Purulent diseases of the lungs and pleura - Clinical cases Flashcards
A 39-year-old patient complains of coughing up sputum, shortness of breath, hemoptysis, pain in the left side of the chest when breathing, fever up to 39°C, sweating, weakness. He fell ill acutely 10 days ago, when the body temperature increased to 39°C, chills appeared, then the above stated complaints joined. The cough at first was dry, painful, then sputum appeared. Three days before admission to the hospital, the amount of sputum increased sharply, it acquired an unpleasant putrid odor, streaks of blood appeared in the sputum, and pain in the left side increased.
The patient’s condition is serious. The skin is pale, moist. Above the left lung below the angle of the scapula, there is a shortening of the percussion sound, in the same place breathing is weakened with a bronchial tinge, fine bubbling moist rales are heard. Heart sounds are muffled. Heart rate 100 in 1 minute. BP 90/60 mm Hg.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Acute Lung abscess
(Lung Cancer, lung cyst)
A 38-year-old patient was transferred to the thoracic department from the therapeutic department, where he was diagnosed with croupous pneumonia. The condition at admission is extremely serious. The patient is conscious, inhibited. The skin is pale, hot to the touch. Body temperature 38.3°C. RR 26 in 1 minute. When percussion over 9 and 10 segments of the right lung, a dull percussion sound is determined. In the same place, breathing on the right is weakened, with an amphoric shade, a lot of moist wheezing. The patient produces dirty brown sputum up to 400 ml per day. Heart rate 100 in 1 minute. BP 110/60 mm Hg.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Lung Gangrene
( Lung Cancer)
A 41-year-old patient was admitted to the clinic in an extremely serious condition. The patient answers questions with difficulty, is inhibited. Body temperature 39.4 ° C. Heart rate 120 in 1 minute. BP 100/70 mm Hg NPV 26 in 1 minute. The left half of the chest lags behind in the act of breathing. Above 8 and 9 segments of the left lung, a dull percussion sound is determined. In the same place, breathing on the right is weakened, with an amphoric tinge, a lot of moist rales. On examination during coughing, a dirty green phlegm with a fetid odor is released.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Bronchiectasis
( lung abscess)
A 42-year-old patient was admitted to the hospital with complaints of coughing attacks with discharge of purulent sputum with an unpleasant odor up to 100-150 ml per day, an increase in body temperature above 38.5 ° C. The patient 1 month ago was discharged from the therapeutic department, where he was treated for 1.5 months for right-sided community-acquired pneumonia, which was accompanied by prolonged, high fever. The patient was discharged from the hospital, but all the subsequent time his temperature rose to 37.2-37.3 ° C in the evening. Worsening 7 days ago, when the body temperature began to rise again, the weakness increased, and a cough appeared. The patient called the local therapist, took the prescribed antibiotic therapy. Yesterday, against the background of a cough, purulent sputum began to drain.
The patient’s condition is closer to serious. Body temperature 38.4 ° C. Heart rate 96 in 1 minute. BP 105/60 mm Hg. RR 24 in 1 minute. On examination during coughing, a dirty green phlegm with a fetid odor is released. Above the lower lobe of the right lung, the vocal tremor is intensified. With percussion, a dull sound with a tympanic tone is determined. Bronchial respiration, large and medium-sized vesicular rales are also determined there.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Acute Empyema
( lung abscess, lung cancer)
A 43-year-old patient was admitted with complaints of severe cough with sputum discharge, chills, severe weakness, thirst. The patient leads an asocial lifestyle, regularly abuse alcohol and its substitutes. 2 weeks ago, in a state of alcoholic intoxication, he slept on the street all night (the season is autumn). After 2 days, the patient felt chills, weakness, pain in the right side, cough with light sputum. The patient was treated with alcohol. Yesterday the patient lost consciousness at home, after regaining consciousness, he discovered that with a cough, sputum with an extremely unpleasant odor began to stand out. Relatives called an ambulance.
The condition is serious. The patient is emaciated. Body temperature 38.8°C. Heart rate 96 in 1 minute. BP 110/70 mm Hg RR 22 in 1 minute. On examination during coughing, a dirty green phlegm with a fetid odor is released. Above the lower lobe of the right lung, the vocal tremor is intensified. With percussion, a dull sound with a tympanic tone is determined. Bronchial respiration, large and medium-sized vesicular rales are also determined there.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Lung Gangrene
( Lung Cancer)
A 22-year-old patient was admitted to the hospital with complaints of weakness, severe shortness of breath, chills, fever above 38°C, coughing attacks with mucopurulent sputum.
The patient from childhood periodically in spring and autumn had a cough with mucopurulent sputum, subfebrile condition. Over the past 3 years, such episodes have become more frequent up to 4-6 times in 1 year. The patient noted an increase in body temperature up to 37.6-37.8°C. He is under the supervision of a pulmonologist. There is worsening 4 days ago, when the complaints described above appeared again.
On examination, the patient’s condition is closer to serious. Pale skin, fingers in the form of “drumsticks”. Body temperature 38.1°C. Heart rate 96 in 1 minute. BP 110/70 mm Hg. RR 22 in 1 minute. There is a lag and retraction of the left half of the chest during breathing. With percussion: above the left half of the chest, a boxed sound with dullness along the back surface is determined, breathing is hard. On the back of the lungs, medium-bubbling rales are heard, which decrease after coughing up sputum.
In CBC: RBC 3.9 * 1012 / l, HGB 105g / l, HCT 0.29, MCV 74.4 fl, MCH 26.9 pg.
In the general analysis of urine - density 1008, protein 23 g / l
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Chronic Lung abscess
(bronchiectasis, lung cancer, tuberculosis)
A 20-year-old patient was admitted with complaints of pain in the left side of the chest, aggravated by deep breathing, shortness of breath, dry cough. Five days ago, after undercooling, the temperature rose to 38°C and chest pains appeared. The pains were very severe at first, then decreased, but shortness of breath increased.
On admission: a serious condition. The skin is pale. Body temperature 38.6°C. RR 32 in 1 minute. The patient prefers a sitting position. The left half of the chest bulges out, lags behind in breathing. On the back and side surfaces of the left half of the chest, the shortening of the percussion sound is determined, starting from the 3rd intercostal space. Breathing is not performed there. Heart rate 100 in 1 minute. BP 100/65 mm Hg The abdomen is soft, painless, peristalsis is active. Liver 18 * 14 * 10 cm.
With pleural puncture, 900 ml of a cloudy yellowish liquid was obtained. Specific gravity 1023, protein 4.8%, Rivalta test is positive. Microscopy: the bulk is made up of degeneratively changed neutrophils, single macrophages and mesothelium cells.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Pleural Empyema
(Acute purulent pleurisy)
A 44-year-old patient was admitted with complaints of coughing attacks with discharge of purulent sputum of green-yellow color, especially at night, weakness, shortness of breath when walking, body temperature rise once above 38.5 ° C.
For many years, the patient has been troubled by a cough that occurs at night with a difficult-to-discharge viscous sticky sputum. Deterioration in the last 3 weeks, when, after undercooling, weakness and shortness of breath increased, body temperature increased, the amount of sputum increased significantly to 100 ml per day. The patient has been smoking for 28 years.
On examination: a state of moderate severity. The patient is conscious. Skin with a grayish tint. Body weight 65 kg. Body length 181 cm. NPV 20 at rest. A percussion sound with a box shade, hard breathing, scattered dry rales, and large bubbly moist rales are determined in all fields of the lungs.
Questions:
1. Your presumptive diagnosis
2. What diseases should be used for differential diagnosis?
Bronchiectasis
( lung abscess)
