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ANSWERS ON QUESTIONS

Main part

Patient S. 21 years old for two weeks notes weakness, drowsiness,

increased irritability, loss of appetite, subfebrile condition. Also noted

intermittent headache without clear localization, not relieved by analgesics, vomiting,

not associated with eating, without prior nausea.

I sought medical help at the clinic at the place of residence. After

of the examination by a general practitioner, the local doctor was diagnosed with ARVI,

moderate severity. " Appointed symptomatic therapy (antipyretic,

antihistamines, vitamin therapy) with a second appearance at a reception after three

of the day. Against the background of the treatment, the patient's condition deteriorated sharply:

headache intensity, temperature increased to 39 ° C, began to be noted

spontaneously occurring and rapidly disappearing red spots on the face and chest.

Given the above clinical symptoms and the course of the disease,

the local general practitioner appointed a consultation of a neurologist. At

study of neurological status revealed positive meningiologic

symptoms, dilated pupil, divergent strabismus. For further examination

delivered to the infectious ward.

When conducting a spinal puncture found: high blood pressure

(fluid flows out), cytosis - 200 cells (neutrophils - 10%, lymphocytes - 90%),

chlorides - 70 mmol / l, sugar - 0.6 mmol / l, protein - 1.2 g / l. PCR method in cerebrospinal fluid

detected by the office.

In the general analysis of blood: red blood cells - 3.5 × 10 12 / l, hemoglobin - 115 g / l, white blood cells -

9.4 × 10 9 / l, eosinophils - 3%, stab neutrophils - 7%, segmented

neutrophils - 61%, lymphocytes - 17%, monocytes - 12%, ESR - 22 mm / hour.

Questions:

1. Assume the most likely diagnosis in the patient.

2. What pair of cranial nerves is affected in a patient? What other cranial

can brain nerves be affected in this disease?

3. What are the changes in cerebrospinal fluid, confirming the etiology of the disease.

4. What are the diseases with which to conduct differential

diagnostics.

5. Make a treatment plan for this patient and justify your choice.

 

Situational task 64 [K000243]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A man of 26 years old was delivered to the emergency room of a multidisciplinary hospital

complaints of fever up to 39 ° C, chest pain, cough with sputum

mixed with blood. Profession - teacher at school.

From the anamnesis: over 4 months, weakness gradually increased, decrease

appetite, weight loss. Last year I had tuberculous contact with a relative.

Worse 3 days ago: fever, cough.

On examination: moderate severity. Exhausted. The skin is pale,

acrocyanosis. When coughing, blood is leaking, 30-40 ml of blood is allocated. Shortness of breath, BH - 30 in

a minute at rest. The right half of the chest lags in the act of breathing. Shortening

percussion sound over the upper lobe of the right lung. There is bronchial breathing,

small and medium bubbling rales. Heart sounds are muffled. 1 cm liver protrudes

from under the edge of the costal arch. The rest - without features.

Clinical blood test: hemoglobin - 95 g / l, red blood cells - 3.8 × 10 12 / l,

leukocytes - 15.0 × 10 9 / l, stab neutrophils - 14%, segmented

neutrophils - 70%, eosinophils - 1%, monocytes - 7%, lymphocytes - 8%, ESR - 45 mm / h.

In the analysis of sputum - acid-resistant sticks.

Chest x-ray: in the upper lobe of the right lung -

massive inhomogeneous infiltration with multiple decay cavities. Foci

seeding in the lower parts of both lungs.

 

Questions:

1. Make a preliminary diagnosis.

2. Justify the preliminary diagnosis.

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

4. What anti-epidemic measures should be taken?

5. What is the complication of this disease, requiring urgent measures.

Prescribe and justify the treatment.

 

 

Situational task 65 [K000245]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 35-year-old woman was identified during a prophylactic FLG examination.

From the anamnesis: chronic diseases - thyroxicosis, at the endocrinologist

observed irregularly. Living conditions are prosperous, occupational hazards

No, he works as a sales assistant. In the past 1.5 years ago took place

tuberculous contact with a work colleague; preventive measures are not

were carried out. Preventive FLG was not done for 3 years.

No complaints, symptoms of intoxication are absent. Percussion,

There are no auscultatory changes.

Microscopy of sputum at the office - neg.

Immunodiagnosis: Mantoux test 2 TE - p. 12 mm, DST - p. 4 mm

X-ray - tomography: in the upper lobe of the left lung, subpleural

determined by non-uniform limited darkening of rounded shape with dimensions 1.5 × 2.0

cm.

 

Questions:

1. Formulate a preliminary diagnosis.

2. Justify the preliminary diagnosis.

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

4. What are the main treatment methods recommended?

5. Determine the period of disability of the patient.

 

 

Situational task 66 [K000246]