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ANSWER TO QUESTIONS
Main part
A 53-year-old woman consulted a local GP with complaints of heartburn,
pain behind the sternum, appearing after eating and physical activity. Notes also
increased pain when bending and in a horizontal position. From the anamnesis it is known that
heartburn worries about 20 years. Not surveyed. The last 2 months there was data
pain behind the sternum.
On examination: satisfactory condition. Body mass index (BMI) - 39 kg / m 2
.
The skin of normal color, clean. In the lungs - vesicular breathing, wheezing
not. Heart sounds are clear, rhythmic, heart rate - 72 beats per minute, blood pressure - 120/80 mm RT. Art. At
palpation of the abdomen is soft, painless. Liver on the edge of the costal arch. Sizes -
10 × 9 × 8 cm. The spleen is not palpable.
Data fibrogastroduodenoscopy: in the lower third of the esophagus revealed erosion,
occupying about 40% of the circumference of the esophagus.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make and justify a plan for an additional examination of the patient.
4. Give non-drug recommendations to the patient.
5. What medical treatment would you recommend to the patient? Justify
own choice.
Situational task 69 [K000251]
Instructions: READ THE SITUATION AND GIVE AN EXTENDED
ANSWER TO QUESTIONS
Main part
A 60-year-old man consulted a local GP with complaints of pain in
epigastrium 20 minutes after eating, vomiting, which brings relief, lost weight in a month
7 kg. Epigastric pain worries about 2 months.
On examination: satisfactory condition. The skin is of normal color,
clean. In the lungs - vesicular breathing, no wheezing. Rhythmic heart sounds,
Heart rate - 72 beats per minute, blood pressure - 120/80 mm RT. Art. On palpation, the abdomen is soft,
painful in epigastrium. Liver on the edge of the costal arch. Dimensions - 10 × 9 × 8 cm.
The spleen is not palpable.
Fibrogastroduodenoscopy performed: ulcerative defect in the middle third of the stomach
3 cm in diameter, biopsy taken.
Questions:
1. Formulate a preliminary diagnosis.
2. Justify your diagnosis.
3. Create a differential diagnosis plan.
4. Make an additional examination plan.
5. What medical treatment would you recommend to the patient? Justify your
a choice.
Situational task 70 [K000252]
Instructions: READ THE SITUATION AND GIVE AN EXTENDED
ANSWER TO QUESTIONS
Main part
A 35-year-old patient came to the clinic complaining of loose stool with an admixture of
blood 5-6 times a day, fever up to 37.5 ° C, weakness, dizziness,
pain in the ankle, elbow, shoulder joints.
He became ill about 2 months ago, when his body temperature increased,
joint pain. Several courses of antibiotic therapy were carried out, against which
loose stools appeared.
Objectively: the skin is pale, clean. On palpation, the abdomen is soft,
painful in the iliac areas. The liver does not protrude from under the edge of the costal arch.
The size of the liver according to Kurlov is 10 × 9 × 8 cm. The spleen is not palpable.
In the general analysis of blood: red blood cells - 3.2 × 10 12 / l, hemoglobin - 61 g / l, white blood cells -
11 × 10 9 / l, platelets - 350 × 10 9 / l, ESR - 30 mm / h.
Questions:
1. Formulate a preliminary diagnosis.
2. Justify your diagnosis.
3. Create a differential diagnosis plan.
4. Make an additional examination plan.
5. Formulate and justify a treatment plan.
Situational task 71 [K000254]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient B. 38 years old complains of shortness of breath with minor physical
stress, fatigue, weakness, episodes of suffocation occurring in
horizontal position, swelling of the legs and feet. At the age of 17 was identified
rheumatic heart disease - mitral valve insufficiency.
On examination: serious condition. Acrocyanosis. Swelling of the legs and feet. NPV - 24 in
a minute. With comparative percussion of the lungs to the right below the angle of the scapula,
blunting percussion sound. With auscultation, weakened vesicular breathing, in
lower parts - a small amount of moist finely bubbling rales. Left
the border of the heart is 3 cm outwards from the midclavicular line in the VI intercostal space.
Auscultatory picture corresponds to the existing defect. Heart rhythm
contractions wrong, heart rate - 103 beats per minute. HELL - 110/65 mm RT. Art. Stomach
increased in volume due to unstressed ascites, mild, painless. Dimensions
according to Kurlov - 13 × 12 × 10 cm. The liver protrudes from the edge of the costal arch by 3 cm,
its edge is rounded, slightly painful.
On the ECG, the rhythm is incorrect, P waves are absent.
Questions:
1. Highlight the leading syndrome.
2. Establish a preliminary diagnosis.
3. Outline a plan for examining the patient in the first step.
4. Define treatment tactics.
5. Which specialist should the patient be referred to and for what purpose?
Situational task 72 [K000256]
Дата: 2019-12-10, просмотров: 267.