Tuberculosis Report111

8/18/2019 Tuberculosis Report111

1/18

UNEVERSITATEA DE STAT DE MEDICINA SI

FARMACIE“ NICOLAE TESTEMITANU “

DIN REPUBLICA MOLDOVA

Department of pneumophthisiology - TB

Represented by :

GROUP :

Date :

http://www.med.umich.edu/intmed/http://www.med.umich.edu/intmed/


2/18

UNEVERSITATEA DE STAT DE MEDICINA SI

FARMACIE“ NICOLAE TESTEMITANU “

DIN REPUBLICA MOLDOVA

Department of pneumophthisiology - TB

Represented by :

GROUP :

Date :

http://www.med.umich.edu/intmed/http://www.med.umich.edu/intmed/


3/18

General Data :

i) Name : Arapu Vlad

ii) Sex :male .

iii)Age : 6 months .

iv) Date of birth : 26/!/2"#

v) $%%upation :&ome sta' .

vi) Address : Stefan Voda

vii) Date of hospitali(ation : "#/"/2"6

V") Defenetive diagnosis: intathoracic lymph node TB progressive phase

Present Complains :

he patient %omplains from dr' %ough *ithout hemopt'sis from

""/"/2"6+ expe%toration+ fatigue+ bad general state+ and intermittent fever

,- degree . A little pain in the %hest + loud breathing sounds + agitation + loss

of apetite


4/18

History of present disease:

he patient started %omplaining from %ough *ithout hemopt'sis+ persistent

fever+ fatigue+ and pain in the %hest pleural involvement). And its dete%ted

b' an a%tive *a' as %onta%t *ith mother *ith D0 1+ performed mantoux

station revealing of induration of " ml + onset of disease *as a%ute in

""."."6 + in 2/"2/2"# *as performed %hest 34ra' and *as revealed right

lung infiltration + *as treated *ith augmantim from 2/"2/2"# till

,"/"2/2"# + after that started *ith %efiruxime from ,"/"2/2"# and themother didn5t bu' the medi%ations and in ""/"/2"6 the %ondition of the

bab' *orsened + as mentioned above he *as in %onta%t *ith his si%7

mother and *as hospitali(ed in his village Stefan Voda) + dete%ted there

some abnormalities in 340A8 + and *as dire%ted to 1 hospital in

9hisinau . he bab' *as va%%inated 2-/!/2"# s%are of 2mm not

ualitative) + and *as born - months + 2-g *eight + *ith big fontanels

about "3" 9

;pidemiologi%al ris7 fa%tor : %onta%t *ith si%7 mother

Objective examination:

i)


5/18

vii) Normal s7in %olour .

viii) Normal elasti%it' + and humidit'.

ix) Normal hair gro*th.

x) Normal sub%utaneous fatt' tissue .

xi) No signs of peripheral edema.

xii) =alpation of the l'mph nodes : normal dimensions + and no pain

during the palpation.

xiii) Normal mus%les and bones stru%ture+ absen%e of inflammation signs

in the >oints

espiratory !ystem

Complains :

Dr' %ough *ithout hemopt'sis+ a little pain in the %hest.

"nspections :

i) thorax is %'lindri%al in shape *ithout deformation

ii) S'mmetri%al right and left sides..

iii)9lavi%les and the shoulder blades are at the same level.


6/18

iv) Supra%lavi%ular fossa eual on both sides .

v) Astheni% %hest

• Palpation :

i) Normal thorax elasti%it' .

ii) Normal %hest si(e and shape.

iii)?arm+ dr' s7in.

iv) No tender spots.

v) S'mmetri%al %hest expansion.

vi) diminished vo%al vibration

Perc#ssion : $O CH%$G&!

espiratory rate : '()min

1. limit of pulmonary

apex

right left

a) anterior 4 cm superior from theclavicule

3 cm superior from theclavicule

b) posterior Spinousus process C 7 Spinousus process C 72. Kronig area cm 4 cm

!imit of inferiorpulmonary

right left

a) parasternal " intercostal

b) me#ioclavicular " intercostal


7/18

c) anterior axillary 7 intercostal 7 intercostal

#) me#ial axillary $ intercostal $ intercostal

e) posterior axillary % intercostal % intercostal

f) scapular 1& intercostal 1& intercostal

g) paravertebral 11 thoracic vertebra 11 thoracic vertebra

'obility of pulmonary base to the me#ialaxillary line

7 cm " cm

• %#sc#ltation :

Aus%ultation reveal : Dr' rales.

Cardiovasc#lar !ystem

Complains :

n%reased heart rate : "2 beats/min

"nspection of the heart region :

i) =resen%e of the normal pulsation in the fifth inter%ostals spa%e mediall'

of the left mid%lavi%ular line.


8/18

"nspection of the peripheral vessels :

i) Normal %arotid pulse + s'n%hronous to the heart beat.

ii) @ugular pulsation + are hardl' noti%eable.

iii)No pathological phenomenon ( swollen arteries ,

pronounced pulsation , turgescent jugular veins , .. ).

• Palpation :

i) Apex beat present in the fifth inter%ostals spa%e + *ith the area of ".#42%m and moderate height and po*er.

ii) No enlargement of the right ventri%le.

Perc#ssion :

i) Normal si(e + position + and shape of the heart .

ii) Normal length of the vas%ular bandle.

iii)Normal heart borders.

iv) &eart %onfiguration


9/18

nter%ostals

Spa%e

0ight eft

9ardia% dullness is not dete%ted 9ardia% dullness is not dete%ted

he vas%ular pedi%le not ex%eed

the lateral border of the sternum

he vas%ular pedi%le not ex%eed

the lateral border of the sternum

At a distan%e of " %m from theright border of the sternum

At a distan%e of ".# %m from theleft border of the sternum

V At a distan%e of .# %m from the

right edge of the sternum

2 %m from the lateral border of

the sternum

V At the right lateral border of the

sternum

$n the mid%lavi%ular line at the

point of the apex beat

• %#sc#ltation :

0egular rate and rh'thm + 0egular S"+S2 + No murmurs *as heard + At the

follo*ing aus%ultation points:

i) he itral valve B At the area of the apex beat.

ii) he Aortal B n the se%ond inter%ostals spa%e + to the right of the sternum.

iii)he =ulmonar' trun7 B n the se%ond inter%ostals spa%e + to the left of the

sternum.

iv) he ri%uspid valve B At the lo*er part of the sternum + near its >un%tion

*ith the xiphoid pro%ess.

v) =oint of ;rb B At the left of the sternum bet*een the ,rd and

thinter%ostals spa%e.

$o signs of cardiovasc#lar abnormalities or diseases*


10/18

Digestive !ystem

• Complains :

No %omplains related to digestive S'stem.

• "nspection :

i) Normal s'mmetri% form and volume of the abdomen.

ii) Normal %olour of the abdomen.

iii)No signs of %aput medusa *as observed.

iv) No presence of surgical scars or other sin a!normalities.

%#sc#ltation :

Creuentl' bo*el sounds are heard in ea%h of the nine regions of abdomen.

• Palpation :

he spleen *asn5t felt during palpation No enlargement of the spleen ).


11/18

+iver and gallbader

• Complains :

pulsation in the right %ostal margin and right upper uadrant not determined

• "nspection :

iver si(e after 9urlov: bet*een point " and 2 to ", %m bet*een point

, and 4! %m bet*een point , and # to - %m. iver protrudes belo*

the %ostal margin *ith about 2 %m.

• Palpation :

iver 2 %m+ *ith a smooth surfa%e+ hard %onsisten%'+no pain.

,rinary !ystem

Complains :

No %omplains related to Erinar' S'stem.

"nspection : - +#mbar region .

i) No s*elling regions *as observed.

ii) Normal s7in %olour.


12/18

iii)No signs of ;dema *as observed.

Palpation : - /idney palpation.

he inferior pole of the right and left 7idne's *as palpated .

&ndocrine !ystem

• he patient didn5t %omplains about pain the level of the th'roid glands + and

no enlargement of the glands *as observed

.

$ervo#s !ystem

• Complains :

No %omplains related to nervous S'stem.

• Conscio#sness :the patient dosen5t sho*s an' %hanges on the %ons%iousness level + respond

to stimuli and spee%h absen%e of letharg' or %oma ) .

• Cranial $erves examination :absen%e of %ranial nerves palsies sign .


13/18

• %#tism : absen%e of autism + normal neural development for this age .

• Cognitive development : the normal %ognitive development for this age + as the mother mentioned

is in the normal range .

• 0eningeal !ign :Absen%e of Nu%hal rigidit' + Fernig5s sign %annot be ele%ted + 1rud(ins7i

sign %annot be ele%ted + so absen%e of meningitis

+aboratory plan and instr#mental exploration

$n x4ra' examination *as sho*n lung tissue of both lung in hilar region

Strengthened+ enlargement of the hilum+ more evident on the right side.

i%ros%opi% examination performed on #.-.2" is negative 4). $n

April another mi%ros%opi% examination *as performed and *as also negative 4).


14/18

*General ,rine %nalysis

G)Erine test anal'sis in general *as in the normal range *ithout sho*ing

an' pathologies.

Prelminary diagnosis :

b intrathora%i% l'mph node + progressive phase infiltration+ dissemination )

Ne* %ase : the pation didn5t git an' anti tb tretmanet at lest one month


15/18

Chest X-Ray :

Conclusion : intrathoracic Tb in the right


16/18

Diferential Diagnosis

Asthma :In asthma characterized wheezing , cough andslight cyanosis , but in asthma there is no fever ,and the exacerbation of asthma is related toallergic exposure ( specially on spring season when pollen is distributed ) , to make a decisivediagnosis for asthma we use an spirometery , andspirometery after β -agonist inhalation . Aspiration O Foreign Body for foreign bodyaspiration it characteristics stridor on inspiration ,and if its impact the right bronchus can lead towheezing , but its di!erent frombronchopneumonia that its exacerbates morerapidly with moderate to severe cyanosis , andepisode of choking and heavy coughing , and in

some situation the parents evidence the aspirationof the foreign body on the mouth of the child .

Croup (laryngotracheobronchitis) in croup

with a mirror laryngoscopy we can observe that

there is edema , redness , and in"ammation

and larynx and sub-glottic region , and in

addition to this with #-ray from lateral view we

can observe a steeple sign of narrowing of the

subglottic region , and patient will present with

stridor and barky cough that is di!erent from

bronchopneumonia .


17/18

Clinical diagnosis :

b of intrathora%i% l'mph node + progressive phase infiltration+ dissemination )AC1 negative. Nr."6"#+ from 2/6/" ne* %ase

*Treatment of the patient : Anti-Biotics for treatment of tuberculosis

Streptomycin 1,2g/day in 3 divided doses I.M , For 1 !ays .

Isonia"id #,#$%g/day in 3 times &or 1 days.

'yra"inamide #,$g/day in 3 times &or 21 days.

(i&ampicin #,1%g/day in 3 times &or 1 days .

Plan of the treatment :

") he patient should be provided *ith %lean fresh air and a good health'

environment.

2) Diet plan that provides the optimum %onditions for the patient rea%tion to the

disease+ ri%h in proteins+ vitamins+ fibres and minerals.

,) Administration of anti41 drugs: his bab' is at 6 months 2g *e

pres%ribe formula H2&0I;J S H &0 H.)

"4sonia(ed: "# mg in the morning

24rifamp%in: "# mg in the morning


18/18

,4prima(imed: ,K# mg in the morning

4streptom'%in: 22# mg in the morning

2 months remain in intensive %are in the hospital follo*ed b' ambulator' period*ith ta7ing isonia(ed and rifampi%in for months and to be monitored *ith

ba%terios%op' for , +#+ 6 months

Tuberculosis Report111

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