Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

A 32-year-old woman consulted a local GP with complaints of

suffocating attacks during the last month, they are accompanied by

audible at a distance, wheezing, coughing with a small amount

viscous sputum, followed by relief. Similar conditions worry about 2

years, not surveyed. A history of allergic rhinitis. Deterioration binds

with the transition to a new job in the library. Over the past month, symptoms

occur daily, at night 3 times a week, disrupt activity and sleep.

Objectively: the general condition is satisfactory. Normosthenic

constitution. The skin is pale pink in color, there are no rashes. Peripheral

edemas are absent. Hard breathing is over the lungs, scattered dry are heard

wheezing NPV - 18 per minute. Heart sounds are clear, the rhythm is correct, heart rate is 72

shock per minute. HELL - 120/80 mm RT. Art. The abdomen on palpation is soft, painless.

Complete blood count: red blood cells - 4.2 × 1012 / l, hemoglobin - 123 g / l, white blood cells -

4.8 × 109

/ l, eosinophils - 16%, segmented neutrophils - 66%, lymphocytes - 18%,

monocytes - 2%, ESR - 10 mm / h.

Sputum analysis general: mucosa, leukocytes - 5-7 in the field of view, flat

epithelium - 7-10 in the field of view, detritus in a small amount, Kurschmann spirals.

X-ray of the lungs. Infiltrative shadows are not defined in the lungs.

Aperture, shadow of the heart, sinuses without features.

Spirotest. Initial data: VC - 82%, FEV1 - 62%, FVC - 75%. After 15

minutes after inhalation 800 μg of Salbutamol: FEV1 - 78%.

The questions are:

1. Formulate a clinical diagnosis. Justify the severity of the disease.

2. How is a test with a bronchodilator performed? Rate the results.

3. What studies need to be done to confirm the diagnosis?

4. Prescribe treatment.

5. Are there indications for the appointment of inhaled glucocorticoids in this

case?

Situational task 35 [K000192]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient N., 25 years old, complains of frequent (up to 10-15 per day) loose stools with

an admixture of blood and mucus, pain in the left iliac region, fever

body to 38.3 ° C, a sharp general weakness, weight loss. Violation of stool notes during

2 months, but 7 days ago blood appeared in feces, fever,

weakness, malaise, dizziness.

Objectively: a state of moderate severity. The skin is pale. Tongue slightly

coated with white coating. The abdomen is oval, slightly swollen. On palpation

moderate pain in the descending part of the colon is determined.

Percussion, the size of the liver according to Kurlov is 10 × 9 × 8 cm.

Complete blood count: hemoglobin - 90 g / l, ESR - 35 mm / h, white blood cells - 13.0 × 109

/ l;

leukoformula: basophils - 1%, eosinophils - 5%, stab neutrophils - 20%,

segmented neutrophils - 40%, lymphocytes - 24%, monocytes - 10%.

Biochemical blood analysis: total protein - 60 g / l, albumin - 40%, ALT - 42.68

U / L, AST - 32 U / L, seromucoid - 2.0 mmol / L, CRP - (+++), fibrinogen - 5 g / L.

Coprogram: stool color - brown, character - unformed, in sight -

a large number of white blood cells, red blood cells. The Tribule reaction is sharply positive.

Irrigoscopy: rapid filling of the colon with barium suspension is noted,

uniform narrowing of the intestinal lumen (symptom of a “water pipe”), expansion

rectectal space, smoothness of the haustra, cellular relief of the mucosa in

areas of the transverse colon, in the area of ​​the rectum and sigmoid colon -

multiple filling defects.

The questions are:

1. Formulate a diagnosis.

2. List the predisposing factors leading to the development of this

diseases.

3. What extraintestinal manifestations are possible with this pathology?

4. What anticytokines are needed, and in what situations are they prescribed for

this disease?

5. What antibacterial drugs are indicated for this disease?

 

Situational task 36 [K000193]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 36-year-old patient was referred by a GP to the clinic with complaints

for sharp weakness, dizziness, flickering flies before the eyes, shortness of breath with

physical activity, occasionally stitching pains in the heart,

propensity to use chalk, dough.

In the anamnesis: weakness and fatigue are noted about 6 years, not to the doctor

appealed. During pregnancy 2 years ago, mild anemia was detected in the hemogram

degrees, iron preparations did not receive. Worsening around 2 weeks when

shortness of breath and pain in the heart area appeared. Obstetric and gynecological history:

hyperpolymenorrhea from 12 years, pregnancy - 5, childbirth - 2, medical abortion - 3. From

past diseases: colds, peptic ulcer of the duodenum,

chronic pyelonephritis.

Objectively: the skin is pale, dry. Transverse nails

striation, exfoliate. Peripheral lymph nodes are not palpable.

In lung vesicular breathing, no wheezing. Heart sounds are muffled, the rhythm is correct,

systolic murmur at the apex of the heart. Heart rate - 92 beats per minute. HELL - 100/60 mm RT. Art.

The tongue is moist, the papillae are smoothed. The liver and spleen are not palpable. Symptom

striking is negative on both sides.

Complete blood count: hemoglobin - 82 g / l, red blood cells - 3.2 × 1012 / l, color

indicator - 0.7, reticulocytes - 13%, platelets - 180 × 109

/ l, white blood cells - 4.2 × 109

/ l

stab neutrophils - 6%, segmented neutrophils - 62%, lymphocytes -

29%, monocytes - 3%, ESR - 18 m / h; anisocytosis, red blood cell hypochromia.

The serum iron content is 4.0 μmol / l, total iron binding

serum ability - 86.4 μmol / L, transferrin saturation - 5.0%, serum

ferritin - 10 μg / l.

The questions are:

1. Make a preliminary diagnosis of the patient.

2. What can be caused by systolic murmur at the apex of the heart?

3. What laboratory and instrumental research methods are necessary

appoint a patient to clarify the diagnosis?

4. Prescribe treatment. Justify the choice of therapy.

5. What recommendations could you give the patient for secondary prevention

disease?

 

 

Situational task 37 [K000194]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient L. 55 years old went to the clinic with complaints of frequent headaches,

dizziness, discomfort in the left half of the chest. Sick about 6

years, an increase in blood pressure to 180/100 mm Hg was periodically recorded. Art. Was treated

occasionally with an increase in blood pressure (Kapoten, Furosemide). Smokes a pack of cigarettes per day

about 20 years, notes frequent alcohol abuse. Work is associated with frequent

business trips. Heredity: mother has hypertension, diabetes

2 types.

Objectively: the general condition is satisfactory. Hypersthenic

physique, BMI - 34 kg / m2

. The skin of the face is hyperemic. Peripheral

no edema. In lungs, harsh breathing, no wheezing. NPV - 18 per minute. The boundaries of the heart:

right - at the right edge of the sternum IV intercostal space, upper - III rib, left - on the left

midclavicular line in the V intercostal space. Heart sounds are muffled, emphasis 2 tones on

aorta, the rhythm is correct. Heart rate - 88 beats per minute. HELL - 190/110 mm Hg. Art. The liver is not

increased. The symptom of lumbar effusion is negative.

Blood lipids: total cholesterol - 7.4 mmol / l; triglycerides - 2.6 mmol / l;

low density lipoprotein cholesterol - 5.2 mmol / L.

The questions are:

1. Assume the most likely diagnosis.

2. What are the risk factors for cardiovascular disease present in the patient?

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

4. What non-drug recommendations will you make first?

5. What diuretics can be recommended to the patient as part of a combination

therapy?

 

 

Situational task 38 [K000195]