MARIA DIMITROVA 65
ANAMNESIS
The patient was admitted in the pulmology department with complaints of cough with
yellowish sputum, easy tiredness, fatigue, shortness of breath, heaviness in the chest. The
symptoms started about 3-4 weeks ago with running nose, sore throat, coarse voice and
accelerated progressively. During the last days the patient has shortness of breath even at
rest which is not relieved in sitting position. The patient has chronic cough with
periodical exacerbations since 6 years, and easy tiredness and fatigue during the last two
years. Treated with inhalers with moderate effect.
Previous diseases – 3 pneumonias, the last time one year ago, 2003 hysterectomy because
of myoma, 2005 – resection of the thyroid gland, without consequent substitute hormonal
therapy.
No anamnesis for family diseases.
Risk factors – smoking 20 cigarettes daily, no drinking and toxicity, allergy toward dust,
fish, strong smells.
PHYSICAL EXAMINING
Slightly impaired general condition. Normal height and body weight. Active position in
bed. Aware of time place and self identity. Central cyanosis. No edema.
Head with normal configuration, normal sclera, tongue slightly cyanotic, no high neck
veins, no enlarged lymphatic nodes, thyroid gland not enlarged.
Normal shape of the chest. Box-like percussion sound, lower borders of the lungs,
decreased respiratory mobility. Breathing coarse vesicular with prolonged exhale, some
snoring and whistling wheezes, and resonant ronchi in both bases.
Normal borders of the heart. Regular heart rate 84, RR 110/80 mm. decreased sounds, no
murmurs.
Abdomen without pain. Liver on the costal curve, spleen not enlarged. Sucussio renalis
negative.
No edema and normal pulsations of the limbs.
QUESTIONS
1 Please write the primary diagnosis
2 The lack of which signs from the physical examining suggests that the patient probably
has not developed cor pulmonale with right side heart failure.
3 Which lab and instrumental tests will be required for this patient and what changes you
expect?
4 What tests are used to determine the presence and the type of respiratory failure and
how you interpret them?
5 For which disease is used the Ziel-Nelson test and what other test could be performed
for the diagnosis of that disease?
6 Which test should be performed to confirm or exclude cor pulmonale and what would
be the signs if the patient has this complication?
7 Last question – which is the main indication for bronchoscopy?