Instructions: read the situation and give explained

ANSWERS ON QUESTIONS

Main part

Patient B., 35 years old, was taken to the clinic by an ambulance complaining of

chest tightness, shortness of breath, especially exhalation, excruciating cough.

Sick 10 years of bronchial asthma. Before that - several years was observed with a diagnosis

"Chronical bronchitis". 5 years took prednisolone 2 tablets per day and inhalation

Berotek with suffocation. Exacerbations of bronchial asthma 3-4 times a year, often requiring

hospitalization in a hospital. The current deterioration is associated with cancellation

a week ago prednisone. Allergic history - calm. Asthma attacks

preceded by a short episode of excruciating cough, at the end of the attack it intensifies, and

viscous mucous sputum begins to stand out in a small amount.

Objectively: a serious condition, upon examination, the skin of the patient is pale, with

bluish tint. The patient sits in the orthopnea position. High

nutrition (gained 15 kg in weight over 3 years). Cushingoid Face, Striae on Hips and

the stomach. Speaks in separate words, excited. The chest is in

deep breath position. The abdominal muscles are involved in the act of breathing.

Breathing sharply weakened, a small amount of dry wheezing, 32

respiratory movements per minute. Percussion over light boxed sound all over

pulmonary fields, especially in the lower sections. Heart sounds are rhythmic, muffled.

Pulse - 120 beats per minute, rhythmic. HELL - 140/90 mm RT. Art., SpO2 - 85%.

During the day received more than 15 inhalations of Berotek. Emergency doctor already

10.0 ml of a 2.4% solution of Eufillinum, 60 mg of Prednisoloneum are intravenously entered.

The questions are:

1. Formulate a preliminary diagnosis.

2. Justify the diagnosis. How to explain the deterioration of the patient?

3. What is shown to the patient first of all in this situation?

4. What additional examination is necessary for the patient during stabilization

condition?

5. Has the patient received the correct therapy in recent years? Why? Which

prescribe basic therapy to the patient

Situational task 47 [K000223]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient N. 30 years old turned to the clinic with complaints of general weakness,

dry mouth, polyuria, impaired vision, numbness, lower paresthesia

extremities, frequent hypoglycemic conditions (night and day). Sick with sugar

diabetes since 15 years. Diabetes manifested ketoacidosis. Gets Humulin NPH - 20

IU in the morning, 18 IU in the evening, and Humulin regulator - 18 IU / day. Leads an active image

life, trained in self-control techniques.

Objectively: the general condition is satisfactory. Build, body hair by

male type. BMI - 19 kg / m2

. The skin is dry, clean. There are jams in the corners of the mouth.

There are no peripheral edemas. The thyroid gland is not enlarged, in the lungs - breathing

vesicular, no wheezing. Heart sounds are rhythmic, pulse - 82 beats per minute. HELL -

120/80 mmHg Art. The abdomen is soft, painless. The liver and spleen are not enlarged. Leather

legs and feet dry, on the feet areas of hyperkeratosis, pulsation on the arteries of the rear foot

satisfactory.

Examination results: fasting blood glucose - 10.4 mmol / l, after 2 hours

after eating - 14.5 mmol / l. General urine analysis: specific gravity - 1014, protein - traces;

white blood cells - 1-2 in the field of view.

Ophthalmologist: fundus - single microaneurysms, solid exudates,

edema of the macular region.

Sub-pediatrician: decrease in vibrational, tactile sensitivity.

The questions are:

1. Formulate a preliminary diagnosis.

2. Justify your diagnosis.

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

4. Name and justify the target level of glycosylated hemoglobin in

this patient.

5. Conduct and justify the correction of hypoglycemic therapy.

 

Situational task 48 [K000224]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient R. 24 years old complains of irritability, muscle weakness, constant

palpitations, weight loss of 3 kg over the past 5 months with increased

appetite, shortness of breath when walking, tearfulness. The disease binds to stress

family situation 3 months before going to the doctor. Took Corvalol, Seduxen;

the condition has not improved. A history of frequent sore throats.

Objectively: the condition is satisfactory, body temperature - 37.2 ° C. Skin

integument moist, warm to the touch, no peripheral edema. Moderate

bilateral exophthalmos. A positive symptom of Rosenbach. Small tremor of fingers

outstretched arms. The thyroid gland is elastic, enlarged due to the isthmus and right

share. Soft. When swallowing, it moves freely. Retrobulbar resistance and

diplopia is not observed. The vesicular breathing, no wheezing. Heart sounds are clear

rhythmic, 1 tone at the top reinforced. Pulse - 118 beats per minute, rhythmic. HELL -

155/60 mmHg Art., pathology from the gastrointestinal tract and

there is no urinary system.

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. Determine the tactics of treatment for this patient.

5. Evaluation of the effectiveness of the therapy

 

Situational task 49 [K000225]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient M. 54 years old complains of severe weakness, shortness of breath and palpitations with

insignificant physical activity; when quickly getting out of bed -

dizziness and tinnitus. Such complaints worry several months, but for

the last 2 weeks, health began to rapidly progressively worsen. The patient

delivered to the hematology department by agreement by ambulance

medical care on a stretcher, since going to an appointment with a GP

I could not.

History of heavy menstruation for 15 years (after establishment

intrauterine device), with an estimated blood loss of up to 400.0-450.0 ml per cycle, 3

childbirth, 5 abortions. Menopause 3 years. For 10 years - a fanatical vegetarian, meat,

fish completely excluded from the diet.

Objectively: the general condition of the patient is severe. Sluggishness, answers questions

quietly, slowly, monosyllables. Pallor of the skin and mucous membranes are expressed. Ictericity

sclera. The language is raspberry, geographical, varnished. Koylonikhii. Angular

stomatitis. Many decayed teeth, 5 teeth removed. Addiction to chalk and

sunflower seeds. Swelling on the legs, thighs, abdominal wall. Peripheral

lymph nodes are not enlarged. Prefers an elevated position in bed. BH - 34 in 1

a minute. In lung vesicular breathing, no wheezing. The pulse is soft, 96 beats per minute.

The borders of the heart are extended to the left by 2 cm, heart sounds are muffled, systolic murmur

on all points and vessels of the neck. The abdomen is soft, painless. The liver and spleen are not

enlarged.

An urgent examination was carried out: red blood cells - 1.2 × 1012 / l; hemoglobin - 30 g / l;

hematocrit - 12%; color indicator - 1.0; platelets - 156.4 × 109

/ l, white blood cells -

2.4 × 109

/ l (stab neutrophils - 3%, segmented neutrophils - 42%,

lymphocytes - 50%, monocytes - 5%), ESR - 40 mm / hour. Total blood protein - 4.2 g / l;

blood bilirubin - 48 μmol / l, Van-den-Berg reaction - indirect; in urine, urobilin +++.

On the ECG - dystrophic changes in the myocardium, single atrial and ventricular

extrasystoles. In the myelogram: red germ hyperplasia, red germ with features

severe megaloblastoidness.

The questions are:

1. What is the main reason for the severity of the patient's condition?

2. Does the patient have sideropenic syndrome?

3. What is the cause of iron deficiency?

4. Why is the color indicator normal?

5. Formulate a detailed diagnosis of the patient.

 

Situational task 50 [K000226]