ex-navy session 2

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ex-navy session 2 by Mind Map: ex-navy session 2

1. chronic diseases

2. Presentation

2.1. heavy occupational exposure to asbestos which lead to fibrotic changes in the lung

2.2. breathlessness, vague chest pain, productive cough, cyanosis

3. Step 6

3.1. Review session 1

3.1.1. Summary of step 5

3.2. Report new knowledge

3.2.1. occupational respiratory diseases what is common in navy most of ships where using asbestos asbestosis and mesothelioma neoplasms fibrotic lung diseases

3.2.2. pathophysiology for the process of cyanosis

3.2.3. what causes vague chest pain not related to breathing or exertion any tumor in the chest may cause chest pain mainly the pain is from excessive cough and called tightness could it be caused by lung cancer? it could be pleural or mediastinal cause because lungs are well innervated

3.3. 40 minutes

4. Step 8

4.1. Diagnostic decision

4.1.1. fibrotic lung disease (asbestosis)

4.2. Mechanism

4.3. Supporting data

4.3.1. history and physical examination crackles, clubbing, reduced chest expansion occupational exposure

4.3.2. test results ABG CXR reticulonodular changes CT we need high resolution CT Spriometry hypoxemic with respiratory alkalosis with compensatory metabolic acidosis restrictive lung disease

4.4. 10 minutes

5. Step 7

5.1. Inquiry plan and info gathering

5.1.1. History of presenting complain history of cyanosis nothing he's aware of SOCRATES of the chest pain pain distrubting sleep started recently last two months vague no radiation not related to breathing or movement mild to moderate 3-4 out of 10 sputum production whitish grayish sputum fatigue yes hemoptysis no breathlessness type get worse last 6 months not related to activity fever no fever weight loss some weight loss night sweats no no wheezing

5.1.2. Previous medical / surgical history pain killers previous surgery hospitalization started over last few years ulcers can cause aspiration which by time may cause aspiration to lung NO PREVIOUS HISTORY

5.1.3. Drug history / allergy no allergy didn't seek medical advice before

5.1.4. Family history Clean family history of any diseases

5.1.5. Social / occupational history 20 pack year smoker retired 5 years ago social drinker heard that one of his collegues had a problem in breathing no other jobs married with two grown-up kids symptoms affecting his daily activity especially last 6 months lost apetite because he feels sick not able to exercise depression and scare feeling

5.1.6. worked for the last 30 years

5.1.7. Physical examination vital signs no fever 25 respiratory rate pulse 105 150/80 BP O2 88-90 % peripheral clubbing cyanosis no muscle wasting no hypertrophic osteoarthropathy JVP no edema no horner's syndrome voice change looks breathless, using accessory muscles for breathing, tripole positioned no lymphadenopathy chest inspection palpation percussion auscultation

5.1.8. tests results CBC little bit high hemoglobin level ABG hypoxemic with respiratory alkalosis with compensatory metabolic acidosis CXR reticulonodular changes CT we need high resolution CT Spriometry restrictive lung disease after all this we have to consider biopsy by bronchoscopy not yet done

5.2. 40 minutes