Question

And has a low-grade fever, persistent cough, night sweats and unexplained weight loss over the last two months. She has no history of cigarette smoking. She has coughed up blood several times in the past two days. Routine lab tests are within normal limits. Her chest x-ray shows lesions in her lungs. What is a reasonable pulmonary diagnosis? What is the significance of the skin test?

Answer 1

Symptoms including a persistent cough, night sweats, and lesions in the lungs suggest tuberculosis, with the significance of a skin test being its ability to detect TB infection.

Step-by-step explanation:

The symptoms of a low-grade fever, persistent cough, night sweats, unexplained weight loss, and coughing up blood, along with lesions in the lungs observed on a chest x-ray, are highly suggestive of a diagnosis of tuberculosis (TB). Tuberculosis is a serious pulmonary infection caused by the bacterium Mycobacterium tuberculosis. The significance of a skin test, specifically the tuberculin skin test (TST) or Mantoux test, lies in its use for the detection of a tuberculosis infection. A positive skin test indicates that the person has been infected with TB bacteria; this is important even if the person does not have active TB.

Other diagnoses could include lung cancer or a fungal infection, but the mention of night sweats and coughing up blood makes TB a likely candidate, especially if the patient has a history of exposure to TB, such as travel to a high-prevalence area or contact with infected individuals.

To conclusively diagnose TB, further tests such as a sputum culture for acid-fast bacilli and a nucleic acid amplification test should be conducted. The final answer in two line explanation in 300 words would include discussing the symptoms that align with TB and explaining the importance of the skin test and additional diagnostics for a thorough assessment.