra-axillary, interscapular,
infrascapular areas. Tubular bronchial breath sounds heard over infra-
axillary, interscapular, infrascapular areas. Bronchophony, aegophony
and whispering pectoriloquy heard in the infra-axillary, interscapular,
infrascapular areas.
PROVISIONAL DIAGNOSIS

A case of right sided consolidation probably

due to Community acquired Pneumonia.
INVESTIGATIONS
• Specific Investigations
• Chest x-ray
• Sputum Examination ( Gram’s stain and culture)
• RT-PCR
• Blood culture
• Basic Investigations
• Complete blood count
TREATMENT
• Admit the patient
• O2 therapy and adequate hydration
• IV Paracetamol
• Erythromycin 500 mg 6 hourly IV
• Ceftriaxone 1-2 g IV daily
THANK YOU