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ANSWERS ON QUESTIONS

Main part

52-year-old patient suffering from iron deficiency anemia and taking about

of this disease, iron (II) preparations. In connection with the exacerbation of chronic

pyelonephritis, the patient was prescribed ciprofloxacin 250 mg 2 times a day. Both

the patient took the drug at the same time. 5 days after the start of reception

Ciprofloxacin persists subfebrile fever, pollakiuria.

Questions:

1. What are the possible causes of the ineffectiveness of antibiotic therapy?

2. What research needs to be done additionally?

3. According to bacteriological analysis of urine, Escherichia coli was isolated,

sensitive to ciprofloxacin. What is the reason for drug inefficiency?

therapy?

4. What will be your further treatment recommendations?

5. What is the duration of iron supplementation?

 

Situational task 76 [K000305]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient N. 65 years old went to the clinic with complaints of deterioration during

the last 2 weeks of the condition: increased blood pressure to 150/100 mm RT. Art.,

weakness, sweating, aching pain in the lumbar region, fever

37.8 ° C in the evening, slight pastiness of the eyelids and faces in the morning.

Over the past 2 months, takes Diclofenac at a dose of 150 mg per day from

joint pain (suffering from osteoarthritis).

Blood test: ESR - 30 mm / h, white blood cells - 6500, HB - 112 g / l.

Urinalysis: light yellow, transparent, 1003, acidic; protein - 0.33%;

erythrocytes - 5-6 in the field of view; white blood cells - 10 in the field of view.

Questions:

1. What is the possible cause of these clinical manifestations?

2. What additional studies will you assign to clarify the diagnosis?

3. What will be your recommendations before receiving the results of the additional examination?

4. What are the possible side effects when taking non-steroidal

anti-inflammatory drugs?

5. What group of antihypertensive drugs do you assign to this patient,

Considering the possible use of non-steroidal anti-inflammatory drugs?

 

Situational task 77 [K000307]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 35-year-old patient undergoing treatment in the urology department

urolithiasis, fever up to 39 ºС, chills, symptom of shocking

sharply positive. In a general urinalysis, signs of a urinary tract infection.

Diagnosed with acute pyelonephritis on the background of urolithiasis, in

the laboratory sent material for sowing.

Questions:

1. The drug of which group of antibacterial chemotherapeutic agents would you

recommended to the patient? Justify your choice.

2. After 2 days of antibiotic therapy, the clinical effect is negligible,

bacteriologically revealed that E. coli is a producer of ß-lactamase

extended spectrum that destroys all penicillins and cephalosporins.

Suggest a choice of antibiotic.

3. Bacteriological analysis data showed intestinal sensitivity

sticks to Imipenem and Meropenem. Which one to appoint the patient?

4. On the 4th day of the use of Meropenem, urticaria appeared, from Quincke, in connection with

than the drug is canceled. Offer a replacement drug.

5. How long should be a course of antibiotic therapy for complicated

pyelonephritis?

 

Situational task 78 [K000308]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 60-year-old patient was diagnosed with endocrine ophthalmopathy, active stage

moderate severity. " Sick of hypertension 15 years, hypertensive

crises with manifestations of cardiac asthma. Constantly receiving antihypertensive therapy:

Perindopril 5 mg in the morning, Amlodipine 10 mg in the evening, blood pressure is maintained at 130-

140 / 80-85 mmHg Art. Regarding frequent vertebral pain, takes periodically

Diclofenac 50-100 mg as needed. Body weight - 65 kg.

Questions:

1. What is the drug of choice for active active stage ophthalmopathy?

2. How to distribute the daily dose of the drug 1 mg / kg, and what are the control measures

security?

3. On the 4th day of GCS therapy, blood pressure more often exceeded 140/95 mm Hg. Art. were

episodes of hypertensive crisis with cardiac asthma were noted. What do you need

to undertake?

4. What medications should be prescribed for prevention

steroid osteoporosis?

5. What should be done to prevent ulcerogenic effects?

 

 

Situational task 79 [K000309]