ANSWERS ON QUESTIONS

Main part

A 52-year-old man was hospitalized with a reception in the clinic with complaints of

fever up to 39.5 ° C, excessive sweating, chills, shortness of breath, dizziness with

light physical exertion, weakness, lack of appetite, weight loss of 10 kg per

last 2 months.

Bad habits: for many years abuse alcohol, for 30

smokes 1 pack per day for years.

About 2.5 months ago, tooth extraction was postponed. One week after

manipulations appeared subfebrile condition and excessive sweating. In two weeks

treated with folk remedies, against the background of which there was a fever with chills,

excessive sweating, pain in muscles and joints. Another week for

I did not seek medical help. When contacting the clinic in place

residence during chest x-ray revealed no pathology.

In blood tests, leukocytosis was noted - 14 × 10 9 / l, an increase in ESR up to 24 mm / h.

Ampicillin was prescribed at a dose of 2 g / day, against which a marked decrease in temperature

body to subfebrile digits and joint pain. Persistent hyperhidrosis persisted,

sharp weakness, lack of appetite. 5 days after completion of administration

antibiotics again noted an increase in body temperature to 39 ° C with chills.

On examination. The condition is serious. Is inhibited. Orthopnea. Body temperature 39.5

° C. Low power. The skin is pale with a jaundice, moist,

turgor is reduced, on the palms are painless hemorrhagic spots 3 mm in diameter.

There are no fathers. Peripheral lymph nodes are not enlarged. With comparative percussion

lungs - a sound with a boxy tint, with blunting in the lower sections. The boundaries of the lungs

fine. During auscultation, breathing is hard, moist rales in the lower parts of both

easy. BH - 24 per minute. Apical impulse in the sixth intercostal space on the left front

axillary line. Borders of relative cardiac dullness: right - 1 cm

outward from the right edge of the sternum, upper - upper edge of the III rib, left - on the left

anterior axillary line in the VI intercostal space. On auscultation of the heart: heart sounds

rhythmic, weakening of the I tone in the VI intercostal space on the left front axillary line,

attenuation of II tone in the II intercostal space to the right of the sternum. In the II intercostal space to the right of

sternum and at the point of Botkin-Erba - soft blowing protodiastolic murmur, in VI

intercostal space on the left front axillary line - systolic murmur. Pulse

tall, fast, rhythmic, symmetrical on both hands. Heart rate - 115 beats per minute.

HELL - 130/40 mm RT. Art. Ripple of the carotid arteries. The abdomen is soft, painless.

The size of the liver according to Kurlov: 14 × 12 × 10 cm. Palpation of the liver is moderately painful.

The spleen is palpated at the edge of the costal arch, soft, painful. Diameter - 10 cm

length - 12 cm.

Complete blood count: hemoglobin - 85 g / l, white blood cells - 22 × 10 9 / l, stab

neutrophils - 8%, segmented neutrophils - 78%, eosinophils - 1%, lymphocytes -

8%, monocytes - 5%. ESR - 38 mm / h.

Biochemical blood test: total bilirubin - 41.2 μmol / l, CRP +++,

fibrinogen - 6.5 g / l, albumin - 40%, rheumatoid factor +.

Urinalysis: specific gravity - 1010, protein - 0.99 g / l, white blood cells - 5-6 in the field

vision, leached red blood cells - 5-8 in the field of view.

Echocardiography: thickness of the posterior wall of the left ventricle and interventricular septum

- 1.0 cm. Expansion of the cavity of the left ventricle: final diastolic size of the left

ventricle - 6.0 cm, the size of the left atrium - 5.5 cm. On the aortic valve leaflet

there is an echogenic formation 1.0 × 0.8 cm in size. Aortic regurgitation III

degrees, mitral regurgitation of the II degree.

Questions:

1. Highlight the syndromes available to the patient.

2. Formulate and justify the clinical diagnosis.

3. What is the most important additional study you need to perform

patient to clarify the diagnosis? How to perform this study?

4. What are the basic principles of treatment of the patient and indications for surgical

treatment.

5. What measures and to whom should be taken to prevent development

this disease?

Situational task 52 [K000228]