Pulmonary Tuberculosis-Clinical Picture

Examination of the Patient

Before treating the patient it is necessary to make a correct diagnosis of the disease and to determine its aetiology, i.e. the causes of the disease. The doctor must know well the pathogenesis of any disease, i.e. the way and mechanism of its development, as well as the symptoms by which it can be revealed.

A number of different procedures is used to establish a diagnosis: history-taking, physical examination, which includes visual examination, palpation, percussion, auscultation, laboratory studies, consisting of urinalysis, blood, sputum and other analyses; instrumental studies, for example, taking electrocardiograms or cystoscopy, X-ray examination and others.

For determining a disease it is very important to know its symptoms such as breathlessness, edema, cough, vomiting, fever, haemorrhage, headache and others. Some of these symptoms are objective, for example, haemorrhage or vomiting, because they are determined by objective study, while others, such as headache or dizziness () are subjective, since they are evident only to the patient.


Lobular Pneumonia

Patient Smirnov aged 48 was admitted to the hospital with the diagnosis of lobular pneumonia. He had been developing lobular pneumonia gradually. A week before the admission to the hospital he had had bronchitis after which his condition did not improve.

Fever had an irregular course and the temperature changes were caused by the appearance of the new foci of inflammation in the pulmonary tissue. Fever had been persisting for two weeks and had been decreasing gradually.

The patient's breathing was rapid with 30-40 respirations per minute. There was breathlessness and cyanosis of the face associated with the accompanying bronchitis, decrease in the respiratory surface and occlusion of numerous bronchioles and alveoli.

The patient complained of the pain in the chest particularly on deep breathing in and cough with purulent sputum. The pulse rate was accelerated and the arterial pressure wa s reduced

On physical examination dullness in the left lung, abnormal respiration, numerous r a les and crepitation were revealed. Dry r a les caused by diffuse bronchitis were heard all over the lungs. The liver and spleen were not enlarged. The examination of the organs of the alimentary tract failed to reveal any abnormal signs but the tongue was coated.

The blood analysis revealed leucocytosis in the range of 12,000 to 15,000 per cu mm of blood and an accelerated erythrocyte sedimentation rate (ESR).

The urine contained a small amount of protein and erythrocytes. The X-ray examination of the lungs revealed numerous foci of inflammation of various size, irregular form and different intensity. Shadowing was particularly marked at the root of the left lung due to the enlargement of the lymphatic glands.

It was a severe form of lobular pneumonia which was difficult to differentiate from pulmonary tuberculosis and pleurisy. Yet the physician made a correct diagnosis.


Pulmonary Tuberculosis-Clinical Picture

Pulmonary tuberculosis is caused by mycobacterium tuberculosis, which produces characteristic tuberculous changes in the lung. This disease may also affect other organs: bones, joints, lymphatic glands, kidneys, etc. The causative agent of tuberculosis was discovered by Koch in.1882.

In the early stage of tuberculosis the patient usually complains of a general malaise, fatigue, loss of appetite and body weight. Cough may be dry or productive, i. e. with sputum discharge. Coughing becomes worse at night and in the morning. In patients with cavities in the lungs coughing is accompanied by a considerable discharge of sputum.

Sputum is mucopurulent. Its microscopic examination reveals a large number of pus corpuscles, erythocytes, and tuberculous organisms. Blood in the sputum is sometimes the first sign of tuberculosis. If large blood vessels are involved the discharge of blood may become profuse.

Fever is one of the permanent symptoms of pulmonary tuberculosis. In benign processes the body temperature is often subfebrile. In active forms it may range from 38 to 39C. A considerable elevation of temperature is observed in pneumonic forms, when fever persists at a level of 38C and higher for several months.

Cold profuse perspiration at night is sometimes evidence of a severe form of tuberculosis. Loss of body weight is one of the typical signs of pulmonary tuberculosis. It is caused by tuberculous intoxication, a sharp increase in the metabolic rate and loss of appetite. Loss of body weight is.0particularly marked in progressive forms of the disease.


Rheumatic Endocarditis

The patient complained of a general malaise, early fatigue on exertion, cardiac discomfort and palpitation.

The physician found him to have been having an increase of body temperature to a subfebrile level for a prolonged period of time. The patient stated that the onset of the disease had been preceded by tonsillitis. The patient's pulse rate had become irregular and accelerated on physical exertion.

The blood analysis revealed moderate leucocytosis and an elevated ESR. The electrocardiogram showed the changes in the most important readings. On184percussion the doctor determined the heart to be slightly enlarged. These findings of the physical examination were confirmed by the X-ray examination.

While listening to the patient's heart the doctor found a soft systolic murmur to be heard at the heart apex. These symptoms were accompanied by diastole murmur heard at the apex and base of the heart. The doctor estimated the murmurs to be varying in their intensity and duration. It was evidence of an inflammatory process in the valves. The doctor determined the organic changes in the mitral, aortic and tricuspid valves to be clearly marked.

The physician considered the patient to be ill with rheumatic endocarditis and insisted on his following a strict bed regimen at the in-patient department.


Symptoms of Rheumatoid Arthritis
Against the background of rheumatic fever or its inception in severe intoxication, high body temperature, there is an acute or sub-acute inflammation of the joints. Joints are deformed due to the accumulation of inflammatory fluid cavities (synovitis). There is a sharp pain. The affected joints become bent a reflex position.
Temperature of the skin over the joint is increased, diffuse pain, formed nodules under the skin. Quite often observed annular erythema, positive symptom fluctuations, and the knee - floating patella. Srednefalangovye marveling at the joints is very rare.
Blood results show leukocytosis, increased erythrocyte sedimentation rate, the severity of which depends on the severity of the disease, increased levels of fibrinogen, seromucoid, immunoglobulins. In the inflammatory synovial fluid is significantly increased concentration of fibrin, mononuclear cells to 80-95%. For rheumatoid arthritis is characterized by inflammation of the joints decreased visual acuity with the start of treatment with salicylates.



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