TuberculosisHassan Alibrahim213121096SN: 29

Objectives:

Which two diseases do you consider that are most likely in this case?

Provide arguments in favour of each of the diagnoses that you consider 

Which questions would like to ask him in order to differentiate between each of the diagnoses that you consider? 

• A 48-year-old Caucasian homeless man, is brought to the emergency department. At admission patient appears ill.

• He has complaints of cough and yellow-green sputum with an occasional trace of blood .

• On physical examination : there is shortness of breath.

Case ..

Cont..• He is extremely tired for weeks. and has lost a lot of

weight during the past few weeks.

• The patient has a 40 pack-years smoking history. but has recently stopped smoking spontaneously.

• He has a constant pain near his right scapula which increases with moving.

• He sleeps poorly and has a night sweats.

“The differential diagnosis”

Based on the medical history

Weight loss

Cough

hemoptysis

Shortness of breath

These symptoms are common in

Lung cancer.

Tuberculosis.

Tuberculosis (TB) :

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs of an infected person.

TB is caused by a bacterium called Mycobacterium tuberculosis. 

The bacteria usually attack the lungs, but TB bacteria can attack any part of the body .

Symptoms and Signs of TB

Weight lossNo appetite

A bad cough that lasts 3 weeks or longer

ChillsFever

Cont..

Coughing up blood or sputum

Pain in the chestShortness of breath

Sweating at night

Homeless people are at increased risk of TB

Lung Cancer

Lung cancer is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung.

Causes of Lung Cancer

Smoking The incidence of lung cancer is strongly correlated

with cigarette smoking. About 90% of lung cancers arising as a result of

tobacco use. The risk of lung cancer increases with the number of

cigarettes smoked.

Symptoms of lung cancer

Which questions would like to ask him in order to differentiate between TB and lung cancer

Is there fever?

Is the weight loss is sudden or gradual?

Your exposure to smoke from other people's smoking

Your contact with certain chemicals, such as radioactive dust

What kind of work do you do?

Do you live in overcrowded areas ?

Are taking any medications ?

Do you have a personal or family history of respiratory problems and/or cancer?

Is there any other medical conditions ?

Are you contact with a person who has active TB?

Are you travel to places where TB is common?

Kumar & Clarks, Clinical Medicine , eighth edition (2012)..

The Merck manual nineteenth edition 2011.

MLB Bhatt, Surya Kant,Ravi Bhaskar. Pulmonary tuberculosis as differential diagnosis of lung cancer. South Asian J Cancer. 2012 Jul-Sep; 1(1): 36–42.

References