Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

A 75-year-old woman complains of pain in the lumbar spine, in

small joints of the hands, pain in the knee joints, especially during the first movements after

rest period. Morning stiffness for about 30 minutes. These complaints worry more

10 years, periodically took Diclofenac 100 mg / day with a positive effect. IN

recently, the patient began to notice difficulties when dressing, taking a shower,

climbing and descending stairs due to joint pain. Concomitant diseases: about

10 years increase in blood pressure to 180/110 mm RT. Art., 5 years ago suffered a myocardial infarction.

On examination: the general condition is satisfactory. The skin is normal

coloring, humidity. Varicose veins. Pastosity

lower legs. Weight - 96 kg, height - 162 cm. Nodular deformation of II-V distal

interphalangeal joints and II-III proximal interphalangeal joints of both hands.

Defibration of the knee due to periarticular edema, with flexion

knee joints intraarticular crunch, range of motion is not changed, palpation and

the movements are moderately painful. Swelling and deformity of the sternoclavicular

joints on the right, palpation of it is painless. Palpation tenderness

paravertebral points of the lumbar spine. In the lungs breathing

vesicular, no wheezing. NPV - 18 per minute. Heart sounds are muffled, rhythm

correct. Heart rate - 86 beats per minute. HELL - 150/90 mm RT. Art. The stomach is soft

painless. The liver is not enlarged.

Clinical blood test: hemoglobin - 130 g / l, white blood cells - 7.7 × 109

/ l, ESR - 15

mm / hour Biochemical blood test without pathology.

Immunological blood test: rheumatoid factor negative, reactive protein - 8 mg / l.

General urine analysis without pathology.

The questions are:

1. Formulate a detailed diagnosis.

2. Justify your diagnosis.

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

4. What is the tactics of patient management (non-drug and drug)?

5. What additional appointments should be made taking into account the attendant

diseases?

 

Situational task 43 [K000219]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 49-year-old patient complains of severe weakness, constant

drowsiness, weight loss of 6 kg for six months, gingival and nosebleeds, increase

abdomen in volume, itching. From the anamnesis - prolonged alcohol abuse.

The state of moderate severity. On examination, yellowness of the skin is revealed,

mucous membranes, sclera, vascular asterisks in the neck, chest, palmar erythema,

Dupuytren's contracture. There is atrophy of the muscles of the upper shoulder girdle, deficiency

weight (weight 58 kg with a height of 177 cm - BMI - 17). Subcutaneous hematomas are determined on

arms and legs. The abdomen is enlarged in volume. When percussion, fluid is detected in the abdominal

cavity. The liver is palpated 4 cm below the level of the costal arch, the edge is sharp, dense.

Percussion dimensions - 13 × 11 × 6 cm. Increased percussion dimensions of the spleen 17 × 12

cm.

Total protein - 59 g / l, albumin - 48%, globulins - 52%, gamma globulins -

28.5%

The questions are:

1. Assume the most likely diagnosis.

2. What are the syndromes of damage to internal organs.

3. Justify why these syndromes have been identified.

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

5. What groups of drugs should be prescribed to the patient?

Situational task 44 [K000220]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient R., 35 years old, came to the clinic with complaints of aching pain below

abdomen, more in the left departments, loose stool up to 5-7 times a day. In the stool often admixture

mucus and blood. Concerned severe weakness, reduced ability to work, reduced

appetite, fever up to 37.5 ° C, pain in the joints of the hands, weight loss

body in recent weeks by 5 kg.

Objectively: a state of moderate severity. The skin and mucous membranes are pale.

Peripheral lymph nodes are not palpable. Erythema nodosum on

the medial surface of the left forearm - 1.5 × 2 cm. Joints are not changed, function

saved. On the part of the lungs - without features. Pulse - 96 per minute, rhythmic, blood pressure -

100/70 mmHg Art. The boundaries of the heart are within normal limits. Heart sounds are sonorous. Tongue Overlaid

at the root dirty, dry. Abdomen swollen, palpation sensitive in left

bottom quadrant. Rumbling on palpation in the sigmoid colon. Liver,

spleen not enlarged.

Blood test: red blood cells - 3.4 × 1012 / l, hemoglobin - 85 g / l, white blood cells -

10.0 × 109

/ l, ESR - 25 mm / hour.

Urinalysis - no pathology.

X-ray examination: in the left parts of the large intestine (up to

splenic bend) there is a loss of haustration, a decrease in clearance and rigidity

intestines, uneven pattern of the mucous membrane.

The questions are:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

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

4. What diseases should be used for differential diagnosis?

5. Determine the treatment tactics of the patient

 

Situational task 45 [K000221]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient M., 65 years old, came to the clinic with complaints of shortness of breath with a small

physical activity, periodically unproductive cough (especially with

hypothermia, in wet weather), a feeling of wheezing and heaviness in the chest, palpitations.

From the anamnesis: smokes 30 years in a pack a day. Dyspnea appeared 3 years ago and became

progress over the past year. During the last month, after the transferred

ARI, shortness of breath intensified, sputum began to stand out more, she acquired yellow-green

Colour. A few years is observed with a diagnosis of angina pectoris II FC, 2 years ago

large focal myocardial infarction, anterolateral, and therefore constantly takes

Sotalol, Cardiomagnyl, Monochincwe (isosorbide-5-mononitrate).

Objectively: general state of moderate severity. Mild acrocyanosis. Sick

low nutrition, chest expanded across, with chest percussion

cells - an easy sound with a box tint. With auscultation of the lungs - breathing

weakened, in the lower parts of the lungs, dry low-timbral and pneumosclerotic

wheezing, exhalation lengthened.

When viewed NPV - 24 per minute, heart rate - 100 per minute. HELL - 130/80 mm RT. Art.

On the ECG: cicatricial changes on the side wall of the left ventricle. Single

ventricular extrasystoles.

Spirography: VC - 52%, FEV1 - 37%, Typhno test - 57.2.

A chest x-ray shows signs of emphysema and

pulmonary pneumosclerosis.

General sputum analysis: leukocytes - until the fields of vision are closed, neutrophils -

90%, lymphocytes - 10%.

The questions are:

1. Formulate a preliminary diagnosis.

2. Justify the diagnosis. Determine the smoker's index in the patient.

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

4. What basic therapy is necessary for the patient in accordance with his diagnosis?

5. What would you change in the basic treatment of coronary artery disease? Justify why.

 

Situational task 46 [K000222]