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Passport data Name: Bryushinina Dariya Igorievna Gender: female Age: 9 years old (20.10.2004) Date of admission: 08.08.

2013 Clinical diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. Mycobacterim <-ve> Complaints At the time of admission: decreased of appetites . At the time of Supervision: no complaints. Anamnesis Morbi Contact with her sick mother. Her mother receives an outpatient treatment. Patient did not vaccinate with BCG. Primary tuberculosis infection in 2009, Mantoux test was 14mm. History of Mantoux test: 2006-2008; negative 2009- 14mm 2010-15mm 2011- 13mm 2012-13mm 2013-18mm (hypergic) Life history Second child from 9th pregnancy. Pregnancy was full term. Birth weight 3100gr. Did not received breastfeeding Growth and development are according to their ages. Patient had history of frequent viral respiratory infections, chicken pox. Her Mother is suffers from tuberculosis and AIDS <+> Allergic reactions: no. Hereditary disease-absent. Blood transfusion-absent. Injuries and surgeries- absent. Vaccinations- did not receive BCG. Epidemiological. history: lives in a comfortable one-bedroom apartment. The family of 3 persons: 1 child, mother and father. Status Presents · Habitus: Good, patient is calm, conscious, alert with surrounding, no fever(36.5ºC), edema on both legs, mucous membrane pinkish normal, skin normal, extremities normal, no ulcer, hypersthenic constituents, lymph nodes are not enlarged, skeletal-muscular system without pathology.

Pasternatsky’s symptom(palpation on ilioinguinal region): negative * Hemopoietic system: no enlargement of superficial lymph nodes on neck. * Endocrine system: thyroid gland is not palpable. Percussion . tongue is pink. no adventitious sound. no murmur Percussion-normal heart border Palpation-apex beat is at 5th intercostals space midclavicular line. * Urinary system: urine output normal. Percussion-normal liver borders . GCS score 15. * Digestive system: Normal pinkish mucous membrane.vesicular breathing. rhythm. When topographic percussion: Lower Bounds LINE RIGHT parasternalis 4 intercostal/spac e medioclavicul 5 aris intercostal/spac e axilaris 6 anterior intercostal/spac e axilaris 7 media intercostal/spac e axilaris 8 posterior intercostal/spac e scapularis 9 intercostal/spac e paravertebrali 10 s intercostal/spac e LEFT 6 intercostal/spac e 7 intercostal/spac e 8 intercostal/spac e 9 intercostal/spac e intercostal/spac e * Nervous system: Glasgow coma scale. * Respiratory system: Auscultation .symmetrical.· Cardiovascular system: Pulse-78bpm Bp-110/70 Auscultation-dual. Patient is conscious and calm. normal lungs borders.

Palpation: prelium line without protrusion.120g/liter Colour index-0. the epigastric region is slightly hardened.6 x 10^9 Eusonophils-7 Segmented form : 34 Band orm-8 Lymphocyte : 27 Monocyte : 5 ESR= 3 mm/h Urine Analysis Quantity : 50.07 Timolova test.14mm 2010-15mm 2011.13mm 2012-13mm : 0. Labaratory Analysis Blood analysis Erythrocytes-33. and liver.13 AST-0.0 Reaction : acidic Colour : clear Specific gravity : 1013 Protein No of leukocyte per visual field No of fresh RBC per visual field Liver Function test Total bilirubin – 5. palpatable stomach. gallbladder and pancreas.5mmol/l ALT-0. Unpalpatable spleen. on palpation.5.17 :0 :0 . negative 2009.91 Leucocyte : 5. ascending descending sigmoid colon.8 Sputum Analysis MBT <-> Tuberculin skin test History of Mantoux test: 2006-2008.9x109/liter Hemoglobin.

Tuberculosis must be differentiated from adenomas: Hodgkin's disease. the structure is bluured and intensity is increased. Mediastinal tumor-like lesions. X-ray . and calcification on left lung. relative to the structure. Present calcification of right lung. Shadow of enlarged lymph node of bronchopulmonary group of right root lung is clearly seen on tomogram. Also can be distinguished from the thymus hyperplasia. The difference is negative tuberculin skin test. And the need to differentiate from lymphocytic leukemia. which is typical for primary tuberculosis. lymphopenia. thymomas: their distinctive characteristic is that in these pathologies revealed signs of compression in the mediastinum and hormonal variations that are not found in tuberculosis. even if they previously were positive.15 mg x 1 per day . due to reduced immuni. Defined and enlarged lymph nodes bronchopulmonary groups. and a negative reaction to tuberculin.relative neutrophilia. Mycobacterim <-ve> Differential Diagnosis Tuberculosis of intrathoracic lymph nodes must be differentiated from the pathological changes in the mediastinal and hilar. absent BCG vaccination.clear lung fields. Isoniazid 0. Clinical examinations. Clinical Diagnosis By analyzing and comparing the data of complaints (slight intoxication: decrease appetide). The difference: In blood found leukemia blast cells.2013-18mm (hypergic) Dia Skin test 21/6/2013. And on the basis of the findings put a final diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. nonspecific adenopathy. medical history: contact with sick mother. Distinguish these diseases can be the fact that negative result in tuberculin test. Shadow of right root lung is extend more than 4 ribs.21mm 20/8/2013-15mm Chest X-ray No focal inflammation on both lung. the outside countour is dim. Impression. vascular malformations of the chest cavity. Treatment Этиотропная специфическая терапия по I режиму : 1.tuberculosis intrathoracic lymph node in phase of consolidation and calcification.

Good. Body Temperature is 36. heart rate 85 beats / min. 02.15 mg x 1 per day 3.13. soft . active.10. VOLGOGRAD STATE MEDICAL UNIVERSITY Department of Phtysiopulmonology CLINICAL CASE HISTORY . respiratory rate 20/min.09. soft. The condition is satisfactory. The skin is clean.2012.375 mg x 1 per day 4. Complain of Decrease appetite. Prognosis. Vitamin B6 0. The condition is satisfactory. P yrazinamide 0.5 ° C. respiratory rate 22/min.015mg/day 5.5 ° C. Rifampicin 0. Body Temperature is 36.2. active. Polyvitamins Duration of treatment-6 months Diary 29. heart rate 85 beats / min. The skin is clean. Complain of Decrease appetite.

L. Popkova .Patient’s name: : Bryushinina Dariya Igorievna Clinical diagnosis: Tuberculosis of intrathoracic lymph node in phase consolidation and calcification. Mycobacterim <-ve> By: Nur Atikah Mohd Jamil Group No. 33 Supervised by: N.