Pulmonary Tuberculosis. Clinical Picture

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Pulmonary Tuberculosis. Clinical Picture

Pulmonary tuberculosis is caused by mycobacterium tuberculosis, which produces characteristic tuberculous changes in the lung. This disease may also affect other organs: bones, joints, lymphatic glands, kidneys, etc. The causative agent of tuberculosis was discovered by Koch in 1882.

In the early stage of tuberculosis the patient usually complains of a general malaise, fatigue, loss of appetite and body weight. Cough may be dry or productive, i.e. with sputum discharge. Coughing becomes worse at night and in the morning. In patients with cavities in the lungs coughing is accompanied by a considerable discharge of sputum.

Sputum is mucopurulent. Its microscopic examination reveals a large number of pus corpuscle, erythrocytes, and tuberculous organisms. Blood in the sputum is sometimes the first sign of tuberculosis. If large blood vessels are involved the discharge of blood may become profuse.

Fever is one of the permanent symptoms of pulmonary tuberculosis. In benign processes the body temperature is often subfebrile. In active forms it may range from 380C to 390C. A considerable elevation of temperature is observed in pneumonic forms, when fever persists at a level of 380C and higher for several months.

Cold profuse perspiration at night is sometimes evidence of a severe form of tuberculosis. Loss of body weight is one of the typical signs of pulmonary tuberculosis. It is caused by tuberculous intoxication, a sharp increase in the metabolic rate and loss of appetite. Loss of body weight is particularly marked in progressive forms of the disease.


Task 7 Read and translate the sentences using corresponding English equivalents of the terms given in brackets:

1 It is sometimes difficult to make a correct diagnosis (на ранніх ступенях) of some diseases.

2 (Втрата апетиту) is a very important symptom, which a physician must always pay attention to.

3 (Підвищення температури) has been persisting for several months since it was a pneumonic form of tuberculosis.

4 Dullness in the lungs, accelerated respiration, dry or moist râles and crepitation may be (свідченням) of lobular pneumonia.

5 (Різке збільшення) of the number of leucocytes is often the evidence of a certain inflammatory process in the human body.


Home Assignments 3

Task 1 Use the proper tense forms to translate the sentences into English in writing:

1 При тяжких формах пневмонії температура зазвичай тримається на рівні 380С.

2 Зараз у цього хворого температура 380С внаслідок важкої форми пневмонії.

3 У цього хворого температура утримується на рівні 380С вже протягом місяця.

4 Хворий завжди дотримувався постільного режиму при серцевих нападах.

5 Хворий дотримувався постільного режиму, коли в нього стався серцевий напад.

6 У зв’язку із захворюванням серця хворий дотримувався постільного режиму протягом трьох тижнів.

Task 2 Define the root in the terms and translate them into Ukrainian:

intoxication, allowance, changeable, clearly, uncomplicated, disappearance, remarkable, unprotective, senselessness, thickness, warmth, ineffective, enlargement.


Task 3 Form the nouns (1), the adjectives (2), the adverbs (3), the verbs (4) with the same root and translate them:

1) accomplish, accumulate, investigate, pass, perspire, present;

2) protect, effect, change, move, pain, poison, produce, response;

3) loud, exact, mild, quiet, rapid, separate, severe, sharp, smooth, sudden;

4) accomplishment, complicated, considerable, unexpected, elevation.


Task 4 Choose the right answer:

1 What forms of tuberculosis are accompanied by a subfebrile temperature?

a) benign forms of tuberculosis;

b) pneumonic forms of tuberculosis.

2 What kind of sputum has the patient with tuberculosis?

a) it is purulent; b) it is mucopurulent.

3 The evidence of what form of tuberculosis may cold profuse perspiration at night be?

a) it may be the evidence of a benign form of tuberculosis;

b) it may be the evidence of a severe form of tuberculosis.

4 What erythrocyte sedimentation rate has the patient with lobular pneumonia?

a) it is slow; b) it is accelerated.

5 What does the X-ray examination reveal in case of lobular pneumonia?

a) it reveals a marked shadowing in the lungs;

b) it reveals a cavity in the lungs.

Task 5 Fill in the blanks with “what”, “which”, “whose”, “when”:

1 … treatment is indicated if a patient has a severe form of lobular pneumonia?

2 … may the patient’s erythrocyte sedimentation rate be accelerated?

3 … of the following symptoms is characteristic of tuberculosis: a bad headache, cough with mucopurulent sputum or a coated tongue?

4 Thanks to … scientific investigations was mycobacterium tuberculosis discovered?


Task 6 Read the text using a dictionary. Learn the words in bold type. Entitle the text. Write down irregular verbs and give their basic forms. Get ready to discuss the text. Give the English equivalents of the following word combinations:

симптоми, типовi для первинного туберкульозу; в ураженій легенi; клiнiчнi прояви; позитивна проба; ущільнення легеневої тканини; перкуторний звук.


Primary tuberculosis usually begins in childhood and affects the lungs and bronchial lymphatic glands of the lung roots. Primary tuberculosis may not give any clinical manifestations and is revealed only by a positive Pirquet’s and Mantoux’s tests and X-ray examination. Loss of appetite, short periods of fever, slow growth, and loss of weight may be some of the symptoms characteristic of primary tuberculosis.

Physical examination sometimes reveals consolidation of the pulmonary tissue. A shorter percussion sound and a small number of dry and fine moist râles are heard in the involved lung.

A favorable course of primary tuberculosis leads to the formation of a Ghon’s focus. In unfavorable cases primary tuberculosis may lead to an extensive inflammation.


Home Assignments 1

Task 1Read the sentences paying attention to the translation of various forms of the Infinitive:

1 I know this surgeon (him) to operate on successfully.

Я знаю, що цей хірург (він) оперує успішно.

2 I know this surgeon (him) to have operated successfully.

Я знаю, що цей хірург (він) прооперував успішно.

3 I know this patient (him) to be operated on at our clinic.

Я знаю, що цього хворого (його) прооперують у нашій клініці.

4 I know this patient (him) to have been operated on successfully.

Я знаю, що цього хворого (його) успішно прооперовано.

Task 2Study the rules of formation Complex Object:


Noun (Pronoun) + Infinitive (Participle)

Ex.: I want you to come at five.


Complex Object is used after the following verbs:

a) expressing wish: to want, to wish, to desire, should like, would like;

b) expressing expectation: to expect, to think, to believe, to suppose, to consider, to find;

c) expressing order: to order, to command, to ask, to allow;

d) the verbs of perception: to see, to hear, to notice, to feel, to watch, to observe;

e) the verbs to force, to make.

In this case, the Infinitive as a part of Complex Object is used without particle to.

Ex.: I felt the pain become less.

The doctor made the patient lie down.

Task 3Read the following sentences and find Complex Object in them:

1 I expected my sister to be operated on as soon as her temperature returned to normal.

2 The physician wanted my mother to be following a bed regimen for several days.

3 The cardiologist considered the electrocardiogram waves to have changed after the heart attack.

4 The physician supposed the intensity of the shadow in the lung to decrease after the treatment.

5 The investigator observed the primary manifestations of the disease be associated with the reduction of the number of erythrocytes.

6 The surgeon noticed the amount of pus in the mucopurulent discharge from the wound have been decreasing.

7 The examiner saw the marked shadowing in the lung have areas of various intensity.

8 I heard this patient coughing badly at night.

9 We watched the patient’s condition gradually becoming worse.

10 We saw typical signs of intoxication associated with the over-dosage of this poisonous drug appearing gradually.


Task 4 Learn the following words and word combinations:

palpitation– сильне серцебиття

onset– початок

precede – передумовити

moderate – помірний

readings– покази (обладнання)

slight– слабкий, незначний

confirm – підтверджувати

murmur– дзюрчання; шелестіти

duration – тривалість

insist on – наполягати на

strict– суворий


Task 5 Read the text. Find and translate the sentences with Complex Object. Entitle each paragraph. Write down the English equivalents of the following word combinations:

при фізичному напруженні, чітко виражений, на верхівці серця, змінюватися за щільністю та тривалістю, наполягати на дотриманні постільного режиму.

Rheumatic Endocarditis

The patient complained of a general malaise, early fatigue on exertion, cardiac discomfort and palpitation.

The physician found him to have been having an increase of body temperature to a subfebrile level for a prolonged period of time. The patient stated that the onset of the disease had been preceded by tonsillitis. The patient’s pulse rate had become irregular and accelerated on physical exertion.

The blood analysis revealed moderate leucocytosis and an elevated ESR. The electrocardiogram showed the changes in the most important readings. On percussion the doctor determined the heart to be slightly enlarged. These findings of the physical examination were confirmed by the X-ray examination.

While listening to the patient’s heart the doctor found a soft systolic murmur to be heard at the heart apex. These symptoms were accompanied by diastole murmur heard at the apex and base of the heart. The doctor estimated the murmurs to be varying in their intensity and duration. It was evidence of an inflammatory process in the valves. The doctor determined the organic changes in the mitral, aortic and tricuspid valves to be clearly marked.

The physician considered the patient to be ill with rheumatic endocarditis and insisted on his following a strict bed regimen at the in-patient department.

Task 6 Answer the following questions:

1 What most characteristic clinical manifestations does rheumatic endocarditis have?

2 What readings does the electrocardiogram show in case of rheumatic endocarditis?

3 How can a therapeutist determine the enlargement of the heart?

4 How can systolic and diastolic heart murmurs be revealed in patients with rheumatic endocarditis?

5 What regimen must a patient with rheumatic endocarditis follow?


Task 7 Learn the following words. Translate the sentences with the new words:

insufficiency– недостатність

Cardiac insufficiency was diagnosed in this patient.

eliminate – усувати, знищувати

The pain was eliminated due to the administration of this drug.

nourish– живитися

to be well nourished – бути добре нагодованим

The patient was a well nourished male.

tablespoonful–столова ложка

You must take a tablespoonful of this medicine.

preparation– препарат

Adonis preparations are administered in case of rheumatic endocarditis.

follow-up– віддалений результат; диспансерний облік

The patient was followed up at the out-patient department.

The follow-ups did not reveal any pathologic signs.

You must come for the follow-up examination in a month.


The recurrence of the disease was rather unexpected.

Home Assignments 2

Task 1 Translate the following terms with the same root:

sufficient недостатній, недостатність, достатньо

locate розташований, місцевий, розташування

involve уражати, ураження

prepare препарат, підготовлений

limit обмежений, обмеження


Task 2 Divide the complex words into the components and translate them:

toothache, cardiovascular, tablespoonful, earache, stomachache, breastbone, gallbladder, overdosage, headache.


Task 3 Translate the following sentences paying attention to the words in bold type:

1 Суворий постільний режим послідував за діагнозом серцевої недостатності.

2 За приступом болю в грудях настала загальна слабкість.

3 Після рецидиву ревматичного ендокардиту хворий знову потрапив до лікарні.

4 Аби простежити віддалені результати у хворого, лікар викликав його до поліклініки кілька разів.

5 У деяких хворих, які стоять на обліку, були виявлені несприятливі зміни у печінці.

6 Усі хворі з підозрою на рак повинні проходити подальші обстеження регулярно.


Task 4 Change the sentences using Complex Object:

1 The X-ray examination confirmed (that the patient had) organic changes in the mitral, aortic and tricuspid valves.

2 The physician determined (that the primary focus of infection had been eliminated) due to antibiotic therapy.

3 Physicians consider (that the loss of weight is) one of the typical signs of pulmonary tuberculosis.

Task 5 Change the sentences using participial constructions:

1 (to have been treated) with Adonis preparations for several weeks the patient stated that his breathlessness had decreased.

2 (to have listened) to the patient’s heart the doctor believed him to suffer from cardiac insufficiency.

3 (to be fed) with the nourishing diet containing many vitamins the patient began to gain weight.


Task 6 Learn the following words:

note – помічати

radiate – випромінювати(ся)

frequently – часто

incidence – кількість випадків

overstrain– перенапруження

disturbance – розлад, порушення

diminish– зменшувати(ся), послабляти

deviate – відступати від норми

adequate– відповідний

rise (rose, risen) – підніматися


Task 7 Translate the following word combinations:

the pain radiated to the back; considerable disturbances of metabolic rate; a frequent sharp pain in the substernal area; the diminished waves of electrocardiogram; marked deviations in the electrocardiogram readings; the overstrain may produce nervous system disturbances; to administer an adequate dose of this preparation.

Task 8 Read the text. Find and translate the sentences in which a) Complex Object is used; b) the word “one” is used and define its function. Write down 1 question to each paragraph. Make up a plan of the text.

Angina Pectoris

On being admitted to the in-patient department the patient complained of pain in the chest.

He had been suffering from pain of various intensity in the chest and behind the breastbone for several weeks. The patient noted the pain to radiate to the left shoulder and down the arm. The patient also observed the pain have been growing worse on moving and on physical exertion. He stated that it frequently began suddenly at night during sleep.

During the attacks of pain he was covered with cold perspiration and his face was pale. The incidence of attacks was frequently associated with physical and mental overstrain.

On physical examination the doctor revealed areas of very sensitive skin from the 7th cervical vertebra to the 5th upper thoracic one. On percussion, palpitation and auscultation of the heart no significant abnormality was revealed.

The electrocardiogram taken during the attack showed a disturbance in the coronary blood circulation. The most important readings of the electrocardiogram were either diminished or deviated. By having repeated the electrocardiogram after the end of the attack the cardiologist found the adequate readings of the electrocardiogram to return to normal ones.

During the attacks of moderate pain no changes in the peripheral blood or elevation of body temperature were noted. However the temperature rose insignificantly and there was an accompanying slight leucocytosis when the attacks of pain were particularly severe.

The doctor made the diagnosis of angina pectoris with a severe course. Its main cause was atherosclerosis of the coronary arteries.

Home Assignments 3


Task 1 Group the words according to the parts of speech (in writing):

various, severity, hospitalize, doubtful, radiation, favourable, sensitive, incidence, measure, disturbance, frequently, slightly, duration, characterize, improvement, eliminate, rupture.


Task 2 Group the words with the same root (in writing):

dilate, disturb, eliminate, unit, different, dilated, union, eliminated, differ, recurrence, dilatation, disturbance, elimination, unite, recur, difference, undilated, unity, disturbing.

Task 3 Read and memorize the facts:

Do you know that:

1 At rest the blood makes a complete circle in our body within 20 – 25 seconds?

2 Within 70 years of life the human heart contracts about 2.5 milliard times and pumps 145 million litres of blood?

3 At rest the human heart pumps 4 litres of blood per minute but on great exertion 40 litres?

4 The man can live without water for 10 days and without food for more than a month?


Task 4 Remember the reading of the following terms:

academician, coronary, defect, biochemical, manipulation, interval, characterize, hypothermia.


Task 5 Learn the following words and word combinations:

suffer from – страждати на

congenital– природжений

besides– окрім; крім того

failure – зупинка; порушення

heart failure – раптова зупинка серця

fibrillation – фібриляція

arrest– затримка; зупинка

damage– пошкоджувати

result in – призводити до

result from – бути наслідком

danger – ризик

exclude – виключати

bandage – пов’язка

incision– розтин


Task 6 Read and translate the following words and word combinations:

1 Сongenital: congenital disease, congenital heart defect, to suffer from a congenital heart defect.

2 Failure: heart failure, cardiac failure, to reveal heart failure, to prevent the development of heart failure.

3 Result: to result in the impairment of heart function, the inflammation resulted from infection.


Task 7 Learn the following word combinations paying attention to the prepositions:

in the presence of, to result in, to result from, to be operated on for smth, to be preceded by, a damage to some organ, because of a bad state, within a certain period of time


Task 8 Put up questions to the given answers:

1 Yes, there are about ten main kinds of congenital heart defects which can be treated both therapeutically and surgically.

2 Yes, heart defects result in the impairment of heart functions and the changes in its anatomical structure.

3 Yes, heart failure may occur during the operation on the heart.


Task 9 Read the text. Find and translate the sentences a) with the construction “it is … that”; b) with the predicate in Perfect Continuous; c) with the pronouns used instead of the nouns. Write the English equivalents of the following word combinations:

за наявності цих порушень, вада серця, виявлення шумів серця.


Cardiosurgery has been developing successfully in our country. The beginning of its development was marked by the first operation on the heart performed by Academician Bakulev. It is due to the work of such prominent surgeons as Vishnevsky, Meshalkin, Petrovsky, Amosov, and others that great progress has been achieved in cardiosurgery. The lives of many thousands of people suffering from cardiac diseases and from those of coronary vessels have been already saved.

The operations on the heart are performed to eliminate the existing heart defects, congenital or developed, and to restore the normal function of the heart.

The operation on the heart is preceded by various examinations, which enable the surgeon to make a correct diagnosis. The most important ones are listening to the heart, its X-ray examination, electrocardiograms, the revealing of heart murmurs, and clinical and biochemical blood analyses. Only having made an exact diagnosis and having come to the conclusion that the therapeutic measures have been ineffective the surgeon can perform the operation on the heart.

The operations on the heart are very difficult to perform because of the intricate anatomical structure of the heart and because the heart constantly contracts.

Some operations are performed on the contracting heart, but such operations give the surgeon only a very short period of time for his surgical manipulations. Besides in such cases there is always the danger of the impairment of cardiac functions such as heart failure, fibrillation and others. In the presence of these impairments complete or partial arrest of blood circulation develops.

Such intervals of blood circulation result in the damage to some organs, for example, the brain can live without blood supply only four-five minutes; if the interval is longer the brain cells die.


Task 10 Write annotation to the text.


Home Assignments 4


Task 1 Find the predicates, determine their tense form and translate the sentences:

1 The life of the girl was saved thanks to a successful operation for a congenital heart defect.

2 On his first admission to the hospital the patient complained of palpitation and discomfort in the chest.

3 The patient had numerous foci of inflammation in the left lung before he underwent the streptomycin treatment.

4 The girl has had heart murmurs since the age of seven and no therapeutic measures were effective in their elimination.

5 On palpation the physician determined that the liver was considerably enlarged.


Task 2 Choose the right ending to complete the sentence:

1 The doctor wanted …

a) the heart failure to develop frequently;

b) the patient to be followed-up at the out-patient department.

2 The nurse made …

a) the patient take bromide to control his sleeplessness;

b) the heart be excluded from the blood circulation.

3 The surgeon ordered …

a) the patient’s wound to be bandaged immediately;

b) the intensity of the inflammatory process to be reducing gradually.

Task 3 Group the following terms according to the parts of speech:

a) nouns b) adjectives c) verbs d) adverbs

rupture, dangerous, incision, fibrillation, congenital, recurrence, eliminate, strictly, bandage, failure, extensive, frequently, evidence, sensitive, radiate, disturbance, damage, accelerate, feverish, deviate, insufficiency, slightly, duration


Task 4 Determine the function of the word “that” and its meaning:

1 The doctor expected that the disturbances in blood circulation would be eliminated by the administration of atropine.

2 The patient that is undergoing the course of treatment for rheumatic endocarditis will be followed up for several months.

3 That the inflammatory process would involve new areas in the lungs was clear at the onset of lobular pneumonia.

4 That child’s life was saved after cardiosurgeon had made the operation eliminating the congenital heart defect.

5 Subfebrile temperature accompanied by cold perspiration may be the clinical manifestation of tuberculosis and that of chronic rheumatic endocarditis.

Task 5 Answer the following questions:

1 What most characteristic clinical manifestations is lobular pneumonia accompanied by?

2 What treatment is administered to the patient with lobular pneumonia?

3 What is the causative agent of tuberculosis?

4 What do you know about primary tuberculosis?

5 What course is lung abscess characterized by?

6 What are the patient’s complaints in case of rheumatic endocarditis?

7 What treatment can you administer a patient with rheumatic endocarditis?

8 Describe a severe attack of angina pectoris.

9 What methods of performing operations are employed in cardiosurgery?


Task 6 Read the text. Write down the English equivalents of the following word combinations:

зовнішні ознаки, профілактичні заходи, розумове перевантаження, міцний сон.

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