2020-06-29
319
# 22
*! A man, 56 years old, a traveling worker from the Atyrau region, fell ill acutely, with an increase in body temperature to 39 0 C, the appearance of chills; there was pain in the groin on the left. On examination, the condition is serious. In the inguinal region, a sharply painful, dense motionless conglomerate is palpated, the skin over which is hyperemic.
What is your suspected diagnosis?
Plague, bubonic form
# 23
*! A 48-year-old man, a resident of the Petropavlovsk Region, fell ill acutely - with fever, general intoxication, a painful ulcer on the skin of the forearm on the right (a sucking tick was noted at this point). On examination, a moderate condition, an ulcer with purulent-hemorrhagic discharge, there is lymphangitis, on the right axillary lymphadenitis (dense, moderately painful).
What is your suspected diagnosis? Tularemia
# 25
*! A 42-year-old man, a resident of the Kyzylorda region, a shepherd, was hospitalized with complaints of fever up to 39.9 ° C, severe headache, chills, body aches, nosebleeds. On examination, signs of hemorrhagic syndrome were revealed: on the body there was an abundant petechial rash, at the injection site of the hematoma. Symptom tourniquet and pinch positive. Bradycardia, hypotension, hepatomegaly were noted. The patient was discharged after 21 days with improvement.
What is the length of the follow-up period for patients who have been ill? 12 months
Infectious diseases * 3 * 22 *
#1
*! A woman of 30 years old, turned to the therapist on the 2nd day of illness. Complaints of cramping abdominal pain, nausea, headache, loose stools up to 15 times a day, tenes we, false desires. On examination: body temperature - 38.1 ° C, blood pressure - 90/60 mm Hg On palpation of the abdomen: pain in the left iliac region, whitefish movidnaya gut spasm. The stool is calcite, mucus streaked with blood. At OAK: er. - 4.0x10 12 / l, Hb -145 g / l, lake 11.4x10 9 / l, e - 1%, n - 2%, s - 75%, l - 18%, m - 5%. ESR - 17 mm / h
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What is MOST likely to be seeded during bacteriological examination of feces?
Shigella
# 2
*! A man, 25 years old, turned to the clinic. Ill acutely after 6 hours after pre byvaniya visiting: epigastric pain, nausea around the navel, 3-4 times vomiting, loose stools. On admission: temperature - 38, 6 ° C. The abdomen is not swollen, palpation painful in the epigastrium and right iliac region. There is no bowel spasm. HELL - 90/60. Pulse - 100 beats. in minutes Urinates. The stool is plentiful, with mucus of a dark greenish color, fetid.
What is the most effective treatment?
Ciprofloxacin
# 3
*! A 42-year-old woman fell ill acutely after returning from a picnic. Temperature 37.2 of C, chills, headache, weakness, dizziness. There was vomiting once. Then there were cramping abdominal pains, loose stools, at first fecal, plentiful, from the second day of the disease, the stool became scarce, fecal, with an admixture of mucus and blood, up to 20 times a day. Marked tenesmus, false desires.
Which drug is most appropriate to prescribe?
Furazolidone and ciprofloxacin
#4
*! A man, 19 years old, was admitted on the 2nd day of illness with complaints of cramping abdominal pain, weakness, fever, and loose stools up to 15 times a day. Temperature 38.8ºС. AD-100/70 mm RT. Art. Pulse 92 beats. in 1 min. The sigmoid colon is spasmodic, painful on palpation. The stool is sparse, with mucus and streaks of blood.
Which method is the MOST informative to confirm the diagnosis?
Coprology with bacterial feces
#5
*! A man, 20 years old, was admitted to the hospital on the 2nd day of illness with complaints of a headache in the frontal region and orbits of the eyes, sore throat, dry cough, aching muscle pain. Objectively: Temperature 39.5C. The mucous oropharynx is brightly hyperemic, the granularity of the posterior pharyngeal wall. Injection of vascular sclera. Serous-mucous discharge from the nose. Dry, unproductive cough. In the lungs, hard breathing, no wheezing. Heart sounds are clear, tachycardia, heart rate-92 beats / min, blood pressure: 100/60 mm Hg The abdomen is soft, painless.
What change in KLA is typical for this infection?
Leukopenia, lymphocytosis
# 6
*! A 29-year-old man came to the hospital with complaints of a headache in the frontal region and orbits of the eyes, sore throat, dry cough, aching muscle pain. Objectively: Temperature 39.5C. On examination: the 2nd day of the disease, the mucous membranes of the oropharynx are brightly hyperemic, the granularity of the posterior pharyngeal wall. Injection of vascular sclera. Serous-mucous discharge from the nose. Dry, unproductive cough. In the lungs, hard breathing, no wheezing. Heart sounds are clear, tachycardia, heart rate-92 beats / min, blood pressure: 100/60 mm Hg The abdomen is soft, painless.
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Which survey will be the most informative?
Nasopharyngeal swab
# 7
*! A man, 28 years old, was admitted to the hospital on the 2nd day of illness with complaints of a headache in the frontal region and orbits of the eyes, sore throat, dry cough, aching muscle pain. Objectively: Temperature 39.5C. The mucous oropharynx is brightly hyperemic, the granularity of the posterior pharyngeal wall. Injection of vascular sclera. From nasal-mucous discharge. Dry, unproductive cough. In the lungs, hard breathing, no wheezing. Heart sounds are clear, tachycardia, heart rate-92 beats / min, blood pressure: 100/60 mm Hg The abdomen is soft, painless. It was prescribed: cefazolin 1.0 * 3r i / m, glucose 5% -500.0 i / v, suprastin 1.0 i / m, Amizon tablets, gargle with furacilin.
What is the mistake made in the prescriptions: AB with a viral infection
#8
*! A woman of 25 years old was admitted to the hospital on the 2nd day of illness. Acutely ill: a rise in body temperature up to 39 of the C, pain in the temporal, frontal, retro-orbital areas, sore throat, stuffy nose, body aches, pain in bones and joints. On examination: hyperemia and puffiness of the face, vascular injection of the sclera, dry cough. Hard breathing is heard in the lungs, no wheezing. ChSS-92, ChD-20, AD-100/60 mm Hg In the hemogram: white blood cells - 3.5 × 10 9 , H b -120 g / l, erythritol-3.38 × 10 12 , p / y.-6%, s / y-56%, mon.-8%, lymph. -40%, ESR-15 mm / h.
Which antiviral is most appropriate? Oseltamivir
#9
*! A woman, 27 years old, a kindergarten teacher, fell ill acutely with fever up to 40 ° C, headache, repeated vomiting, weakness. The skin is pale, on the lower extremities a hemorrhagic rash of irregular shape. Rigidity of the occipital muscles is noted and the Kernig symptom is sharply positive on both sides. HELL 90/60 mm Hg, pulse 100 beats / min. On the 2nd day of the disease, she was sent to an infectious diseases hospital, where her leukocytes were taken during the initial examination.
MOST characteristic changes in the blood with meningococcal meningitis: hyperleukocytosis
# 10
*! A woman, 29 years old, a kindergarten teacher, fell ill acutely with fever up to 40 ° C, headache, repeated vomiting, weakness. The skin is clean, no rash. Rigidity of the occipital muscles is noted and the Kernig symptom is sharply positive on both sides. HELL 90/60 mm Hg, pulse 100 beats / min. On the 2nd day of the disease, she was sent to an infectious diseases hospital where a spinal puncture was performed: the cerebrospinal fluid is cloudy, comes out under pressure, the Pandy reaction (+), cytosis of 1200 cells in 1 μl (neutrophils -98%, lymphocytes-2%), protein - 0.066 glucose 2.8 mmol / l.
MOST characteristic changes in cerebrospinal fluid in this clinical case? Cytosis due to neutrophils
# 11
*! A 26-year-old woman was admitted to the hospital in serious condition. According to relatives, she fell ill sharply last night at about 10 p.m., with a fever, her body temperature rose to 40 ° C, and a headache appeared. I drank paracetamol and went to bed. In the morning, the woman does not get out of bed, a rash appeared throughout her body, the temperature of 39.8 ° C does not get off with antipyretic drugs. State hard e in mind. There are no meningeal symptoms. On the skin of the trunk and extremities, a hemorrhagic "star" rash. HELL - 80/60 mm Hg, heart rate 120 beats. in minutes., the pulse is weak, in the morning did not urinate.
What complication developed? ITS
#12
*! A student, 19 years old, was admitted with complaints of subfebrile temperature, weakness, sore throat. Objectively: the skin is clean, scanty serous-purulent discharge from the nasal passages, the mucous membrane of the posterior pharyngeal wall is hyperemic with hypertrophied follicles. Diagnosed with SARS. In the hemogram: white blood cells - 12x10 9 / l. with a shift of the leukocyte formula to the left, ESR - 30 mm / hour.
What examination is necessary to clarify the diagnosis?
