The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical and pedagogical faculty

1.Clinical Case

A patient 36 years old, there is a cough with sputum, sweating, fatigue, weight loss and body temperature subfebrnlnaya.

In the words of a patient is sick for 2 months when I started to feel fatigue, sweating and weakness. Gradually began to lose weight and started to bother short, dry coughs. During this period the subfebrnlnaya body temperature (about 37,8 ° C) and increased sweating, especially at night. Recently there was a muco-purulent sputum character. Recently released from prison. Smokes one pack a day, consume alcoholic beverages.

OBJECTIVE: pale skin. Heart sounds. Pulse 98 in 1 minute. RR - 22 to 1. minutes. Auscultation: Right in the middle there is a slight weakening of the departments of vesicular breath and listened voiced fine moist rales. Body Temperature 37,5 ° C

.: 118 g Hb / l, Ar 4 0h10/12 l, L-3,9 x10 / l 9. ESR - 22 mm / h OAM: 100 ml, color w / w, y / - 1019, protein - abs, leukocytes 3-4/1;

X-ray examination of the chest: Right in the middle portion of the shadow infiltrates a diameter of about 5 cm, homogeneous, with blurred boundaries, amid the shadows isolated foci are found, in the shadow of infiltration area is defined enlightenment without clear boundaries, irregular

1.        List at least four diseases are accompanied with cough syndrome

2.        Preliminary diagnosis:

3.        Informative survey methods;

4.        The tactics of the GP (principles of treatment and secondary prevention);

Pneumonia, TBZ, lung cancer BEB	25
Infiltrative pulmonary tuberculosis	25
Kat'... 3.1. In a hovercraft or VENTURE: KLA, OAM (.: Hb 118 g / l, Er-4 0h10/12 l, L-3,9 x10 / 9 liters.ESR - 22 mm / h OAM: 100 ml, color w / w, y / - 1019, protein - abs, leukocytes 3-4/1) Kat'... 3.2.: - Chest X-ray, sputum for mycobacteria TBZ	25
Hospitalization in the tubes. Dispensary (program DOTS)	25

 

 

2.A patient 49 years complains of cough with purulent sputum difficult to separate, shortness of breath, weakness and reduced ability to work.

Sick for the past 5 years. In the words of the patient, cough increases or appears 2 times a year and lasts about 3 months. However, the patient not to move dusty place, as shortness of breath and cough worse. Smokes one pack a day.

Skin and visible mucous membranes of normal color, pulse 92 beats per minute, regular, BP 120X70 mm Hg, respiratory rate 27 per minute. Thorax barrel. Over light percussion sound box. The mobility of the lower edge of the lungs is limited. Auscultation - against a weakened vesicular breathing dry wheezing. Pikfluometriya 430 ml.

PSV from the due amount - 78%. In general blood-leukocytosis. General analysis of urine was normal. ECG was normal. General analysis of sputum: the secret mostly purulent mucous character, contains many neutrophils and macrophages isolated.

Chest X-ray: increased vascular pattern of the roots of the lungs and signs of emphysema.

 

1.        List at least four diseases are accompanied with cough syndrome

2.        Preliminary diagnosis:

3.        Informative survey methods;

4.        Identify the specific changes on chest radiograph

5.        The tactics of the GP (principles of treatment and secondary prevention);

 

 

3.Male 56 years appealed to the SVP and complained of cough with blood-streaked, severe weakness, fatigue, and rapid weight loss, and lack of appetite.

The disease began to cough. Then gradually began to feel weakness and loss of appetite.Then came hoarseness and within a month notes rise in body temperature (daily up to 38 ° C). 2 months has lost 10 kg.For many years smoked 1-2 packs of cigarettes a day.Recently, a cough with blood-streaked.

On examination, pale skin, palpation revealed an enlarged lymph node in the left axilla, respiratory rate 22 per minute, heart sounds are muffled, in the light percussion in the left ribs 3-4 blunting pulmonary sound auscultation left weakened vesicular breathing.

HL-74 g / l; Er 3 1h10/12 l, L-8,5 x10 / l 9. ESR - 45 mm / h .: 200 ml, color w / w, y / - 1019 protein - abs, leukocytes 1-2/1; overall analysis of sputum: atypical cells in sputum.

Chest X-ray: the presence of a rounded education left with fuzzy contours in the apex of the lung.

1.        List at least four diseases are accompanied with cough syndrome

2.        Preliminary diagnosis:

3.        Informative survey methods;

4.        Identify the specific changes on chest radiograph

5.        The tactics of the GP (principles of treatment and secondary prevention), 4.

 

4 Case

The patient 33 years old, there is a cough with "rusty sputum" pain in the right side of the chest and high body temperature.According to the patient, sick 4 days ago after hypothermia, started sharply with the increase in body temperature to 39,8 ° C and cough. First was a dry cough, and then 2 days later was released bloody "rusty" sputum.

OBJECTIVE: pale skin, blush cheeks. Heart sounds, respiratory rate 34 per minute. The right half of the chest behind in the act of breathing. Palpable: enhanced voice tremor on the right bottom. Percussion: the right and back to the lower parts of a dull sound. Auscultation: Right in the lower bronchial breathing. Abdominal pathology were found. Body Temperature 38,8 ° C

.: 118 g Hb / l, Ar 4 0h10/12 l, L-10,8 x10 / l 9. ESR - 22 mm / h OAM: 100 ml, color - s / w, y / - 1019, protein - abs, leukocytes 3-4/1;