tuberculosis

cases

Case 1
 G.A.,

32 y/o female, married, housewife  Non-smoker  No history of PTB, BA, diabetes

1

month- on and off productive cough of whitish phlegm (+)occasional undocumented fever (+) weight loss 10% - self-medicated with amoxicillin for 5 days with no perceived improvement consulted rural health unit

 Family

history: - Widow, a mother of 2 small children - Shares house with parents and other siblings - Father is a smoker with prominent chronic cough

 Pertinent
   

Physical examination

 

BP: 100/70 CR: 92 RR:20 T: 37.8 Asthenic, not in respiratory distress No cervical adenopathy appreciated Chest: symmetrical chest expansion, harsh breath sounds Abdomen: scaphoid, soft, no organomegaly EXT: no edema, no cyanosis, no clubbing

 Is

pulmonary TB a good consideration in this case? Why? is the diagnostic test recommended under the NTP for this patient?

 What

 Sputum

AFB x 3 takes

Day 1: +1 Day 2: +2 Day 3: negative
 How

reliable is this test and what is the significance of the results?

 What

is the diagnosis at this point?

 Do

you need other diagnostic tests? What does the NTP say?

CXR-PA

 What

is the recommended treatment for this case? do you implement the therapy?

 How

 When

do you know that the patient is cured? How do you document cure?

CASE 2
 J.T.,

58 y/o male, smoker (30 pack- yrs)  Office worker

2

yrs PTA- on and off cough with febrile episodes
-consulted a local health center - Sputum AFB apparently (+) - Started on anti-Koch’s medication for free - Religiously took meds for 2 months but discontinued since he apparently became well and because he has to go to the health center everyday to get medicine

 

 

1 year PTA- recurrence of cough 4 months PTA- increase frequency of cough (+)weight loss (+)progressive dyspnea (+)febrile episodes 1month PTA-progression of s/s now with bloodstreaked sputum Few hrs PTA-coughed out about 3 tbsp per bout of fresh blood

Consulted health center

 Pertinent
    

physical examination

 

Conscious, coherent, weak-looking, cachectic BP: 90/60 CR: 105/min RR: 22/min T: 37.1C (+) pallor (-) CLAD (-)NVE Chest: symmetrical chest expansion, decreased breath sounds, crackles on both lung fields more on the right Abd: scaphoid, no organomegaly, no masses (-)clubbing (-)cyanosis

 Should

we suspect TB in this case?

Why?

 What

is the next diagnostic test you would order in the health center?

 Sputum

AFB x 3 takes

Day 1: +3 Day 2: +2 Day 3:  How

reliable is this test and what is the significance of the results?

 What

is the diagnosis at this point?

 Do

need other diagnostic tests? What does the NTP say?

CXR-PA

Please interpret

 What

is the recommended treatment for this case? do you implement the therapy?

 How

 When

do you know that the patient is cured? How do you document cure?

 What

are the other things this patient needs?

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