Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

Patient Yu. 54 years old called an ambulance. Is presenting

complaints of headache, tinnitus.

From the anamnesis it is known that for 10 years there is an increased arterial

pressure. Within six months, unstable blood pressure (fluctuations from 120/80 to 170/110 mm RT.

Art.), accompanied by headaches. My father has hypertension since 50 years.

Smokes a pack of cigarettes for 30 years. Examined in a hospital 5 years ago,

diagnosed with hypertension. Treated irregularly, only during

Captopril took a headache. Yesterday I abused alcohol, late to bed.

This morning, I noticed a headache, tinnitus, flickering of “flies” in front of my eyes,

dizziness. In addition, nausea appeared, once there was vomiting, which did not

brought relief.

Objectively: the condition is satisfactory. Consciousness is clear. BMI - 32 kg / m2

.

Waist circumference (OT) - 106 cm. The face is hyperemic. In lungs, harsh breathing,

no wheezing. NPV - 20 per minute. Heart sounds are sonorous, the rhythm is correct, the emphasis of II tone on

aorta. The left border of the heart is 1 cm outward from the mid-clavicular line. Heart rate - 90

beats per minute, blood pressure - 190/120 mm RT. Art. on both hands. The stomach is involved in breathing

soft, painless, the liver does not protrude from under the costal arch. Symptom

lumbar efflux negative. There are no fathers. Physiological

shipments are not broken. ECG conclusion: sinus rhythm with heart rate - 90 beats per

minute, signs of left ventricular hypertrophy.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Describe the tactics of emergency care in this condition.

4. Make and justify a plan for further additional examination of the patient

and justify it.

5. For subsequent therapy, you would recommend monotherapy or

combination therapy? Justify.

 

Situational task 12 [K000123]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 32-year-old man when contacting a polyclinic with a general practitioner

complains of unformed stool with an admixture of blood up to 10 times a day,

cramping pains in the lower abdomen before defecation, weight loss of 7 kg in 3 months.

From the anamnesis: impurities of blood in the feces and unformed stool bother for 3

months. The temperature did not rise. Contact with infectious patients denies

I didn’t leave the region. He smoked 1 pack of cigarettes a day for 10 years, stopped a year ago.

Alcohol abuse, intravenous drug abuse denied. Relatives

there are no diseases of the gastrointestinal tract. Works as a manager, professional

no harm.

Objectively: the condition is satisfactory. Temperature 36.7 ° C. Skin integument

pale, wet. Height - 175 cm, weight - 58 kg. In lung vesicular respiration, adverse

no breathing noises. NPV - 18 per minute. With auscultation - the rhythm of the heart

correct, the ratio of tones is normal, there is no noise. Heart rate - 98 beats per minute. HELL -

110/70 mmHg Art. (D = S). On examination, the abdomen is symmetrical, participates in the act of breathing. At

palpation is soft, painful in the left flank and left iliac region. Liver

according to Kurlov - 9 × 8 × 7 cm. Dimensions of the spleen - 6 × 4 cm. Urination is free,

painless.

Complete blood count: red blood cells - 2.7 × 1012 / l, Hb - 108 g / l, color indicator -

0.6, platelets - 270 × 1012 / l, white blood cells - 7.0 × 109

/ l, eosinophils - 1%, stab

neutrophils - 2%, segmented neutrophils - 65%, lymphocytes - 27%, monocytes -

5%, ESR - 22 mm / h.

Coprogram: unformed feces, mucus +++, white blood cells - 10-15 in the field of view,

red blood cells - 5-6 in the field of view

Fibrocolonoscopy: mucous membrane of the descending colon, sigmoid and direct

the intestine is diffusely hyperemic, easily bleeds upon contact with a colonoscope,

vascular pattern smeared. In the rectosigmoid section, multiple erosions were detected,

coated with fibrin.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a plan for an additional examination of the patient.

4. Which drug groups are indicated for treating a patient in this situation?

Justify your choice.

5. After 2 weeks of therapy, a decrease in stool frequency to 2 times a day was noted, no

impurities of blood in the feces. What is your further therapeutic tactic? Justify your

a choice.

 

Situational task 13 [K000124]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient E. 23 years old, an auto mechanic, fell ill two weeks ago after hypothermia.

The general practitioner diagnosed acute tonsillitis at the place of residence.

Amoxicillin therapy was recommended for a course of 10 days, but after 3 days in connection

with a significant improvement in well-being and normalization of body temperature treatment

the patient has stopped. Two weeks after these events, the patient noted

the appearance of edema on the face, general weakness and malaise, decreased appetite, appeared

headache, also urine became dark red and its quantity decreased.

Along with the above symptoms, the patient was disturbed by abdominal pain and

lower back. When measuring blood pressure - blood pressure 140/90 mm RT. Art.

On examination: the skin is pale. With auscultation of lungs, breathing

vesicular, no incidental respiratory noise, NPV - 17 per minute. Heart sounds

muffled, the rhythm is correct. HELL - 140 and 90 mm RT. Art. Heart rate - 90 beats per minute.

The abdomen is soft, painless. The dimensions of hepatic dullness according to Kurlov are 11 × 9 × 8 cm.

Diuresis - 700 ml per day.

Conducted laboratory research.

General blood test: hemoglobin - 136 g / l, white blood cells - 10.8 × 109

/ l, ESR - 70

mm / hour

Urinalysis: relative density - 1025, proteinuria - 1.5 g / l,

white blood cells - 14-15 in the field of view, red blood cells - completely cover the entire field of view.

Biochemical blood test: total protein - 62 g / l, albumin - 39 g / l, cholesterol

- 4.5 mmol / L, urea - 5.6 μmol / L, creatinine - 110 μmol / L, GFR - 79.4

ml / min / 1.73 m2

according to CKD-EPI, titer ASL-O - 1: 1000.

Ultrasound of the kidneys: kidneys are enlarged, contours are even, location

typical; differentiation of the parenchyma words is broken, echogenicity of the parenchyma

moderately elevated; pyelocaliceal system without deformations and ectasia.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. What is the patient examination plan?

4. Prescribe the necessary therapy.

5. Indicate in which cases with this disease is carried out

immunosuppressive therapy.

 

Situational task 14 [K000129]