ANSWERS ON QUESTIONS

Main part

A young man of 18 years turned to the clinic with complaints of increased

fatigue, loss of appetite, weight loss, intermittent subfebrile condition, obsessive

cough. These symptoms appeared after SARS and intensified over 1.5 months,

despite antitussive and antibacterial therapy. Deterioration in well-being

during the last week: fever up to 38 ° C, increased cough with sputum,

the appearance of shortness of breath. Preventive fluorography 2 years ago, detected

single foci of Gon.

From the anamnesis: contact with a father with tuberculosis who died from tuberculosis 1

a year ago. In a TB dispensary, it was never observed.

Anti-epidemic measures in the outbreak were not carried out. Living conditions

dysfunctional, lives with his mother in a communal apartment. Smokes for 5 years.

Objectively: moderate state, body weight - 50 kg, symptoms are expressed

intoxication, BH - 30 per minute, pallor, acrocyanosis. Percussion - shortening the sound

in the upper and middle sections, intermittent wet rales over all pulmonary

by fields.

Radiological: focal dissemination in all pulmonary fields from both

parties, mainly in the upper and middle sections. Outlines of foci are fuzzy, foci

merge into focal shadows, with areas of enlightenment.

He was hospitalized in a TB hospital.

Immunodiagnosis: Mantoux test 2 TE - papule 12 mm, Diaskintest - papule 10

mm

The study of sputum at the office microscopically - neg. Sowing method BACTEC -

growth of rifampicin and isoniazid resistant MBT.

Questions:

1. Formulate a diagnosis.

2. Justify the diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. What necessary preventive measures have not been taken to this

to the patient?

5. What features will specific chemotherapy have for a given patient?

Justify the answer.

Situational task 67 [K000247]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 20-year-old patient, a student, was admitted to the therapeutic department with complaints of

pain in the left half of the chest, shortness of breath, fever up to 39 ° C.

Anamnesis: for three months noted increased fatigue, weakness,

weight loss, fever to subfebrile digits, stitching pains under the left

shoulder blade, which was regarded as neuralgia. Well-being worsened sharply after

hypothermia, cough without sputum, shortness of breath with a small load, pain and

chest tightness associated with breathing, fever. A year ago

had contact with a relative suffering from tuberculosis with the Office (+).

On examination: moderate severity. Pallor, shortness of breath with BH - 30 per minute in

peace. Pulse - 110 beats per minute, satisfactory filling. Heart sounds

clean. The left half of the chest lags in the act of breathing, intercostal

the gaps are smoothed out. Shortened percussion sound above the lower ones

parts of the left lung, voice trembling is weakened, breathing in these parts is not

bugged. From the side of the abdominal organs - without features.

Clinical blood test: hemoglobin - 120 g / l, red blood cells - 4.8 × 10 12 / l,

leukocytes - 5.0 × 10 9 / l, stab neutrophils - 8%, segmented neutrophils -

66%, eosinophils - 1%, lymphocytes - 18%, monocytes - 7%, ESR - 35 mm / hour.

Urinalysis: no pathology. R-Mantoux with 2 TE: 17 mm papule. Diaskintest -

papule 15 mm.

Chest x-ray: homogeneous shading noted

lower parts of the left pulmonary field and costo-diaphragmatic sinus. Shading

has an oblique upper boundary going from top to bottom and from the outside in.

Questions:

1. Formulate a presumptive diagnosis.

2. Justify the alleged diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. What laboratory findings of pleural fluid testing will benefit

tuberculous etiology of pleurisy in this patient?

5. Assign a chemotherapy regimen if there is no detection of MBT in

pathological material.

Situational task 68 [K000248]