Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

A 30-year-old patient went to the clinic with complaints of frequent and painful

urination, pain in the lumbar region on the right, the allocation of turbid urine, increased

body temperature up to 37.6 ° C.

From the anamnesis: for the first time, such manifestations were observed in a patient 10 years ago

during pregnancy. Antibacterial therapy was carried out in a hospital, childbirth - without

complications. In the subsequent exacerbation of the disease was not observed. Worsening

state 5 days ago after hypothermia.

Objectively: a state of moderate severity. The skin of the usual

color, no peripheral edema. Peripheral lymph nodes are not enlarged.

The chest is the usual shape. The respiratory rate is 20 per minute. In the lungs breathing

vesicular, wheezing is not heard. Boundaries of relative cardiac dullness in

normal limits. Heart sounds are muffled, the rhythm is correct. Heart rate - 90 per minute. HELL -

140/90 mmHg Art. The abdomen is soft, painless. Liver at the edge of the costal arch. Symptom

striking positive on the right.

Blood test: hemoglobin - 118 g / l, red blood cells - 4.0 × 1012 / l, white blood cells -

14.0 × 109

/ l, eosinophils - 1%, stab neutrophils - 10%, segmented

neutrophils - 65%, lymphocytes - 20%, monocytes - 4%, platelets - 200.0 × 109

/ l, ESR -

24 mm / hour.

Biochemical parameters of blood: creatinine - 0.08 mmol / l, urea - 6.5

mmol / l.

Urinalysis: specific gravity - 1010, protein - 0.07 mg / l, acid reaction,

leukocytes - 15-20 in the field of view, red blood cells - 0-1 in the field of view.

Ultrasound of the kidneys: kidneys of normal shape and size. The renal pelvic system

deformed and sealed. There are no calculi.

The questions are:

1. What diagnosis can be made?

2. What additional examination methods should be prescribed for the patient

clarification of the diagnosis? Justify.

3. Is it possible to treat a patient on an outpatient basis? Indications for

hospitalization.

4. List the drugs for etiotropic therapy, the duration of treatment and

monitoring the effectiveness of treatment.

5. What phytotherapy can be recommended during the period of disease remission?

 

Situational task 39 [K000196]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient M. 34 years old complains of burning pain in the epigastric region,

arising on an empty stomach and at night, heartburn, nausea, sometimes, at the height of pain, vomiting,

bringing relief.

These symptoms worry 10 years, occur mainly in spring and autumn.

Self-accepting soda, Almagel, causing a positive effect.

This exacerbation is associated with the reception of Voltaren for pain in the lumbar

area.

Objectively: satisfactory condition, normal skin color, moist.

Pulse - 60 beats per minute, blood pressure - 100/70 mm RT. Art. The tongue is moist, densely coated with white

plaque. The abdomen is of normal shape, not swollen, palpation sharply painful in

epigastric region. A chair with a tendency to constipation (1 time in 2 days).

General blood test: hemoglobin - 130 g / l, ESR - 10 mm / h, white blood cells - 5.2 × 109

/ l;

leukoformula: stab neutrophils - 2%, segmented neutrophils - 66%,

lymphocytes - 27%, monocytes - 5%.

Biochemical analysis of blood: ALT - 40 units / l, AST - 32 units / l. Diastasis of urine - 64 units.

EFGDS: the esophagus is freely passable, the cardia closes. In the stomach on an empty stomach

contains a large amount of light secretory fluid and mucus. Folds

the gastric mucosa is thickened, convoluted, diffusely hyperemic. Bulb

The duodenum 12 is deformed, a mucosal defect is detected on the back wall

shells up to 0.7 cm in diameter. The edges of the defect have clear boundaries, hyperemic,

fatherly. The bottom of the defect is covered with fibrinous overlays of white color.

Postbulbar departments without pathology.

Helic test: basal level - 4 mm; load level - 10 mm; index

growth - 6 mm; Hp (+).

The questions are:

1. Formulate a diagnosis.

2. List the exogenous and endogenous predisposing factors leading to

to the development of this disease.

3. Indications for hospitalization.

4. Complications of this disease.

5. Prescribe treatment.

 

Situational task 40 [K000197]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient K., 24 years old, student, was hospitalized in the cardiology department.

Complaints of shortness of breath when walking up to 100 m, increased shortness of breath in a horizontal position,

palpitations, general weakness, swelling in the legs. Within 2 months marks the appearance of

shortness of breath, weakness. A week ago, interruptions in the work of the heart and palpitations appeared, with

at the same time, swelling on the legs appeared.

Of the transferred diseases, acute respiratory infections, appendectomy in childhood,

flu about 4 years ago.

Objectively: the general condition is serious. The skin is pale. Swelling of the legs, feet.

Peripheral lymph nodes are not enlarged. Blunting percussion sound in

lower parts of the lungs. Vesicular breathing, crepitious wheezing in the lower sections,

NPV - 26 per minute. Apical impulse in VI intercostal space 3 cm outward from left

midclavicular line. Borders of relative dullness of the heart: right - 2 cm

outward from the right edge of the sternum, upper - II intercostal space on the left srednechrochnoy

line, left - on the front axillary line. Heart sounds are muffled

systolic murmur at the apex and at the V point of auscultation. The heart rhythm is wrong

Heart rate - 122 beats per 1 minute, blood pressure - 100/80 mm RT. Art., average heart rate - 105 per minute,

spasmodic. The size of the liver according to Kurlov is 14 × 11 × 10 cm.

Complete blood count: hemoglobin - 125 g / l, white blood cells - 4.0 × 109

/ l, ESR - 10 mm / h.

Radiography of the chest revealed cardiomegaly syndrome.

Echo-CS: dilatation of the left and right ventricles, diffuse hypokinesis, fraction

emission - 28%.

ECG: atrial fibrillation, ChZhS - 132 in 1 minute.

The questions are:

1. Assume the most likely diagnosis.

2. What changes in the myocardium are detected by histological examination with

this disease?

3. List ECG signs of atrial fibrillation.

4. Assign treatment to this patient.

5. Does the patient need to restore sinus rhythm?

 

 

Situational task 41 [K000198]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 56-year-old man turned to a local doctor-therapist who appeared after

hypothermia with cough complaints with a small amount of hard to separate

mucopurulent sputum, shortness of breath with slight physical exertion,

increase in body temperature to 37.4 ° C.

Cough with sputum marks for 10 years. Exacerbations of the disease 3-4 times a

year, mainly in cold damp weather. About 2 years ago, shortness of breath appeared

during physical exertion, sputum began to move away with difficulty. The patient smokes 30 years for 1

a pack a day.

On examination: the face is puffy, there is a warm cyanosis, swelling of the cervical veins

on the exhale. The chest is barrel-shaped. Percussion above the pulmonary fields

boxy sound. Breathing evenly weakened, on both sides

dry wheezing is heard. NPV - 24 per min. Heart sounds are muffled

emphasis of 2 tones on the pulmonary artery, diastolic noise, rhythm is also heard there

correct, heart rate - 90 beats per minute. HELL - 120/80 mm RT. Art. The stomach is soft

painless. The liver and spleen are not palpable. There are no peripheral edemas.

Blood test: hemoglobin - 168 g / l, white blood cells - 9.1 × 109

/ l, eosinophils - 1%,

neutrophils - 73%, lymphocytes - 26%, ESR - 28 mm / h.

Chest x-ray: pulmonary fields increased

transparency, pulmonary pattern enhanced, deformed, vascular pattern enhanced in

center and depleted on the periphery, the roots of the lungs are expanded, the bulging of the trunk of the pulmonary

arteries. No infiltrative changes were detected.

ECG: signs of right ventricular hypertrophy.

Spirography data: decrease in VC - up to 80%, FEV1 - up to 32% of due

quantities.

The questions are:

1. Formulate a clinical diagnosis.

2. What additional research is needed to confirm

the diagnosis?

3. Prescribe a treatment.

4. Criteria for the appointment of antibiotic therapy for this disease.

5. Identify indications for hospitalization.

 

Situational task 42 [K000218]