The Case of the Practical Work of the Family Doctor

Shut S. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The patient M, 24 years old, engineer 12. 12. 2013 appealed to the consultation to the Chair of Inter-nal Diseases Propaedeutics and General Practice-Family Medicine with nursing and complained about weakness, periodic fever up to 37.40С, sweating at night. From an anamnesis of illness it is known that from December 5 to 13 December 2013 were treated for acute bronchitis. After treatment continued to bother periodic increase of body temperature to 37, 40 С, weakness, body weight has decreased for 15 kg. In the reason of there is no any positive effects from treatment he asked for a consultation. From life anamnesis – in 2008 he suffered a sore throat and DNA of virus Epstein-Barr was indentified. An objective examination showed the general condition of the patient is satisfactory and consciousness is. The body structure is correct, hyperstenics, body weight is 69 kg, height is180 centimeter, body temperature is 37, 20 С. Skin color is normal. The subcutaneous fat layer is moderately developed; the lymph nodes are not enlarged. Muscles are evenly developed, their tone is saved, and there is no any pain during palpation. Chest is of normoste-nik form; both parts of chest are symmetric. Auxiliary muscles do not take part in the act of breathing. The number of breaths is15/min. On palpation the chest is resistant; there is no pain in different areas. A voice tremor has not changed. At comparative percussion of the lungs the light clear pulmonary sound is indentified. At auscultation of the lungs on symmetric chest the strengthened vesicular breath is heard. Active and passive excursion (the distance at which the low edge displaces) is within norm. Creditarii, noise of pleural friction is not detected. Bronchophony on symmetric parts of the chest is saved. The pulse is the same on both hands, 76 beats for a minute, rhythmical and satisfactory filling. Blood pressure is 110/70 mm of mercury column on both hands. At Percussion of the heart the borders of relative and absolute dullness are indentified. Borders of relative and absolute dullness of heart are not changed. The width of a vascular bundle is 5 centimeters. Configuration is ordinary. At auscultation of the heart the cardiac sounds are rhythmical and sonorous. The noise is absent. The tongue is of normal size, moist, pink color, yellow-tinged, the tonsils are not enlarged. At examination of the abdomen in the supine and standing positions its configuration is standard; at palpation it is soft and painless. The pancreas is not palpated. The dimensions of the liver under Kulov are 8 x 7 x 6 centimeters, the dimensions of the spleen are 9 x 6 centimeters. At palpation of the lower liver edge at the edge of a costal arch is painless. The edge of the spleen is not defined. The kidneys are not palpated, the Pasternatsky symptom is negative. At pressing on the suprapubic area the pain is not noticed. The general blood analysis shows: hemoglobin – 126 gram for a liter, erythrocytes – 4. 39 Ч1012 for a liter, leuco-cytes – 5.0 x 109 for a liter, ESR – 53 mm for an hour. The blood analysis on blood glucose, general urine analysis, biochemical blood analysis is without features. On fluorogram from 25.10.2013 the heart and lungs are without pathological changes. On electrocardiogram: sinus rhythm, heart rate is 66 beats per 1 min., electrical axis of heart is of S1 –S2 –S3, there is focal bundle branch block. The ultrasonic examination of abdominal cavity organs shows within norm. Under the examination data the x-ray of lungs and consultation of phthisiatrician were prescribed. On review x-ray from 30. 11. 13 there is the mediastinal tumor. In the reason at examination the massive process in the lungs was indentified, the patient was directed to the Regional Oncology center for further consultation. After the carried inspection, examination, computer tomography it was found out the mediastinum thymoma, Hodgkin lymphoma that shows the need of thoracotomy to clarify the diagnosis. On 26. 13. 13 the thoracotomy and biopsy of the tumor was carried out on the right and. The final diagnosis is confirmed: Toma mediastinum. Hodgkin lymphoma of un-specified Genesis, limfogranulematose, II B stage, II clinical group. The disease belongs to the group of diseases related to malignant lymphomas. The main cause of its occur-rence is not clear enough, but some epidemiological data suggest the infectious nature of this disease, namely a virus (the Epstein-Barr virus). A gene of the mentioned virus is detected by special research of 20-60% biopsies. Hodgkin lymphoma disease can occur at any age, however, there are two peaks of incidence: at the age of 20-29 years old and older than 55 years. The main criterion for diagnosis is the detecting the giant Berezovsky – Sternberg cells or Hodgkin cells in the biopsy, which are removed from the lymph nodes. Patient was told to go through che-motherapy. Specific clinical case remains us again that with the purpose of indentifying each symptom and to carry out adequate therapy you should do really full study of it.

family doctor, clinical case, examination

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«Bulletin of problems biology and medicine» Issue 2 part 3 (109), 2014 year, 212-214 pages, index UDK 61:614. 25