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ANSWERS ON QUESTIONS
Main part
Patient T., 48 years old. upon contacting a general practitioner
complaints of weakness, increased fatigue, temperature (in the morning no higher than 37 ° C,
evenings up to 38.5 ° C), shortness of breath on movement, cough with a small amount of mucous membrane
sputum, abdominal pain, loose stools up to 4 times a day.
Anamnesis of life: gastric ulcer for 7 years with frequent
exacerbations. Smokes 1 pack per day. Alcohol is not abused. Earlier
I didn’t have tuberculosis. Contact with a tuberculosis patient denies. FLG regularly.
Last 1 year ago without pathology.
Objectively: a state of moderate severity. The right physique
low nutrition, skin and visible mucous membranes of normal color.
Peripheral lymph nodes are not enlarged. Regular chest
evenly participates in the act of breathing, percussion - shortening of pulmonary sound
paravertebral on both sides, auscultatory - vesicular breathing, with
forced wheezing paravertebrally, forced breathing, more
on right. NPV - 21 per minute. Heart sounds are clear, the rhythm is correct. Pulse - 80 beats per
minute, blood pressure - 120/80 mm RT. Art. The abdomen is of the correct form, with palpation some
muscle tension and pain in the umbilical region, symptoms of irritation
peritoneum absent.
Laboratory data.
General blood test: red blood cells - 3.8 × 10 12 / l, hemoglobin - 105 g / l, white blood cells -
11.2 × 10 9 / l, eosinophils - 1%, stab neutrophils - 7%, segmented
neutrophils - 63%, lymphocytes - 15%, monocytes - 14%; ESR - 38 mm / hour.
Urinalysis: no pathological changes.
General sputum analysis: viscous, mucous, leukocytes - small
quantity.
Analysis of sputum microscopy on KUM (3 analyzes) - KUM not found.
Chest x-ray of the chest in a direct projection: from both
sides totally, but thicker in the upper fields, focal shadows of the middle are determined
intensities, of different sizes, with fuzzy contours, sometimes prone to fusion.
At the level of I-II ribs in both lungs - the decay cavity from 1.5 to 3 cm in diameter. Roots
structural. The sinuses are free. Heart without features.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make and justify a plan for an additional examination of the patient.
4. Define the circle of diseases for differential diagnosis.
5. Define patient management tactics.
Situational task 56 [K000234]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient N. 48 years old for 3 years suffering from diabetes. During
the last 6 months are worried about growing weakness, fatigue, coughing with
phlegm. Periodically notes an increase in body temperature. I didn’t go to the doctor,
since the above complaints are associated with diabetes mellitus. At
another
preventive
fluorographic
survey
identified
pathological changes in the lungs.
X-ray - in the right lung from the apex to the III rib
inhomogeneous dimming with enlightenment in the center of 2 × 3 cm, contours are fuzzy. IN
surrounding lung tissue - focal shadows of low intensity.
In the general analysis of blood: leukocytes - 11.0 × 10 9 / l, stab neutrophils -
12%, segmented neutrophils - 58%, lymphocytes - 19%, monocytes - 11%, ESR - 18
mm / hour
The reaction to the Mantoux test with 2 TE - 11 mm papule. In connection with arising pulmonary
bleeding study of sputum in the office is not made.
Questions:
1. List the diseases that you can think of in this case.
2. Make a diagnosis.
3. Give the rationale for the diagnosis.
4. Explain the low severity of clinical symptoms.
5. Give recommendations for further management of the patient and justify them.
Situational task 57 [K000235]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient M., 33 years old, was transferred to the hospital of the TB dispensary from
infectious diseases hospital in serious condition. For 10 years observed in the center
AIDS, currently diagnosed with HIV infection, stage 4B secondary
diseases, ART phase progression. " Ill sharply a week ago - rose
temperature up to 38 ° С, severe weakness, sweating, shortness of breath appeared at rest,
paroxysmal cough with the release of a small amount of sputum mucosa.
On examination, the skin is pale. The subcutaneous fat layer is weakly expressed.
Ascultation - over the entire surface of the lungs, harsh breathing, no wheezing, NPV - 36 in
a minute. Heart sounds - rhythmic, clear, blood pressure - 90/60 mm RT. Art., heart rate - 122 per minute.
X-ray - in both lungs from the apices to the diaphragm are visualized
multiple small (up to 2 mm in diameter) homogeneous focal shadows of the middle
intensities with fuzzy blurry contours.
Mantoux test with 2 TE PPD-L - negative.
In the general analysis of blood: leukocytes - 15.0 × 10 9 / l, stab neutrophils -
10%, segmented neutrophils - 76%, lymphocytes - 12%, monocytes - 2%, ESR - 46
mm / hour
In sputum, the method of luminescence microscopy does not triple MBT
detected.
Questions:
1. Make a suspected diagnosis.
2. Explain why the patient has a negative Mantoux test.
3. With which non-specific lung diseases should this differentiate
disease?
4. Perform differential diagnosis of the disease with pneumocystis
pneumonia.
5. What is the tactics for further patient management? Justify the answer.
Situational task 58 [K000236]
Дата: 2019-12-10, просмотров: 216.