Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

A 50-year-old patient consulted a local GP with complaints of almost

persistent painful headaches that cannot be relieved by ordinary

antihypertensive drugs.

On examination: large palms and feet with thick fingers are emphasized (with

additional questioning indicated that she can no longer, as before, wear a model

shoes, since it cannot be matched to size). Head is large with large

protruding ears and rough features. Explicit prognathism. Rare teeth. Tongue

big. Skin with numerous papillomas, greasy, with abundant vegetation

by male type. The heart, according to x-ray data, is enlarged. HELL - 120/80 mm RT. Art.

The pulse is normal. The liver is also enlarged, painless.

Biochemical analysis of blood: without significant deviations from the norm, level

blood glucose - 6.3 mmol / l.

Questions:

1. What is the most likely diagnosis for this patient?

2. Justify your diagnosis.

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

4. What is your further therapeutic tactic?

5. What complications can be expected?

 

Situational task 15 [K000131]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 48-year-old patient woke up at night from pain in the epigastric region,

accompanied by weakness, sweating, nausea. Previously, the pain did not bother

considered himself healthy. An attempt to stop the pain with a solution of soda did not bring relief.

After taking Nitroglycerin under the tongue, the pain decreased, but did not completely disappear.

Nausea, weakness, and sweating persisted. In the morning an ambulance crew was called

help. An ECG revealed a deep Q wave in III and aVF leads; ST segment in

the same leads are raised above the contour, arcuate, goes into negative

tooth T; ST segment in leads I, a VL and from V1 to V4 below the contour.

Questions:

1. What is the most likely diagnosis for this patient?

2. Justify your diagnosis.

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

4. What is your further therapeutic tactic?

5. Indicate contraindications for thrombolysis.

 

Situational task 16 [K000153]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient V., 65 years old, went to the clinic with complaints of general weakness,

poor appetite, difficulty swallowing, shortness of breath with minimal physical

load (getting out of bed, dressing), swelling of the legs, constant, several

increasing in the evening.

Anamnesis of the disease: he considers himself sick about six months, when they became

The above complaints appear. The general practitioner, having discovered jaundice

and pallor of the skin, an increase in the liver, sent the patient to an infectious

suspected viral hepatitis hospital ward.

On examination: the patient's condition is severe, significant pallor and moderate

ictericity of the skin and mucous membranes, puffiness of the face, swelling of the legs are expressed.

Consciousness is clear, speech is slow. Lymph nodes are not enlarged. In the lower parts of the lungs

a small amount of wet rales. Heart enlarged 2 cm to the left of the left

midclavicular line. Heart sounds are muffled, systolic soft noise above

all points. Pulse - 109 in 1 min, rhythmic. HELL - 90/60 mm RT. Art. The tongue is bright red, smooth, with cracks. The liver protrudes 3-4 cm from under the edge of the costal arch,

sensitive to palpation. The edge of the spleen is palpated.

Neurological status: distal hypersthesia, increased deep

tendon reflexes, lower muscle strength of the lower extremities.

ECG data: sinus rhythm, blockade of the right bundle branch block.

Negative T wave in V4-V6 leads.

Blood test: red blood cells - 1.0 × 1012 / l, hemoglobin - 40 g / l, MSM - 110 fL,

white blood cells - 3.6 × 109

/ l, platelets - 150 × 109

/ l, reticulocytes - 0.1%, ESR - 23 mm / h,

stab neutrophils - 15%, segmented neutrophils - 48%, lymphocytes -

31%, monocytes - 4%, eosinophils - 2%, basophils - 0%, anisocytosis (macrocytosis),

poikilocytosis, megalocytes, Jolly bodies, Cabot rings.

Questions:

1. Express the alleged preliminary diagnosis.

2. Justify your diagnosis.

3. Make an additional examination plan.

4. Make a differential diagnosis.

5. Make a treatment plan.

 

Situational task 17 [K000154]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 69-year-old woman consulted a local GP with complaints of

pulsating constant headaches in the temporal areas, decreased vision,

aching pains in the muscles of the shoulders, knee, shoulder, elbow joints, stiffness up to 12

hours of the day, weight loss of 5 kg over the past year.

Anamnesis of the disease: sick for 2 years, began with pain in the joints, muscles,

then joined headaches, decreased vision. Due to increased symptoms

went to the doctor.

Objectively: the condition is satisfactory. Skin and visible

physiological mucous membranes. Dense and convoluted temporal arteries were found,

painful on palpation. Peripheral lymph nodes are not enlarged. Fathers and

There are no synovitis. The vesicular breathing, no wheezing. Heart sounds are clear, rhythmic.

The abdomen is soft, painless.

Complete blood count: hemoglobin - 110 g / l, red blood cells - 3.3 × 1012 / l, white blood cells -

5 × 109

/ l, ESR - 36 mm / h, stab neutrophils - 5%, segmented neutrophils

- 55%, lymphocytes - 34%, monocytes - 4%, eosinophils - 2%, basophils - 0%. SRB - 15

mg / dl.

Questions:

1. Express the alleged preliminary diagnosis.

2. Justify your diagnosis.

3. Make an additional examination plan.

4. Make a differential diagnosis.

5. Make a treatment plan.

 

 

Situational task 18 [K000156]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient S., 22 years old, was sent to a hospital for examination with complaints of

severe weakness, diarrhea up to 3-4 times a day, stools are mushy, without

pathological impurities, weight loss of 5 kg in 6 months, pain in

umbilical region, dry mouth, constant thirst.

The patient considers herself sick for 6 years, when diarrhea first appeared

up to 5-6 times a day, weight began to decrease, swelling on the legs appeared. Periodically

stool normalized while taking antidiarrheal drugs. Patient

notes that stool disorders appeared after eating dairy

products, bakery products, pasta, porridge. It was examined by infectious disease specialists -

infectious pathology is excluded.

General inspection. Moderate severity due to severe weakness,

clear consciousness. Height - 163 cm, weight - 45 kg. The skin is pale, clean, mucous

pale pink. Lymph nodes are painless, not enlarged. The tongue is wet, clean. IN

lungs vesicular breathing, no wheezing. HELL - 100/70 mm RT. Art., heart rate - 75 beats per

minute, the pulse is rhythmic. The abdomen on palpation is soft, participates in the act of breathing,

painful in the epigastric, umbilical region. Liver, spleen not

enlarged. Small swelling of the tibia up to 2/3 is determined.

Laboratory studies: hemoglobin - 89 g / l, red blood cells - 3.72 × 1012 / l,

white blood cells - 6.1 × 109

/ l, platelets - 266 × 109

/ l, ESR - 34 mm / h. Urinalysis - no

features. The reaction of feces to occult blood is negative. Blood glucose: 8:00 - 4,5

mmol / L, 13:00 - 7.0 mmol / L, 22:00 - 11.9 mmol / L. Glycosylated hemoglobin -

9.3%. Biochemical parameters: total bilirubin - 23.8 μmol / l, bilirubin

direct - 2.8 μmol / L, ALT - 69 U / L, AST - 45 U / L, γ-GTP - 25 U / L, alkaline phosphatase -

118 U / L, sodium - 137 μmol / L, potassium - 4.3 μmol / L, creatinine - 44 μmol / L, urea

- 4.3 μmol / l, total protein - 51 g / l, antibodies to gliadin (IgG) - 135 units / ml.

FGDS. Esophagus: the mucous membrane is hyperemic, in the middle and lower third

multiple surface erosion coated with yellow fibrin in the form of “curd

masses, ”the cardiac pulp closes completely. Stomach: contents - mixed mucus

light bile in large quantities. The mucous membrane is moderately hyperemic, folds are not

thickened. The gatekeeper is going through. The duodenal bulb - the mucosa

smooth, intestinal villi absent, hyperemic, edematous, bile in the lumen.

Proctologist consultation: complaints of recurrent diarrhea, sometimes with

an admixture of mucus. Sigmoidoscopy. No pathological changes

revealed.

Questions:

1. Express the alleged preliminary diagnosis.

2. Justify your diagnosis.

3. Make an additional examination plan.

4. Make a differential diagnosis.

5. Make a treatment plan.

Situational task 19 [K000158]