Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

Patient Z. 22 years old complains of weakness, dizziness, increased

fatigue, bouts of severe pain in the right hypochondrium.

Anamnesis of the disease: from 11 years the patient notes a recurring

yellowness of the skin, alternating with pallor. These bouts

accompanied by severe weakness. In the past 8 years, the patient began to bother

pain in the right hypochondrium of paroxysmal nature, accompanied by jaundice.

Objectively: the condition is satisfactory, the consciousness is clear. Integuments and

visible icteric mucous membranes against a general pale background, icteric sclera.

Peripheral lymph nodes are not enlarged. In the lungs, breathing is carried out in all fields,

no wheezing. NPV - 17 per minute. Heart sounds are rhythmic, a blowing noise is heard on

the top of the heart. Heart rate - 84 beats per minute. Liver on palpation of usual consistency,

painful, the edge is rounded, protrudes 2.5 cm from under the edge of the costal arch. Sizes by

Kurlov - 12 × 10 × 9 cm. The spleen protrudes 3 cm below the left costal arch. At

superficial palpation of the abdomen is soft, painless.

The results of additional studies.

General blood test: red blood cells - 3.2 × 1012 / l, hemoglobin - 91 g / l, color

indicator - 0.85, reticulocytes - 14.8%, the average diameter of red blood cells - 4 microns,

white blood cells - 11 × 109

/ l, stab neutrophils - 11%, segmented neutrophils -

59%, lymphocytes - 30%, monocytes - 10%, ESR - 20 mm / h. Osmotic resistance

erythrocytes (REM) - 0.78-0.56% (normal min. REM - 0.44-0.48%, max. REM - 0.28-0.36%).

Biochemical analysis of blood: bilirubin - 111.2 μmol / l, direct - 17.1 μmol / l,

indirect - 94.1 μmol / l. Coombs test is negative.

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 23 [K000163]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 45-year-old female sales clerk came to the clinic with complaints of seizures

suffocation and shortness of breath after exercise and spontaneous at night, to discomfort in

breasts. She first became ill after severe pneumonia 11 years ago. Then bouts

repeated after exercise and during colds. Seizures

choking removed by inhalation of Salbutamol (3-4 times a day).

In the anamnesis: community-acquired 2-sided bronchopneumonia, acute appendicitis.

The presence of allergic diseases in themselves and relatives denies. Blood transfusion is not

It was. There are no bad habits.

Objectively: the condition is satisfactory, the consciousness is clear. Skin and mucous membranes

clean, physiological coloration. The tongue is wet. Lymph nodes are not enlarged. In the lungs:

percussion - box sound, auscultatory - hard breathing, dry rales on all

pulmonary fields, whistling with forced exhalation. Respiratory rate

- 18 per minute. The boundaries of the heart are not changed. Heart sounds are muffled, rhythmic. HELL -

140/90 mmHg Art. Pulse - 69 beats per minute, good filling and tension. Stomach

soft, painless. Liver, spleen are not palpable. Physiological

shipments are not broken.

Blood test: hemoglobin - 12.6 g / l, red blood cells - 3.9 × 1012 / l, white blood cells -

9.5 × 109

/ l, stab neutrophils - 3%, segmented neutrophils - 63%,

eosinophils - 5%, monocytes - 6%, lymphocytes - 13%; ESR - 19 mm / h.

Biochemical blood test: total bilirubin - 5.3 μm / l; total protein - 82 g / l

urea - 4.7 mmol / l.

Urinalysis: specific gravity - 1028, protein - negative., Epithelium - 1-3 in the field of view.

Sputum analysis: mucous, odorless. With microscopy: white blood cells - 5-6 in the field

vision, eosinophils - 10-12 in the field of view, bronchial epithelial cells, units alveolar

macrophages. VK - neg. (3x).

Chest Ro-graphy: increased transparency of the pulmonary fields, flattening and

low standing aperture. Pulmonary pattern enhanced. The roots of the lungs are enlarged, the shadow

reinforced. The shadow of the heart is increased across.

Questions:

1. Express the alleged preliminary diagnosis.

2. Justify your diagnosis.

3. Make an additional examination plan.

4. Make a differential diagnosis.

5. Create a treatment plan (name the necessary groups of drugs

drugs)

Situational task 25 [K000181]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient K., 45 years old, turned to the local general practitioner with complaints of

pressing pains in the epigastric region, periodically - girdles, arise through

40 minutes after eating fatty and fried foods, accompanied by bloating

the abdomen; vomiting that does not bring relief, belching with air.

Anamnesis of the disease: he considers himself ill for about two years, when the pain appeared

in the left hypochondrium after eating fatty and fried foods. Do not seek medical help

addressed. 3 days ago after an error in the diet, the pain resumed, appeared

bloating, belching, nausea, vomiting, which does not bring relief.

Objectively: the state is relatively satisfactory, the consciousness is clear. Skin

integument of usual coloring. In the lungs, vesicular breathing, no wheezing. NPV - 18 in

a minute. Heart sounds are clear, rhythmic. Heart rate - 72 beats per minute. Tongue is wet

lined with white and yellow plaque. The abdomen on palpation is soft, painful in the epigastrium

and left hypochondrium. The liver is not palpable, according to Kurlov - 9 × 8 × 7 cm, symptom

striking negative bilaterally.

General blood test: red blood cells - 4.3 × 1012 / l, hemoglobin - 136 g / l, color

the indicator is 1.0; ESR - 18 mm / h, platelets - 320 × 109

/ l, white blood cells - 10.3 × 109

/ l

eosinophils - 3%, stab neutrophils - 4%, segmented neutrophils -

51%, lymphocytes - 32%, monocytes - 10%.

General urine analysis: light yellow, transparent, acidic, specific gravity - 1016,

leukocytes - 1-2 in the field of view, epithelium - 1-2 in the field of view, oxalates - small

quantity.

Biochemical blood test: AST - 30 units / l; ALT - 38 U / L; cholesterol -

3.5 mmol / l; total bilirubin - 19.0 μmol / l; direct - 3.9 μmol / l; amylase - 250

u / l; creatinine - 85 mmol / l; total protein - 75 g / l.

Coprogram: color - grayish-white, consistency - dense, smell -

specific, muscle fibers +++, neutral fat +++, fatty acids and soaps

+++, starch ++, connective tissue - no, mucus - no.

FGDS: the esophagus and cardiac section of the stomach without features. Stomach

regular shape and size. Mucous pink, with patches of atrophy. Folds well

expressed. The duodenal bulb without features.

Ultrasound of the abdominal cavity: normal sized liver, structure

homogeneous, normal echogenicity, ducts are not dilated, common bile duct - 6

mm, gall bladder of normal sizes, wall - 2 mm, calculi not

visualized. Pancreas of increased echogenicity, heterogeneous,

duct - 2 mm, head increased in volume (33 mm), heterogeneous, increased

echogenicity.

The questions are:

1. Highlight the main syndromes.

2. Evaluate the coprogram data.

Methodological center for accreditation of specialists_SZ_Medical business_2018

28

3. Formulate a diagnosis.

4. What additional studies should be prescribed to the patient?

5. What is your tactic for treating this disease?

Situational task 26 [K000182]