- A 18 yr old male mr.Dinesh kumar coming from guindy who is a student belonging to low socioeconomic status presenting with chief complaints of swelling in the right side of the neck for 8 months
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H/O PRESENTING ILLNESS
- The patient was apparently normal 8 months back after which he developed
- swelling - right side of the neck
- Insidious in onset
- Duration-8 months
- initially small size gradually progressive to attain the current size
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- No h/o pain / discharge
- No h/o evening rise of temperature
- No h/o loss of weight/appetite
- No h/o night sweats
- No h/o trauma
- No h/o cough with hemoptysis
- no h/o epistaxis, nasal block
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- No h/o oral ulcers
- No h/o ear pain, ear discharge,
- No h/o abdominal pain, hemetemesis, melena
- No h/o swollen testis
- no h/o hoarseness of voice
- No h/o difficulty in turning head
- No h/o deviation of tongue
- No h/o frequent fainting
- No h/o difficulty in shrugging of shoulders
- No h/o swelling elsewhere in the body
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PAST HISTORY
- No h/o similar complaints in the past
- No h/o DM/HT/TB/asthma/jaundice
- No h/o previous surgery/hospitalization
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PERSONAL HISTORY
- Consumes non-vegetarian diet
- Normal bowel and bladder habits
- No h/o alcoholism/smoking
- h/o contact with TB patient
- FAMILY HISTORY:
- Father is a known TB patient
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GENERAL EXAMINATION
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- Conscious, oriented
- Poorly built and nourished
- No pallor/icterus/cyanosis/clubbing/pedal edema/generalised lymphadenopathy
VITALS
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- Pulse rate- 74/min normal in rate ,rhythm, volume, character, all peripheral pulses are felt, no vessel wall thickening
- RR-18/min abdominothoracic type
- BP-120/80 mm/hg measured in right upper arm in sitting posture
- Temperature-afebrile
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LOCAL EXAMINATION
- INSPECTION:
- swelling- 2 in numbers swelling I Rt side of neck, lower, along sternocledomastoid in the anterior triangle 5*4cm in size
Extension
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- Upper -3cm from angle of mandible
- Lower-3cm from clavicle
- Medial-3cm from midline
- Lateral-8 cm from midline
- Hemispherical in shape
- Smooth surface,
- Skin over the swelling normal
- No scars, sinuses, dilated veins
- No visible pulsation / cough impulse
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Swelling 2:
- right lower lateral aspect in the anterior triangle
- 3*3 cm Extend : upper-5cm from angle of mandible lower-8cm from angle of mandible medial-8cm from midline lateral-7cm from spine
- Hemispherical in shape
- Smooth surface
- Skin over the swelling normal
- No scars, sinuses, dilated veins
- No visible pulsations/ cough impulse
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- Oral cavity: no growth, no ulcer, dental caries present, poor oral hygiene Nasal cavity: free, septum appears to be in midline Ear : normal, no discharge Scalp : normal
Palpation
- Not warmth, not tender
- Inspectory findings of site, size, shape, extend are confirmed
- Smooth surface, freely mobile
- Skin over the swelling pinchable
- Non tender
- Firm in consistency
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- No fluctuation
- No translucency
- No cough impulse
- No pulsations
- No fixity to skin
- Surrounding areas- normal
- Plane of swelling-deep to deep cervical fascia
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- Percussion: dull note Auscultation : no bruit Movement : no restriction of movement Spine, cranium- normal
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OTHER SYSTEMS
Abdomen : soft, non tender, no organomegaly / free fluid, hernial orifice-free, external genitalia normal CVS- SI S2 heard no murmurs RS-normal vesicular breath sounds heard no added sounds CNS-no focal neurological deficit
DIAGNOSIS
- RIGHT SIDED CERVICAL LYMPHADENOPATHY involving level 3 nodes
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DIFFERENTIAL DIAGNOSIS
- TUBERCULOUS LYMPHADENITIS
- HODGKINS LYMPHOMA
- SECONDARIES NECK
- Syphilis
- HIV
- LEUKEMIA
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INVESTIGATIONS
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- ROUTINE;
- Blood- TC, DC, Hb%, ESR, urea, sugar
- ECG
- RFT
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- SPECIFIC FNAC X-RAY CHEST MANTOUX TEST USG NECK SPUTUM CULTURE, SENSITIVITY ACID FAST STAINING
TREATMENT
- ANTI-TUBERCULAR THERAPY CATEGORY- I INTENSIVE PHASE – 2 MONTHS ISONIAZID RIFAMPICINE PYRAZINAMIDE ETHAMBUTOL CONTINUATION PHASE- 4 MONTHS ISONIAZID RIFAMPICIN
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This download link is referred from the post: MBBS Final Year Case Presentation (Clinical Case Examination, Discussion and Treatment)
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