1601006079
A 46 year old female who is a housewife and a resident of nalgonda came to the Hospital with chief complaints of shortness of breath, and cough since 5 days HISTORY OF PRESENTING ILLNESS- The patient was apparently asymptomatic 5 days back and then she developed shortness of breath which was insidious in onset, gradually progressive, aggravated on lying down and relieved on medication Associated with orthopnea, wheeze and paroxysmal nocturnal dyspnea cough with expectoration since 5 days which was insidious in onset PAST HISTORY- Known case of COPD since 12 years and is on inhaler GENERAL EXAMINATION- raised JVP RESPIRATORY SYSTEM EXAMINATION - Inspection-normal Palpation-normal Auscultation-bilateral decreased breath sounds and bilateral rhonchi and crepitations present at infrascapular and infraaxillary areas CVS EXAMINATION- Inspection-normal Palpation- left parasternal heave palpable P2 apex beat at 5th intercostal space ,lateral to midclavicular line Auscultation - S1,S2 heard L