Pulmonary tuberculosis causes symptoms like cough, fever, night sweats, and weight loss. Diagnosis involves tests on sputum or other samples to look for tuberculosis bacteria, including staining, nucleic acid amplification, or culture. Chest x-rays may also show changes. Treatment involves several months of multiple antibiotic medications.

1. https://www.healthline.com/health/pulmonary-tuberculosis#Symptoms3(SUGGESTEDREADING)
PULMONARY TUBERCULOSIS
CLINICALFEATURES INVESTIGATION TREATMENT
 Diurnal fever&nightsweats
 Weightloss
 Anorexia
 General malaise
 Weakness
 Cough – nonproductive &limitedtomorning
 purulentsputum,sometimeswithblood
streaking
 Hemoptysis –20-30% of cases
 Pleuriticchestpain
 Dyspnea
 Systemicsymptoms:-
 Fever( low-grade andintermittent)
 Pallor,fingerclubbing
 Mild anemia,leukocytosis,thrombocytosis,
slightlyelevatedESR+/- CRP
CLINICAL PRESENTATION OF PULMONARY
TB:
 Chroniccough,oftenwithhemoptysis
 Pyrexiaof unknownorigin
 Unresolvedpneumonia
 Exudative pleuraleffusion
 Asymptomatic(diagnosisonCXR)
 Weightloss,general debility
 Spontanouspneumothorax
CRITERIA
 unexplainedcough > 2-3 weeks (particularlyin
regions where TB is prevalent) @ typical chest
X-ray changes
• Diagnostictest
• Tuberculinskintest:low
sensitivity/specificity
• Stain– ZN-- Auramine
fluorescence
• Nucleicacidamplification
• Culture – solidmedia
(LJ media)
-- Liquidmedia
• Pleural fluid:adenosine
deaminase
• Response toempirical
Anti-TBdrugs(usuallyseen
after5-10 days)
Pulmonary
• Sputum*
• BronchoscopywithwashingorBAL
• Gastric washing*(children)
* = at least2, butpreferably3,includingearly
morningsample
Extrapulmonary
• Fluidexamination
• Tissue biopsy
• Investigation:
• No abnormalitiesdetectablebychest
examination(mostly)
• Others– rhonchi (duringinspiration,after
coughing) andamphoricbreathsounds

2. PULMPNARY HYPERTENSION (https://www.mayoclinic.org/diseases-conditions/pulmonary-hypertension/diagnosis-treatment/drc-20350702)
CLINICALFEATURE INVESTIGATION TREATMENT
 Breathlessness
• Chest pain
• Fatigue
• Palpitation
• Syncopetant signs:
• Elevation of JVP
• Parasternal heave
• Accentuation of the pulmonary
component of S2 and right ventricular S3
1. ECG
• Rightventricular‘strain’pattern
• rightaxisdeviation
• rightatrial enlargement
• rightventricularhypertrophy
2. ChestX-ray
• Enlargementof central pulmonary
arteries
• Ass. Withvascularpruning
• Cardiomegaly- Rightatrial &
ventricularenlargement
3. CT scan
Same as chestx ray
4. CT angiogram
• Evaluate acute thromboembolicdisease
5. ventilation-perfusionscanning
• Showsseveral segmental orgreater-sized
perfusiondefectinthromboembolism
• Qualifyingptforsurgical intervention
OTHER TESTS
- initial tests:bloodcounts,PT,PTT& liver
profile.
- antinuclearantibodies,rheumatoidfactor,
SCL- 70 antibodies
- HIV ELISA
- arterial bloodgas
- sleepstudies
- pulmonaryfunctiontest
MEDICATIONS
 Blood vessel dilators (vasodilators)-
epoprostenol
 Endothelin receptor antagonists -
bosentan
 Sildenafil and tadalafil - Sildenafil and
tadalafil
 High-dose calcium channel blockers.-
amlodipine , diltiazem and nifedipine
 Anticoagulants. - warfarin
 Digoxin.- Digoxin
 Diuretics.- Commonly known as water pills,
these medications help eliminate excess
fluid from your body. This reduces the
amount of work your heart has to do. They
may also be used to limit fluid buildup in
your lungs.
 Oxygen.
SURGERIES
 Atrial septostomy
 Transplantation.