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? 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?

Test tasks:

1. The main symptoms of dry pleurisy are: A) cough with sputum, fever up to 40 ° C; B) dry cough, pain in the lateral parts of the chest that worsens during inhalation; C) deep breathing, chest pains irradiating into the left shoulder; D) pain in the right hypochondrium spreading under the right scapula; E) feeling heavyness and dull chest pain.

2. Palpation data of the chest in a patient with dry pleurisy are: A) pain at Vallee points; B) increased vocal fremitus; C) vocal fremitus is unchanged; D) vocal fremitus is weakened or absent; E) feeling of chest tremor while breathing. 3. Data of comparative lung percussion in a patient with dry pleurisy. The sound is: A) dullness (blunted); B) dull; C) clear pulmonary sound; D) tympanite; E) dull tympanitis.

4. What changes can be detected in a patient with dry pleurisy during topographic percussion? A) decrease in active lung mobility on the affected side; B) displacement of the lower border of the lungs downwards; C) displacement of the lower border of the lung upwards; D) wide Krenig fields; E) decrease in height of apex of lungs.

5. What pathology of the pleura is characterized by the presence of hemorrhagic exudate? A) lung abscess; B) focal pneumonia (bronchopneumonia); C) pneumonia crouposa; D) the tumor or its metastasis into the pleura; E) bronchiectasis.

6. What data can be detected during static examination of patients with exudative pleurisy? A) reduction of the affected side, reduction of its size; B) smoothing of the intercostal spaces, enlargement of the affected half of the chest; C) shortness of breath, objective signs of dispnoe; D) lag of the affected half of the chest in the act of breathing; E) participation of additional muscles in the act of breathing.

7. What data can be detected during dynamic examination of the chest of patients with exudative pleurisy? A) enlargement of the affected half of the chest; B) smoothing of intercostal spaces; C) the lag of the affected half in the act of breathing; D) increased lung excursion on the affected side; E) wide Krenig fields.

8. The patient has exudative pleurisy. What changes can be detected with palpation of the chest above the fluid area? A) palpation equivalent of pleural friction sound; B) increased vocal fremitus; C) reduction of vocal fremitus D) reduction or disappearance of voice tremor; E) slight increase in vocal fremitus.

9. Where is the highest point of the Sokolova-Alice-Damuazo line: A) parasternal line; B) mid-clavicular line; C) anterior axillary line; D) medial axillary line; E) posterior axillary line.

10. What are the changes in the percussion tone over the Gauhfus-Grocko triangle? A) tympanic sound; B) dullness (blunted); C) dullness (blunted ) tympanitis; D) dull; E) clear pulmonary sound.

11. What is the auscultation data over the Garland triangle? A) pleural friction noise; B) moist rales; C) increased vesicular respiration; D) weakened vesicular respiration; E) bronchial (or vesiculobronchial) respiration.

12.What amount of fluid is released every hour into the lumen of the pleural cavity: A) 10 ml of liquid; B) 30 ml of liquid; C) 50 ml of liquid; D) 100 ml of liquid; E) 500 ml of liquid.

13. Pleural effusion can be detected when its volume in the pleural cavity more than: A) 200-300 ml; B) 300-400 ml; C) 400-500 ml; D) 500-600 ml; E) 1000-1200 ml.

14.When the fluid level rises 1 rib above (by percussion or x-ray), the fluid volume in the pleural cavity is increased up to: A) 100ml; B) 200 ml; C) 300 ml; D) 400 ml; E) 500 ml.

15. What symptoms become major if fluid volume increases in a patient with exudative pleurisy

A) dull aching chest pain that localizes in the area of fluid accumulation;

B) acute chest pain that is localized in the area of fluid accumulation;

C) moist cough;

D) dry cough without sputum

E) shortness of breath;

F) leg swelling;

G) heartbeat.

16. What are the periods in the development of exudative pleurisy?

A) exudations;

B) proliferation; C) stabilization;

D) resorption;

E) transudation;

F) chronicity;

G) mechanization.

17. Light's criteria for determining exudate is

A. a ratio of the protein level in the pleural fluid to a similar serum level is more than 0.5;

B. a ratio of the protein level in the pleural fluid to a similar serum level is more than 0.2;

C. the ratio of the LDH (lactate dehydrogenase) level in the pleural fluid to the serum level of the LDH is more than 0.6;

D. a ratio of the LDH level in the pleural fluid to a serum level is more than 0.3;

E. the level of LDH in the pleural fluid is more than 1/3 of the upper limit of serum LDH;

F. the level of LDH in the pleural fluid is more than 2/3 of the upper limit of serum LDH;

G. a positive Rivalt’s test.