75 yr old male with Chronic bronchitis

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A 75 yr old male patient came with 

C/O cough with expectoration since 15 days

C/O loss of appetite since 15 days

C/O lethargy since 15 days

C/O difficulty in swallowing to solids > liquids since 15 days

H/O PRESENT ILLNESS:

Patient was apparently asymptomatic 15 days back then he had cough with expectoration,whitish in colour,scanty in amount not associated with any diurnal variation/postural change.

Cough is not associated with SOB ,pedal edema,orthopnea or PND .

From 15 days patient is having difficulty in swallowing to solids > liquids .

Patient is lethargic and is having loss of appetite and constipation.

No H/O any fever,vomitings,loose stools,pain abdomen,chest pain,palpitations.

PAST HISTORY :

Diabetic and Hypertensive since 20 yrs

Post CABG status (8yrs back)

Patient is on Glimi M2,Metformin + Vildagliptin

PERSONAL HISTORY:

Diet : Mixed

Appetite : Lost

Bowel and bladder movements : Regular

Sleep : Adequate

Was a chronic smoker and stopped smoking 10 years ago

GENERAL EXAMINATION:

No pallor,icterus,clubbing, lymphadenopathy pedal edema

VITALS :

BP : 110/70 mmHg

PR : 96 bpm

Temp : afebrile

SpO2 : 96% @ Room air

SYSTEMIC EXAMINATION :

CVS : S1S2 + ,No murmurs

RS : BAE +,NVBS +,No dyspnea,no wheeze

P/A : Soft , Non tender

CNS : NAD

PROVISIONAL DIAGNOSIS :

Chronic Bronchitis with HFrEF (secondary to CAD)

with post CABG ( 9 yrs ago )

with dysphagia with DM and HTN.