PULMONOLOGY(A)

 A1.

Evolution of symptomatology and Event timeline-


  • 20 Years ago - SOB Grade1 for a week , occurred every year for the same duration
  • 18 Years ago- Polyuria and was diagnosed with DM
  • 12 Years ago - SOB Grade 1 for a month
  • 1 Month ago - Weakness was giving IV
  • 30 Days ago - SOB ( latest episode) gradually progressive
  • 20 Days ago - HRCT showed Bronchiectasis
  • 15 Days ago - Pedal edema and facial puffiness
  • 2 Days ago - SOB Grade 4 , drowsiness and  decreased urine output. 
Anatomical location of the problem is BRONCHIOLES.
Primary etiology is rice dust exposure as patient is a farmer working in paddy fields.

A2.
Augmentin - Amoxicillin + Clavulanic acid.

A3.
  • The pt. was started on antitubercular drugs even though she was tested negative for AFB. ATT includes drugs like ISONIAZIDE , RIFAMPACIN , ETHAMBUTOL , PYRAZINAMIDE AND STREPTOMYCIN .

  • ISONIAZIDE can cause side effect like hypersensitivity reaction. COPD is a also an allergic which might have exacerbated due to use of isoniazide.
A4.
YES, some drugs like isoniazide could could acute exacerbation of COPD thereby increasing the symptoms

A5.
  • Electrolyte imbalance is found among people with Copd, especially for people who are female, 60+ old, take medication Spiriva and have High blood pressure.( this pt. is also hypertensive).
  • Patients with COPD tend to retain sodium. In addition, serum potassium should be monitored carefully, because diuretics, beta-adrenergic agonists, and theophylline act to lower potassium levels.
  • Beta-adrenergic agonists also increase renal excretion of serum calcium and magnesium, which may be important in the presence of hypokalemia.
  • Activation of the renin-angiotensin-aldosterone system and inappropriately elevated plasma arginine vasopressin in COPD may aggravate the electrolyte imbalance during acute exacerbation of COPD.

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