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

Chest X-ray: in the basal segments of the lower lobe of the right notes blackout homogeneous character.  

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) Case number 11

The patient 43 years old, there is a cough, accompanied by purulent sputum with a foul odor and increased body temperature.

Additional information (provided in the course of solving the problem).

According to the patient, is ill for a month, when doctors found lobar pneumonia. However refused hospital treatment and was at home. She took only aspirin at higher temperatures. Condition did not improve, and increased fever with sweat. Have become more concerned about chills, malaise, dry cough, sometimes chest pain of uncertain character. Since yesterday was a productive cough and sore relieved.

OBJECTIVE: pale skin. Heart sounds. RR - 34 min. Pulse 99 in 1 minute. Heart sounds, rhythmic. When light percussion sound with a touch of the tympanic. Auscultation: Right listened voiced large bubbling rale, bronchial breathing with amforicheskim shade.Body Temperature 38,8 ° C

. - neutrophilic leukocytosis with a left shift, and anemia. General analysis of sputum: a lot of white blood cells and the presence of red blood cells and elastic fibers.

Chest X-ray 'in the right upper lobe clearly defines a cavity with a horizontal fluid level and perifocal inflammatory infiltration of the lung tissue.

 

 

Number	Correct answers	Point
1   4.5 score	-           To what connect your disease?	0.5
	-           Have treatment, what medications were taking?	0.5
	-           Were these drugs are effective?	0.5
	-           Is there any bad habits?	0.5
	-           Observed a rise in body temperature?	0.5
	- Heredity burdened?	0.5
	-           Sputum is what if there is coughing up blood?	0.5
	-           What is the frequency of asthma attacks, a frequent attacks?There were a nightly asthma attacks?	0.5
	-           Are there any allergies to medications and foods?	0.5
2   8 points	- Assess the patient's condition: increase in body temperature to 38,8 ° C	0.5
	- Assess the skin and mucous membranes: pale skin	0.5
	- Rate subcutaneous fat, PERIPHERAL. n / u: without features	0.5
	- Dyhat. syst.: cough, purulent sputum is accompanied by an unpleasant odor.RR - 34 min. When light percussion sound with a touch of the tympanic. Auscultation: Right listened voiced large bubbling rale, bronchial breathing with a touch of amforicheskim	2.5
	- CCC - no complaints, inspection, palpal., Perk. no change of heart, Auska. - Heart sounds are muffled, rhythmic, pulse 99 in 1 minute.	1
	- Food. syst. - No complaints, inspection, palpal., Perk. b / o, liver Kurlov see 9-8-7	1
	- Mochevyd.sist. - No complaints, with m-tapping neg. on both sides, regular urine output.	1
	- Neuro-Endocrinology. syst. - No complaints, shields. gland is not withdrawn., pathological reflexes are not detected	0.5
	- Calculate BMI	0.5
3 6 on Richter scale	Tuberculosis	2
	Lung abscess	2
	Pneumonia	2
4 6 on Richter scale	Tuberculosis	2
	Lung abscess	2
	Pneumonia	2
5   9 points	Kat'... 3.1. In a hovercraft or VENTURE: KLA, OAM, ECG, ophthalmoscopy, measurement of blood pressure and heart rate (. - neutrophilic leukocytosis with a left shift, anemia)	3
	Additional studies: - The general analysis of sputum - Chest X-ray	3
	Expected results: a lot of white blood cells and red blood cells and the presence of elastic fibers R - in the right upper lobe clearly defines the cavity with the liquid level horizontal perifocal and inflammatory infiltration of lung tissue.	3
6 20 points	Diagnosis: Breakthrough lung abscess in the right bronchus.	2
7 5 points	Referred to a pulmonologist Mark dispensary registration	5
8   14 points	-Implementation of preventive and therapeutic measures	2
	-Consultation on healthy lifestyles	2
	Counseling on diet-	2
	-Monitoring of body mass index	3
	Periodic clinical examinations	2
	-Early diagnosis and prevention of complications	3
9       14 points	No drug therapy - Compliance with high-calorie diet	1.0
	- Avoid hypothermia	0.5
	-Refusal of bad habits	1.0
	- Mode of work and rest	0.5
	Drug therapy: 5.        Abaktal 100 w / cap. 6.        Azithromycin 1 h 2p / s (3 days) 7.        Reopoliglyukin 100 w / cap. 8.        Glucose 5% -200 + ascorbic acid 5% -8.0 w / cap	11
10   4.5 score	Primary prevention: - Maintaining a healthy lifestyle	0.5
	- Refusal of bad habits	0.5
	- A balanced diet	0.5
	- Adherence to rest	2
	- Avoid stressful situations	1
4.5 score	Secondary prevention: - An annual maintenance inspection	0.5
	- The struggle with identified risk factors	1
	- Take on the "D" records of newly diagnosed patients	1
	-Treatment of patients with lung abscess drugs of proven efficacy, observing continuity and long-term therapy	1
	- Maintaining the quality of life.	1
4.5 score	Tertiary prevention: - An individual approach to each patient with the definition of dose and timing of the drug for the prevention of complications	2.5
	- Spa treatment	2.5
100

 

 

Number	Conformity Assesssment	excellent	good	Satisfactory	Unsatisfactory	fair
	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
2	Case study	50-43 points	42.5 - 35.5 points	35 - 27.5 points	27-18,5 Grade	18 points

Tests

     Tests

1. In the group of chronic non-specific lung diseases include:              

a) posttuberkulezny fibrosis             

b) chronic obstructive bronchitis             

c) asthma             

g) fibrosing alveolitis             

d) chronic pneumonia

e) chronic lung abscess             

g) lung empyema

 

2. For lobar pneumonia is characterized by:

a) chest pain

b) "rusty" sputum

c) expiratory dyspnea

d) acute onset

d) purulent sputum

e) increase of body temperature

 

3. At the stage of "tide" lobar pneumonia percussion determined:

a) lung sounds

b) sound box

c) the dullness

g) tympanic sound

e) the disappearance of the percussion sound

 

4. Acid-drugs used in, are:

a) methicillin

b) oxacillin

c) ampicillin

d) Penicillin

d) carbenicillin             

 

5. Rational combinations of antibiotics are considered:

a) + ampicillin penicillin

b) tsefamezin plus gentamicin

c) ampicillin plus gentamicin

z) + tetracycline penicillin

d) ampicillin + tetracycline

 

6. In the treatment of pneumonia in pregnancy in the 1st trimester can be used:

a) tetracycline

b) Penicillin

c) Erythromycin

d) chloramphenicol

e) gentamycin

 

7. For lobar pneumonia (unlike focal) characterized by:

a) evidence of overloading the left chambers of the heart on an electrocardiogram

b) marked leukocytosis

c) the detection of toxic grain rare neutrophils

d) signs of stress right heart chambers on the ECG

d) one-way flush on the cheek on the affected side

e) evidence of hypertrophy of the left atrium on the ECG

 

8. More often than in the general population, in alcoholics, there are:

a) pneumonia caused by gram-positive

b) Aspiration pneumonia

c) abscessed pneumonia

g) klebsielleznaya pneumonia

e) Legionella pnenmoniya

e) viral pneumonia

g) with mild pneumonia

 

9. Of the following symptoms for bronchiectasis is characterized by:

a) hemoptysis

b) "drumsticks"

c) paroxysmal hacking cough

d) a significant amount of purulent sputum          

e) wheezing with prolonged exhalation

e) diffuse cyanosis

 

10. The most informative objective clinical evidence for the diagnosis of localized form of bronchiectasis is:

a) localized moist rales srednepuzyrchatye

b) dry rattles

c) the shortening of percussion tones

d) hard breathing

e) localized moist large bubbling rale

e) fine moist rales

g) strengthening voice tremor

Number	Conformity Assesssment	excellent	Good	Satisfactory	Unsatisfactory	fair
1	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
2	test	15-12,9 score	12,7-10,6 score	10,5-8,25 score	8,1-5,5 score	5.4 score

 

4.2.2 Graphic Organizer: chamomile

 

4.3. Practical part

 

The list of skills that GPs should possess after completing training on the subject

3.        Perform a visual inspection of patients with arthritis and arthralgia.

4.        Interpret the ECG and X-ray in patients with arthritis and arthralgia.

"Coughing up phlegm"

Lobular pneumonia, tuberculoma, lung abscess, lung cancer, lung ehinokkok. Different etiologies of pneumonia (bacterial, viral, mycoplasma). Differential diagnosis in diffuse dissemmnatsii. Lobular pneumonia, disseminated form haematogenously-TBA lung pneumoconiosis, cancer metastases.

of stage	Indicators / interpretation	not completed	Achieved in full
	Examination of the patient	0	50
	Complete Blood Count:
	Total urine test
	Acute phase sample
	General analysis of sputum
	Buck. sputum culture
	EKG
	Chest X-ray
	Consultation pulmonologist TB specialist, an oncologist
	Biopsy
	Differential diagnosis	0	2
	The diagnosis	0	10
	Tactics GP	0	10
	Preventive measures	0	10
TOTAL		0	100

 

 

Number	Conformity Assesssment	excellent	good	Satisfactory	Unsatisfactory	fair
1	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
2	Practical part	15 - 12.9 points	12,75-10,6 score	10,5-8,25 score	8,1-5,5-point	5.4 score