Investigation of TB (physical examination)
Physical examination is an important component of the investigation of tuberculosis (TB). It includes a thorough assessment of the patient's respiratory system, as well as other relevant body systems. The main objectives of the physical examination in TB investigation are to identify any signs or symptoms suggestive of TB, assess the severity and extent of the disease, and monitor the response to treatment.
Here are some key aspects of the physical examination in TB investigation:
1. General appearance: Assess the patient's overall appearance, including their level of consciousness, general hygiene, and nutritional status. In advanced stages of TB, patients may appear cachectic, fatigued, or have a chronically ill appearance.
2. Vital signs: Measure the patient's vital signs, including temperature, heart rate, blood pressure, and respiratory rate. Fever is a common symptom of active TB.
3. Respiratory system examination: Auscultate the chest to assess breath sounds, presence of crackles, rhonchi, or decreased breath sounds. Percuss the chest to assess for dullness, which may indicate pleural effusion. Patients with active pulmonary TB may have abnormal auscultatory findings.
4. Lymph nodes examination: Palpate the lymph nodes, especially the cervical, axillary, and supraclavicular regions. Enlarged and palpable lymph nodes are common in TB, particularly in extrapulmonary cases.
5. Skin examination: Check for any skin lesions, such as ulcers or nodules, which may be present in cutaneous TB or disseminated TB.
6. Abdominal examination: Palpate the abdomen for organomegaly, particularly hepatomegaly or splenomegaly, which can occur in disseminated TB. Ascites may also be present.
7. Central nervous system examination: Assess the patient's mental status, cranial nerve functions, and any signs of meningeal irritation. Meningeal involvement is seen in TB meningitis.
8. Musculoskeletal examination: Evaluate the patient's joints for any signs of arthritis or tuberculous osteomyelitis, which can manifest as pain, swelling, or limitation of movement.
9. Other systems: Depending on the clinical presentation and suspicion of extrapulmonary TB, additional examinations may be performed for specific organs or systems, such as ocular examination for ocular TB, or genital examination for genitourinary TB.
It should be noted that the physical examination alone is not sufficient to diagnose TB definitively. Laboratory tests, imaging studies (such as chest X-ray or CT scan), and microbiological tests (such as sputum culture or acid-fast bacilli smear) are also essential parts of the investigation process.