ANSWERS ON QUESTIONS

Main part

Patient V., 38 years old, sought advice from a local general practitioner

complaints of redness in the anterior surface of the left

hips, right shoulder, pain in the left hip joint.

Medical history: the doctor found that she fell ill four months ago when

found a red spot on the front surface of the left thigh, which for 2-3

days increased dramatically in size. In the area of ​​erythema, mild itching, general

health was not disturbed. Dermatologist examined, received

local treatment (it is difficult to name drugs), took antihistamines,

no improvement was noted. Three months later, a similar change in the skin appeared on

right shoulder. Four months later, pain appeared in the left hip joint. Pain in

pronounced joint, it was difficult to walk, about which the patient was

examination and treatment in the rheumatology department, without improvement. Aimed at

consultation with an infectious disease doctor.

Epidemiological history: 12 days before the appearance of erythema on the thigh was in

the next day I found a sucking tick on the front surface

left thigh, which was removed with tweezers.

Objectively: the condition is satisfactory. The skin is of normal color,

revealed a section of hyperemia of a ring-shaped 25 cm in diameter on the front

surface of the left thigh and 15 cm on the right shoulder, with intensely red and

the edges rising above the unaffected skin, in the center of the erythema pale. Of local

there is no increase in temperature, pain in the erythema. Above the left

hip joint edema, no hyperemia.

In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, heart rate

- 70 beats per minute, blood pressure - 120/80 mm RT. Art. The abdomen is soft, on palpation

painless in all departments. The liver and spleen are not enlarged. Bobbing on

the lumbar region is painless on both sides.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Create and justify a patient examination plan.

4. Which groups of drugs would you recommend to the patient as etiotropic

therapy? Determine the course of treatment. Justify your choice.

5. What are the methods of prevention of this disease.

Situational task 84 [K000318]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient I., 35 years old, came to the clinic at the place of residence on day 9

diseases with complaints of a rash throughout the body, hoarseness, a rough "barking" cough,

difficulty in noisy breathing, poor appetite.

Anamnesis of the disease: acutely ill on April 6: amid fever

body (38.0–39.0 ° С) catarrhal manifestations (nasal discharge, redness

eye, cough, photophobia). In this connection, she received outpatient treatment with a diagnosis

"Acute respiratory viral infection."

On April 10, body temperature was recorded at values ​​of 39.2 ° C, on the face

a bright pink spotty-papular rash appeared, which further on April 11 and 12

spread to the trunk and limbs, body temperature remained high.

The woman complained of lethargy, drowsiness. On the night of April 14 to April 15 state

the patient worsened: there was a hoarseness of voice and a rough "barking" cough. In connection with

deterioration turned to the clinic, where after examination by the head

therapeutic department was sent to inpatient treatment in infectious

the hospital.

Epidemiological history: was on a business trip in Turkey and 2 weeks

back from the trip.

Objectively: a state of moderate severity, clear consciousness. On the skin of the hands and

legs marked by a large-spotted rash in the pigmentation stage. The skin is peeling on the face.

In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, heart rate

- 70 beats per minute, blood pressure - 120/80 mm RT. Art. The abdomen is soft, on palpation

painless in all departments. The liver and spleen are not enlarged. Bobbing on

the lumbar region is painless on both sides.

Questions:

1. What preliminary diagnosis can be made?

2. How can I justify the diagnosis in this case?

3. How can I confirm the diagnosis?

4. What etiotropic drugs are used for this infection?

5. How is the prevention of this pathology?

Situational task 85 [K000320]