75 yr male with cough with expectoration ,sob ,pedal edemasince 15 days

Pt came with c/o cough with expectoration since 15 days
SOB-10 days
Decreased urine output -10days
Pedal edema-10days
Constipation-10days
Facial puffiness -2days
HOPI
Pt was apparently asymptomatic 6 months back then he had ,cough heametemisis (4times), alternative dark brown coloured (melena) and bright colored blood(hematochizia) following this he had loss of consciousness he was taken to hospital ,treatment was given for blood loss (2 transfusions)and late r on next day he had regained consciousness .Now patient had
Cough since 15 days, associated with sputum which is white in colour,copious in amount,it is also associated with pleuritic chest pain on coughing
cough is more during night time,relived by taking medication
SOB since 10 days(grade 2) associated with orthopnea,PND
Past History:
no similar complaints in the past
Personal history
Appetite-decreased
Diet -mixed
Bowel and bladder-constipation , decreased urine output
Sleep-decreased due to cough
Alcohol history- since 50 yrs (last drank 3 days back , amount 90 ml/day
Smoking history-since 50 yrs(last smoked 4 days back,1 chutta/day)
General Examination:
PFamily history: 
No similar complaints.



General Examination: 

Patient is examined in a well lit room after obtaining informed consent. He is conscious, coherent and cooperative, well oriented to time, place and person, moderately built and nourished. 

 No Pallor, Icterus, Cyanosis, Clubbing, generalized lymphadenopathy, 
 B/l pedal Edema 

 Vitals:

Temp.- afebrile

BP- 180/100 MMHG

PR- 92 bpm

RR- 17 cpm
Systemic Examination
CVS-S1,S2+
RS -
URT-POOR ORAL HYGIENE
LRT-
INSPECTION
CHEST - SYMETRICAL
SHAPE-ELLIPTICAL
TRACHEA-MIDLINE
NO DROPPING OF SHOULDERS
NO KYPHOSCOLIOSIS
NO SCARS, SINUSES ,DILATED VEINS
MOVEMENT WITH RESPIRATION -B/l SYMMETRICAL

PALPATION:
TRACHEA MIDLINE
CROWDING OF RIBS+
NO INTERCOSTAL WIDENING
APICAL IMPULSE-FELT IN 5TH ICS MORE LATERALLY
CHEST MOVEMENT-SYMETRICAL MOVEMENT ON BOTH SIDES
VOCAL FREMITUS-B/L EQUAL ON BOTH SIDES

PERCUSSION.                  RT.            LEFT
SUPRACLAVICULAR.     R.             R
CLAVICULAR.               . R.              R
INFRACLAVICULAR.      R.               R
SUPRAMAMMARY.        R.             R
MAMMARY.                     R.            R
AXILLARY                        R.             R
INFRAAXILLARY.              R.            R
SUPRASCAPULAR.        R.           . R
INFRASCAPULAR.         R.              R
INTERSCAPULAR.         R.               R

AUSCULTATION
BREATH SOUNDS
INCREASED VESICULAR BREATH SOUNDS

PER ABDOMEN
SOFT NON TENDER ,NO ORGANOMEGALY
CNS-NFND
DIAGNOSIS
HFPEF WITH LRTI
TREATMENT
1)INJ LASIX 40 MG IV/BD
2)INJ AUGMENTIN 1.2 GM IV/BD
3)TAB AZITHROMYCIN 500 MG PO/OD
4)INJ OPTINEURON 1AMP IN 100ML NS IV /OD
5)TAB.CARDACE 2.5 MG PO/OD
6)SYRUP LACTULOSE PO/TID
7)SYRUP ASCORYL 10 ML PO TID
VITALS MONITORING 4TH HRLY



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