Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

A 23-year-old man turned to a district physician with complaints of seizures

choking, occurring 1-2 times a month, with difficulty breathing out, accompanied by

wheezing and wheezing, paroxysmal cough with difficult to separate

phlegm. Recently, attacks have become more frequent up to 2 times a week, occur at night.

From the anamnesis it is known that seizures appeared about a year ago, are noted in

throughout the year, appear in contact with house dust, pollen from plants,

animal hair, pungent odors, stop on their own or after reception

Eufillin tablets. The patient's grandmother also had similar asthma attacks. IN

for three years in May-June, lacrimation, nasal congestion, sneezing are noted.

The patient is in satisfactory condition, respiratory rate - 24 per min. Skin

integuments are clean, ordinary color. During auscultation, a lot is heard

the amount of dry wheezing scattered wheezing on exhalation. Heart sounds are rhythmic,

clear, 90 beats per minute, blood pressure - 110/70 mm RT. Art. The abdomen is soft, on palpation

painless in all departments. The liver and spleen are not enlarged. There is no dysuria.

The symptom of lumbar effusion is negative on both sides.

In blood tests: white blood cells - 6.0 × 109

/ l; segmented neutrophils - 63%;

lymphocytes - 23%; eosinophils - 10%; monocytes - 4%, ESR - 10 mm / h.

General sputum analysis: viscous consistency, mucous character, leukocytes - 1–

5 in the field of view, eosinophils - 20–30 in the field of view, Kurshman spirals, crystals

Charcot Leiden. Serum IgE is tripled.

Spirometry: increase in FEV1 after inhalation of Salbutamol - 25%.

X-ray of the chest organs - focal or infiltrative shadows are not

revealed.

The questions are:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

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

4. What groups of drugs would you recommend?

to the patient at present. Justify your choice.

5. A week later, the patient again came to see the local GP.

No complaints, seizures stopped. In the lungs with an objective

wheezing is not heard during the examination. Choose further treatment tactics

patient and explain your choice.

 

Situational task 27 [K000183]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 23-year-old patient consulted a local GP with complaints of edema.

face, eyelids, torso, limbs, decreased amount of urine excreted per day,

weakness, headache.

From the anamnesis it is known that suffers from chronic tonsillitis. Similar

symptoms first appeared 2 years ago, was treated for a long time in the nephrological

the department, received Prednisolone with a positive effect, was discharged from the hospital in

satisfactory condition. After discharge, the doctor was not observed, was not treated, although

noted periodically edema on the face. 2 weeks ago I had a sore throat, after that

the condition worsened sharply, the above complaints appeared. When examining blood pressure -

150/95 mmHg Art., heart rate - 92 beats per minute, NPV - 22 per minute.

Survey data.

Complete blood count: red blood cells - 3.4 × 1012 / l, hemoglobin - 124 g / l, color

indicator - 0.89, white blood cells - 5.4 × 109

/ l, leukocyte formula - normal, ESR - 42

mm / h

Biochemical study: total blood protein - 35.6 g / l, albumin - 33%,

blood cholesterol - 9 mmol / l.

Urinalysis: specific gravity - 1012, protein - 5.4 g / l, red blood cells

leached - 20-25 in the field of view, waxy cylinders - 9-10 in the field of view.

The questions are:

1. Indicate the main clinical and laboratory syndrome.

2. Formulate a presumptive diagnosis.

3. What additional studies are needed to clarify the diagnosis?

4. Prescribe treatment according to clinical guidelines for therapy

patients with this pathology.

5. What are the approximate periods of temporary disability for a given

disease? How often should follow-ups be performed?

 

Situational task 28 [K000184]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 18-year-old patient consulted a local GP with complaints of pain in

lumbar region, frequent urination, chills.

From the anamnesis it is known that ARVI often suffers, periodically notes dull pain

lower abdomen, against this background, there is a subfebrile temperature; sometimes noted

painful urination.

On examination: the skin is of normal color, a temperature of 37.8 ° C. In the lungs

vesicular breathing, no wheezing. The number of respiratory movements is 20 per minute. Tones

hearts are clear, rhythmic. Heart rate is 96 per minute. Symptom

Pasternatsky is positive on both sides. Urination is frequent and painful.

There are no fathers.

Complete blood count: hemoglobin - 114 g / l, red blood cells - 4.5 × 1012 / l, white blood cells -

18.5 × 109

/ l, stab neutrophils - 10%, segmented neutrophils - 70%,

lymphocytes - 22%, monocytes - 9%, ESR - 28 mm / hour.

Urinalysis: reaction - alkaline, protein - 0.06%, white blood cells - all on

the entire field of view, red blood cells - 1-2 in the field of view, bacteria - a significant amount.

Ultrasound of the kidneys: the kidneys are located correctly, the sizes are on the upper border of the norm.

The pyelocaliceal system is expanded on both sides.

The questions are:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Indicate additional research methods to clarify the diagnosis.

4. What is the study necessary to prescribe adequate therapy.

5. What are the activities of dispensary observation of the patient upon reaching

remission.

 

Situational task 29 [K000185]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 35-year-old man consulted a local GP with complaints of

fever up to 37.6 ° C for five days, cough with yellow sputum.

He took antipyretic drugs without much effect. No other medicines

accepted. Ten days before this, ARVI was transferred. Drug allergy is not noted.

There are no concomitant diseases.

The patient is in satisfactory condition, respiratory rate - 19 per minute. Skin

integuments are clean, ordinary color. Auscultation listens to moderate

the number of wet crepitious wheezing in the lower posterior chest

on the right, in other parts of the lungs vesicular breathing, no wheezing. Heart sounds

rhythmic, clear, 82 beats per minute, blood pressure - 120/70 mm RT. Art. The abdomen is soft, with

palpation painless in all departments. The liver and spleen are not enlarged. Dysuria

not. The symptom of lumbar effusion is negative.

X-ray of the chest organs of the direct and lateral projection: on the right in 9-10

segments of the lower lobe is determined by infiltration.

The questions are:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

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

4. What groups of drugs would you recommend?

to the patient at present. Justify your choice.

5. The patient is scheduled to appear in two days to evaluate the effect of the assigned

drugs and possible correction of therapy. Choose further

patient treatment tactics and explain your choice

 

Situational task 30 [K000186]