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USMLE CS Cases: Pulmonary TB

Discussion in 'USMLE' started by Egyptian Doctor, Jun 11, 2019.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    History :
    HPI: 45 yo M c/o coughing up blood. Patient reports hemoptysis suddenly started 2 days ago. There
    has been 2 episodes in which streaks of blood were noticed when he coughed. Patient had cough for
    1 month, productive, yellowish/greenish sputum, foul smelling. There is no chest pain or dyspnea.
    There is no fever but patient reports evening rise of temperature with sweating. Patient reports
    unintentional weight loss of 5 lb in 2 weeks.
    ROS: Patient travelled to Africa 3 months ago where he volunteered in the health camps.
    PMH/PSH/Allergies: None
    Medication: Prophylactic Antimalarial before going to Africa.
    F/H: father died of MI, mother has osteoarthritis.
    S/H: non-smoker, non alcoholic, no recreational drug, sexually active with wife, social worker.
    Physical Examination :
    Patient is NAD.
    HEENT: no exudate, no erythema, no LAD/thyromegaly.
    Lungs: Chest expansion normal B/L, BS normal B/L, no tactile fremitus.
    Diagnosis 1 :
    Pulmonary Tuberculosis
    Diagnosis 2 :
    Bronchiectasis
    Diagnosis 3 :
    History Findings Physical Exam Findings
    1) Hemoptysis
    2) evening rise in temperature, night
    sweats, unintentional weight loss
    3) Recent visit to Africa where he
    volunteered in health camps
    History Findings Physical Exam Findings
    1) Hemoptysis
    2) cough for 1 month with foul smelling
    yellowish greenish sputum
    Diagnostic Study/Studies - Labs
    1) CBC with differential
    2) Xray chest
    3) sputum ZN stain, culture/sensitivity
     

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