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ANSWERS ON QUESTIONS
Main part
Patient M., aged 20, was admitted to the neurological department
City Hospital No. 1 with complaints of weakness in the lower extremities, impossibility
walk, as well as general malaise, decreased appetite and body weight, low-grade fever
in the evenings.
He became ill two years ago when he began to worry about gradually growing weakness
in the legs. Repeatedly turned to the local GP, who evaluated
the patient's condition as a manifestation of osteochondrosis of the spine. Recently
stopped walking, and therefore examined by a neurologist who suspected a patient
multiple sclerosis. From the anamnesis it is known that in childhood there was contact with the patient
tuberculosis by an asocial mother who died 15 years ago from a car accident,
subsequently, the patient was raised by his grandmother.
A complex of diagnostic measures was carried out in the hospital.
On the survey roentgenogram (in two projections) and MRI of the spine revealed
contact destruction of bodies of the XI-XII thoracic vertebrae and I lumbar vertebra with
the formation of necrotic masses, compression of the corresponding spinal
brain.
Complete blood count: hemoglobin - 120 g / l, white blood cells - 8.9 × 10 9 / l, eosinophils -
3%, stab neutrophils - 8%, segmented neutrophils - 68%, lymphocytes
- 17%, monocytes - 4%, ESR - 21 mm / hour.
Urinalysis: within normal limits.
Mantoux test with 2 TE PPD-L - 22 mm papule.
On the x-ray of the chest organs pathology was not detected.
Questions:
1. Formulate a diagnosis.
2. What diseases do you need to differentiate this pathology from?
3. What treatment measures should the patient take?
4. For which group of dispensary registration, patient M. is subject to observation and
why?
5. Assign a chemotherapy regimen and etiotropic treatment regimen for the patient.
Situational task 59 [K000237]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
During mass fluorographic examination of the patient’s population,
single focal shadows in the region of the apex of the right lung were revealed. Doctor-
the radiologist assessed these lesions as residual changes after
tuberculosis and did not call the patient for further examination. After 4 months, this patient
appealed to the clinic with complaints of general weakness, malaise, low-grade
temperature in the evenings, sweating, especially at night, coughing with a little
the amount of sputum mucosa. On X-ray examination in the upper lobe
the right lung from the apex to the III rib revealed multiple focal shadows
polymorphic in nature, merging in places, and several cavities
decay sizes up to 2 cm in diameter. In sputum by fluorescence microscopy
Mycobacterium tuberculosis was detected.
Questions:
1. Is the disease detected in a timely manner in this patient? Justify your
answer.
2. Did the radiologist do the right thing after detecting foci in the patient 4
months ago? Justify your answer.
3. What activities needed to be carried out at that time?
4. Formulate a clinical diagnosis.
5. What treatment measures should this patient take? Justify
your answer.
Situational task 60 [K000239]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient B., 24 years old, turned to the local GP with complaints of
fever up to 38.5 ° C, cough with scanty sputum of a mucous character,
mainly in the mornings, shortness of breath at rest, night sweats. Has contact with the patient
tuberculosis father.
Sick for 10 days when, after hypothermia, the temperature increased,
there was weakness, shortness of breath at rest.
After X-ray examination revealed pathology in the lungs. Directed
in the pulmonology department with a diagnosis of community-acquired bilateral focal
pneumonia".
On examination: the skin is pale, flush cheeks, peripheral lymph nodes
not increased. With percussion over mild tympanitis, breathing is weakened, there are no wheezing.
Complete blood count: red blood cells - 3.3 × 10 12 / l, hemoglobin - 120 g / l, white blood cells -
11.8 × 10 9 / L, eosinophils - 4%, stab neutrophils - 14%, segmented
neutrophils - 52%, lymphocytes - 18%, monocytes - 12%, ESR - 30 mm / hour.
General urine analysis: straw yellow, transparent, acidic, specific gravity - 1017,
protein - 0.066 ‰, flat epithelium - 2-3 in the field of view, white blood cells - 5-6 in the field of view.
The Mantoux reaction with 2 TE PPD-L is negative. Analysis of sputum on the office method
luminescence microscopy - no MBT detected.
X-ray: in lungs, total small focal dissemination is determined,
foci 2-3 mm in size, located perivascular, of medium intensity, with clear
contours, without a tendency to merge.
Broad-spectrum antibiotic therapy for two weeks of effect
not given.
Questions:
1. Assume the most likely diagnosis in the patient.
2. Give the rationale for your diagnosis.
3. What other diseases occur with a similar radiological picture?
4. What methods of microbiological diagnosis can be used in this
case?
5. Make a treatment plan for the patient and justify your choice.
Situational task 61 [K000240]
Дата: 2019-12-10, просмотров: 217.