Вы находитесь на странице: 1из 20

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
 Ispulmonary TB a good consideration in this
case? Why?

 What is the diagnostic test recommended


under the NTP for this patient?
 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?

 Doyou need other diagnostic tests? What


does the NTP say?
CXR-PA
 Whatis the recommended treatment for this
case?

 How do you implement the therapy?

 Whendo 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 blood-
streaked 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
 Whatis the recommended treatment for this
case?

 How do you implement the therapy?

 Whendo you know that the patient is cured?


How do you document cure?
 What are the other things this patient needs?

Вам также может понравиться