Question

Topic: Pleurisy dry and exudative: symptoms and syndromes based on clinical-instrumental and laboratory methods of study. Syndrome of fluid and air accumulation in the pleural cavity in pathology of the respiratory system

Objective 1. Patient S. 25 years old, has complaints of severe pain in the left half of the chest, exacerbated by deep breath, lack of air. He first felt sick 3 days ago, noticed a one-time increase in body temperature to 37,5°C. On examination: rapid superficial breathing, the left half of the chest is slower in the act of breathing. Clear pulmonary sound is determined by percussion. During auscultation, there is a pleural friction sound to the left, it is louder in the armpit. The pain increases with inhalation, decreases with lying on the side of pain. In the general clinical blood test - moderate leukocytosis, ESR - 17 mm / h.
Questions:
1. What is the diagnosis?
2. What (all) data will the doctor receive when auscultating the patient's lungs with this pathology?
3. How can you distinguish the pleural friction sound from the pericardial friction sound?
4. What is the normal respiratory rate? What is the respiratory rate of rapid breathing?
5. What are the possible causes of this disease.
Task 2. Patient M., 33 years old, has complaints of chills, fever up to 38,5°C for 3 days, dry cough, pain in the right half of the chest. The pain is exacerbated by breathing and coughing. Objectively: the skin is pale, the lips are cyanotic, the respiratory rate is up to 30 per minute, the right half of the chest is enlarged in volume, the intercostal spaces are smoothed. Percussion - dull sound to the right below the scapula. During auscultation of this area - there are no breathing sounds.
Question:
1. What is the diagnosis?
2. What is the percussion sound in the upper lobe of the patient's lungs?
3. What data will you have in auscultation of the upper lobe of the right lung of this patient?
4. What additional examination methods will help you confirm the diagnosis?
5. What is Damuazo Line?

Task 3. Patient D., 49 years old, has severe shortness of breath that appears with the slightest movement and infrequent dry cough. The left half of the chest is slower in the act of breathing, the intercostal spaces are smoothed. There is no vocal fremitus to the left from the 4-th rib along all the topographic lines. At percussion on this area defines absolutely dull sound. There is no breathing sounds in this area during auscultation. Bronchophonia – there is no sound in this area . The Traube space is not defined.
Question:
1. What pathological syndrome can you think of?
2. What additional research methods will help in making the diagnosis?
3. How to determine the nature of fluid in the pleural cavity?
4. What instrumental or laboratory study will allow to exclude tumor etiology of pleurisy?
5. What changes occur in the lung tissue above the 4-th rib?

Answer 1

Ans) 1) Possible symptoms include pleuritic chest pain, dyspnea, and a dry, nonproductive cough. The chest pain associated with pleural effusion is caused by pleural inflammation of the parietal pleura resulting from movement-related friction between the two pleural surfaces. Pleuritic chest pain may be localized or referred. So, the diagnosis is pleural effusion.

2) Dullness to percussion, decreased tactile fremitus, and asymmetrical chest expansion, with diminished or delayed expansion on the side of the effusion, are the most reliable physical findings of pleural effusion. Mediastinal shift away from the effusion. This finding is observed with effusions of greater than 1000.

3) Pleural rubs are discontinuous or continuous, creaking or grating sounds. The sound has been described as similar to walking on fresh snow or a leather-on-leather type of sound. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub.

- A pericardial friction rub is a rough scraping sound described as "leather rubbing against leather" that may be heard in systole and/or diastole. It is more pronounced if the patient is supine, and diminishes as the patient sits forward.

4)A normal breathing rate for an adult at rest is 8 to 16 breaths per minute. For an infant, a normal rate is up to 44 breaths.

- Rapid breathing of over 20 breaths per minute in adults. slow breathing of under 12 breaths per minute in adults.