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Task №2

Patient L. 60, smokes 20 years, complained of marked general weakness, fever to 38.50C, cough with yellow-green sputum, palpitation, shortness of breathing that progresses over several years, increasing during exacerbations of bronchitis, after exercise, inhalation of cold, moist air, sharp odor.

Examination: The skin, mucous membranes pale, gray color. Chest is emphysematous, additional muscles takes part in breathing. The RR 28/min. Heart rate 110/min, BP 130/80 mmHg. Resistance of the chest is enlarged, vocal fremitus is weakened, percussion sound is tympanicus, during auscultation - weakened vesicular breathing, diffused dry rales and wheezing.

The ECG: overload of right atrium. CBC: Er - 4,0 ∙ 10¹² / l, Hb – 4,3∙10¹²/ l, CI – 0,91, Leuk. - 12,0 ∙ 10⁹ / L, eosinophils - 2%, segm. – 77%, lymph. - 10%, mon. - 11%, platelets - 212 ∙ 10⁹ / l, ESR - 31 mm/h. Total sputum analysis: sputum purulent, yellow-green liquid; leukocytes: 52 in visual field, neutrophils: 45 in visual field. Chest X-ray: increased transparency of lung fields, enhanced pulmonary picture, the lower border of the lungs are shifted down. Spirometry: FEV1 - 63%, daily fluctuations -5%, test Tyffno - 65%, a negative test with bronchodilators.

What are the syndromes can be identified in this patient?

What are the mechanisms of dyspnea in this patient?

Recommended literature:

А. Main:

1. Davidson’s Principles and Practice of Medicine, 2006.

Materials for self-control:

А. The questions for self-control:

1. What are the symptoms and syndromes of respiratory diseases do you know?
2. In which diseases can occur dyspnea and what mechanisms of its occurrence?
3. What diseases are accompanied by the development of hemoptysis?
4. What are the main causes of cough?

5.What laboratory methods for diagnosis of respiratory diseases used?
6.What do you know instrumental methods of diagnosing diseases of respiratory tract?

Methodic chart made by M.D. Ostapchuk O.I.

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