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Нажимая кнопку "Продолжить", я принимаю политику конфиденциальности

ANSWERS ON QUESTIONS

Main part

Patient L. 16 years old complains of headaches, nosebleeds,

leg pain after a long walk.

On examination, the patient’s hypersthenic constitution, developed

shoulder girdle, hyperemia of the face. The pulse on the radial artery is tense, rhythmic with

frequency of 64 per minute, symmetrically on both sides. 2 cm left border of the heart

outward from the left midclavicular line. Heart sounds are sonorous, clear, at all

at the auscultation points, a rough systolic murmur is heard

vessels of the neck and interscapular space, emphasis II tone on the aorta. Brachial arterial pressure

arteries - 170/110 mm RT. Art., on the femoral artery - 150/80 mm Hg at both sides.

Questions:

1. Select and justify the leading syndrome.

2. Establish a preliminary diagnosis.

3. Outline a plan for examining the patient in the first step.

4. Define the circle of differential diagnosis.

5. Define treatment tactics.

 

 

Situational task 73 [K000257]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient A., 38 years old, was admitted by ambulance to the admission department of the hospital with

complaints of a throbbing headache accompanied by a feeling of constriction

head, palpitations, sweating, chills. Over the last 6 months notes

weight loss of 4 kg. Measured blood pressure irregularly. History of the last 8 months - frequent

hypertensive crises stopped by emergency doctors (he doesn’t remember the drugs).

I did not take hypotensive therapy constantly, but with blood pressure increases above 170/100

mmHg Art. took Captopril 25 mg by mouth without a pronounced effect.

On examination: HELL - 220/130 mm RT. Art., heart rate - 180 beats per minute. Temperature

body - 37.8 ° C, pallor of the skin, tremors, cooling hands, photophobia.

Short-term syncope was noted. Intravenous therapy

slow administration of the drug Urapidil with a decrease in blood pressure over an hour to 160/90 mm

Hg. Art.

Questions:

1. Highlight the leading syndromes.

2. Establish a preliminary diagnosis.

3. Outline a plan for examining the patient in the first stage.

4. Define the circle of differential diagnosis.

5. Define treatment tactics.

 

Situational task 74 [K000288]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

45-year-old patient, a programmer by profession, turned to a general practitioner

the district police with complaints of pain in the epigastric region, mainly on an empty stomach and

at night, causing him to wake up, as well as for almost constant heartburn,

feeling of heaviness and fullness in the epigastric region after eating, heartburn,

belching sour, nausea.

From the anamnesis it is known that the patient smokes a lot, abuses coffee, eats

irregularly. Often there are exacerbations of chronic pharyngitis. Sick for about three years.

Not examined, treated independently (took herbal medicine).

On examination: satisfactory condition. BMI - 32.0 kg / m 2 . Skin integument

clean, normal color. The body temperature is normal. Zev - tonsils, back wall

pharynxes are not hyperemic. In the lungs, vesicular breathing, no wheezing. Heart sounds

muffled, rhythmic, heart rate - 70 beats per minute, blood pressure - 120/80 mm RT. Art. Stomach

participates in the act of breathing, on palpation is soft, painful in the epigastric region,

there is no tension in the abdominal muscles, a symptom of shocking along the lumbar region

negative.

EFGDS: the esophagus is freely passable, longitudinal folds are thickened, focal

hyperemia of the mucosa of the distal esophagus, the cardia does not close completely. IN

an empty stomach contains a small amount of light secretory fluid and

mucus. The folds of the gastric mucosa are thickened, convoluted. Onion 12-finger

the bowel is deformed, a mucosal defect of up to 0.5 cm is detected on the back wall

diameter. The edges of the defect have clear boundaries, hyperemic, edematous. Defect bottom

covered with fibrinous overlay of white color. Postbulbar departments without

pathology. The urease test for the presence of H. pylori is positive.

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. What treatment would you recommend to the patient as part of a combination

therapy? Justify your choice.

5. Is it necessary to take a patient to the dispensary? What to assign

to the patient as preventive therapy "on demand" when

symptoms characteristic of exacerbation of peptic ulcer?

 

 

Situational task 75 [K000304]