Long Case Supervised by Dr. Khaled Fathi Presented by Dr. M. Al-Essa

-Productive cough for 2 months

55 years old male patient,prisoner, heavy smoker for 30 years, present in ER with history of productive cough since 2 months associated with SOB, anorexia & weight loss. In the last week he develop haemoptysis & facial & upper limb swelling

 No Hx of nausea or night sweating  NO Hx of fever.

CVS CVS : NO palpitation, syncopal attack or lower limb swelling. Musculoskeletal: Musculoskeletal: NO joint pain or muscle pain abdomen : abdomen : no abdomenal pain, No jundice. CNS: CNS: no headach,neck pain, focal weakness or convulsion

He work as driver He is single Smoker for 30 years, 1 packet per day No Hx of sexual contact

Dilated veins of superior vena cava drainage decrease movement of the RT side of chest Dullness on RT upper zone Decrease air sound in the RT side

abdomen : soft, lax not distended not tender no ascites no organomegaly no mass pallpable No stigmata of chronic liver disease

summery 55 years old male patient,prisoner, heavy smoker for 30 years, present in ER with history of productive cough since 2 months associated with SOB, anorexia & weight loss.

-Lung cancer - Tuberculoma of the lung -Enlarged mediastinum lymph node.

Patient admitted in MMW in isolation prisoner room with following order:

V/S EVERY 6 HR Normal diet Keep SPO2 >=92% Mantox test Sputum analysis, gram stain, cytology Sputum for AFB 3 sampels Sputum culture HRCT ESR CRP

Start Dexamethasone 4mg TID Ceftriaxone 1gm BID. Enoxaparin 40mg OD