An elderly chinese gentlemen with a background hx of parkinson disease come to the A&E with dyspnea, fever and reduce counciousness since 2 days ago.
On examination he was dyspnoeic with RR of 28 + use of accessory muscle + course crepts + bronchial breath sound + pleural rub over the left upper zone.
What is your differential for pleural rub? - one MO ask...
- pleurisy - secondary to pneumonia or pulmonary infarction
- rare - pleural malignancy, spontaneous pneumothorax, pnemodynia
- cogwheel / plastic / leadpipe rigidity - ↑ tone with interrupted nature → muscle give way → jerks
- due to exagerated stretch reflex interrupted by tremor
- eye - 4
- motor - 1
- verbal - 1
- = 6
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