Dry cough and severe weight loss
A 55-year-old male came to his family physician complaining of cough since six months. The cough was non-productive. It was persistent throughout the day and also at night, which disturbed his sleep. Over the past three months, he also noticed he had lost 20 kg weight. There was no history of tuberculosis in the past or amongst his family members or friends. There was no history of chest pain, fever, breathlessness or haemoptysis. He was neither a diabetic nor a hypertensive. He was a chronic smoker, smoking 30 cigarettes a day for the past 25 years. He did clerical duties in an office. On examination, the patient appeared cachexic. His vital parameters were normal. His pulse rate was 76 beats per minute, respiratory rate was 22 breaths per minute and his blood pressure was 128/84 mmHg. He was not cyanosed and his accessory muscles of respiration were not active. On examination of his chest, it was observed that both sides of his chest moved equally well with respiration. A dull note on percussion was heard in the right interscapular region. Rest of the lung fields were normal on percussion. On auscultation, localised rhonchi and tubular bronchial breath sounds were heard in the right interscapular region, posteriorly. Normal vesicular breath sounds were heard over rest of the lungs fields. The patient was immediately referred to a specialist. A chest radiograph was urgently done and the patient was admitted to hospital for further investigations and management. (copied from article)
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