ANSWERS ON QUESTIONS

Main part

Patient P., 44 years old, consulted a local GP with complaints of coughing

with streaks of blood, which appeared a week ago against the background of complete well-being.

Previously did not hurt. FG annually, the last - a year ago, for additional examination is not

they called. Marks contact with a patient with tuberculosis at work in a refrigerator depot

during a long business trip.

On examination: satisfactory condition. The skin is clean. In the lungs

vesicular breathing, on the right above the scapula in a limited space

single rales are heard. NPV - 19 per minute. Heart sounds are clear

rhythmic. Heart rate - 80 beats per minute. HELL - 120/70 mm RT. Art.

General blood test: red blood cells - 4.0 × 10 12 / l, hemoglobin - 130 g / l, white blood cells -

9.7 × 10 9 / l, eosinophils - 1%, stab neutrophils - 8%, segmented

neutrophils - 59%, lymphocytes - 24%, monocytes - 8%, ESR - 22 mm / hour.

General analysis of urine: straw-yellow color, specific gravity - 1010, acid reaction,

leukocytes - 1-2 in the field of view, epithelium pl. - 1-2 in sight.

In the general analysis of sputum: color - bloody, red blood cells - cover the entire field

vision, white blood cells - single, fresh elastic fibers - single. At

bacterioscopy is dominated by cocci. MBT in sputum bacterioscopically stained

Ziel-Nielsen has not been identified. Diaskintest - infiltrate 12 mm.

FOG gr. cells - the infiltration site is determined on the right in the upper lobe

medium intensity irregularly rounded up to 5 cm in diameter, without clear

contours, heterogeneous structure due to enlightenment about 1 cm in diameter in the center,

with a "path" to the root. The roots are structural. The sinuses are free. Cardiovascular shadow

without features.

The patient was referred to a TB doctor for a consultation.

Questions:

1. Assume the most likely diagnosis in the patient.

2. Give the rationale for your diagnosis.

3. What are the diseases with which to conduct differential

diagnostics.

4. List the clinical and radiological types of infiltrates. Define Type

infiltrate in this patient.

5. Make a treatment plan for this patient and justify your choice.

Situational task 62 [K000241]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 24-year-old man P. went to the clinic with complaints of pain in the right

half of the chest, dry cough, fever up to 38 ° C, weakness.

Considers himself ill for a month, when for the first time after hypothermia

these symptoms appeared. Treated with home remedies. Condition not

improved. Contact with a tuberculosis patient denies. Last FOG a year ago - on

additional examination was not called.

During examination, the right half of the chest lags somewhat in the act

respiration, and with percussion, the blunting of percussion sound in the lower

departments. During auscultation, breathing is not heard here. NPV - 20 per minute.

Cardiac tones are muffled, rhythmic, accent II tone above the pulmonary artery on the left.

Heart rate - 86 per minute.

Complete blood count: red blood cells - 4.8 × 10 12 / l, hemoglobin - 141 g / l, white blood cells -

11.7 × 10 9 / l, eosinophils - 2%, stab neutrophils - 10%, segmented

neutrophils - 67%, lymphocytes - 13%, monocytes - 8%, ESR - 40 mm / hour.

General urine analysis: straw-yellow, specific gravity - 1012, no protein, sugar neg.,

the reaction is acidic, white blood cells - 1-2 in the field of view, flat epithelium - 1-2 in the field of view.

On the chest x-ray in the lower right

Intense homogeneous dimming with an oblique upper boundary from the level is determined

anterior segment of the IV rib to the diaphragm. Slight mediastinal displacement to the left.

The patient was referred to the pulmonary surgical department of the regional tuberculosis

dispensary, where he was performed thoracoscopy with a biopsy of the pleura. Wherein

about 2 liters of straw-yellow pleural fluid were evacuated. Visually

parietal pleura injected, with fibrin and small whitish

tubercles. Histologically detected granulomas with caseous necrosis, surrounded by

a shaft of epithelioid cells, among which there are Langhans cells and

fuchsinophilic sticks.

Questions:

1. Assume the most likely diagnosis in the patient.

2. Give the rationale for your diagnosis.

3. What are the diseases with which to conduct differential

diagnostics.

4. Determine the patient's ability to work.

5. Make a treatment plan for this patient and justify your choice.

Situational task 63 [K000242]