Renji Hospital affiliated to Shanghai Jiaotong
Mr. zhang , fifty years old, comes to your outpatient clinic because of fever and
coughing with sputum production and recurrent cough up blood for the past 1 week.
1. what are the key symptoms in the case?
2. Discuss the causes and pathogenesis of these symptoms.
3. which disease may lead to the symptoms of Mr. zhang?
4. If you want to give a progressive diagnosis, do you need to ask Mr.zhang some
characteristics of these symptoms and some accompanying symptoms?
On further questioning zhang told you that he has coughed with sputum, coughed up
blood for 1 week. The quantity of blood produced increased the day before he came to
your clinic. The color of blood is fresh red, accompanying with clotted blood. The
amount of sputum production was also increasing accompanying with fever. The body
temperature is 38.5℃.but he didn’t have any accompany symptoms, for example
weight lose, chest pain and breathing shortness. he has smoked 20 cigarettes every
day for 20 years. He also complained of chronic cough with sputum for 10 years. The
amount of sputum is massive , about 100ml/day. He got mealse in childhood. Does
this information change your hypotheses?
1. According to the presentation ,what is the most diagnosis?
2. How many examinations do you need to do for Mr.zhang?
On examination, Mr. zhang is a slim man with a weight of 60 kg and a height of
1.75m. he has pale conjunctiva and fingernails. The body temperatures normal, the
blood pressure is 120/80mmhg. The heart rate is 85 per minute with regular
rhythm,without any murmur. The chest examination shows the shape of the thorax is
normal. There is no tenderness and no mass on chest wall. Auscultation: Hoarse
breath sound is foundede in two lungs accompanying with rales in the botton of two
lungs. There is no edema in the legs. There is no clubbing fingers.
1. How does this information help you in your hypothesis?
2. You order the following investigations:
- blood routine examination
- sputum examination
- chest X ray
- chest CT
Mr zhang comes back 3 hours later. The results are as follows:
1. WBC 12.5*109 BPC 150*109
2. chest X-RAY
1. How does this information help you in your diagnosis?
2. What are you going to do for Mr.zhang?
3. What is the anatomical source for her bleeding?
TUTORIAL 2 .
You prescribe a stop bleeding therapy together with controlling infections and
relieving sputum therapy.
1. What is the biochemical and pharmacological mechanism for this therapy?
2. What is the evidence based approach for this therapy?