Question

A 29-year-old newly immigrated woman complains of weakness, shortness of breath, cough and night sweats for the past month. She denies other symptoms, significant medical history or allergies.

• What lab or imaging tests would you order for this patient and give a brief explanation of why?
• From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely”.

Answer 1

INVESTIGATIONS

1)COMPLETE BLOOD COUNT

their will be elevated cell count in any infection

ESR will be raised in infection

2) MICROSCOPY OF SPUTUM SAMPLE

if we are suspecting a pulmonary Tuberculosis ,

stained using the Ziehl-Neelson method — mycobacteria are seen as pink rods against a blue or green background.

3) CULTURE OF SPUTUM SAMPLE

Specimens should be cultured on special media containing nutrients, antibiotics, antifungals and specific growth factors. M. tuberculosis grows slowly and can take three to eight weeks to show visible growth on solid culture media.

4) TUBERCULIN SKIN TEST

The tuberculin skin test (Heaf or Mantoux) is used as a screening test for tuberculous infection

IMAGING

CHEST X RAY

show consolidation,fibrosis in pneumonia

cavitation in case of pulmonary TB

CT - CHEST

for better visualization of lesion in the lungs

2) Differential diagnosis

• pulmonary Tuberculosis

• Actinomycosis

• Aspergillosis

• Bronchiectasis

• Constrictive Pericarditis

• Fungal Pneumonia

• Histoplasmosis

• Lung Abscess

• Nocardiosis

• Non-Small Cell Lung Cancer

• Pott Disease