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ANSWERS ON QUESTIONS
Main part
Patient M., 27 years old, turned to the local GP on the 2nd day of illness with
complaints of severe headache in the frontal region, pain in the eyeballs, muscles
and joints, general weakness, lack of appetite, frequent dry cough, nasal congestion
nose and slight discharge from the nose, a feeling of tickling and scratching behind the sternum.
Anamnesis of the disease: fell ill on January 15 in the morning, when
felt chills, the temperature rose to 39.0 ° C, a headache appeared in
forehead, pain when moving eyeballs. I didn’t sleep at night, chills replaced
feeling of heat. The next day, a dry cough appeared, nasal congestion, feeling
perspiration behind the sternum, the temperature increased to 39.5 ° C, the headache intensified.
Epidemiological history: 2 days before the disease visited friends in
dormitories, among which were persons with similar symptoms.
Objectively: a state of moderate severity, clear consciousness. Face
puffy, somewhat hyperemic. There is no rash on the body. Nasal breathing is difficult.
In the throat, spilled bright hyperemia of the posterior pharyngeal wall and its granularity are noted
single hemorrhages on the mucosa of the soft palate. In the lungs - harsh breathing,
single dry rales. Pulse - 102 beats per minute, rhythmic, blood pressure - 115/80 mm RT. Art.
Heart sounds are muffled. The abdomen is soft, painless. Liver and spleen not
enlarged.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make a plan for a laboratory examination of the patient to verify the diagnosis.
4. What antiviral drugs would you recommend to the patient? Name
the mechanism of their action on influenza viruses. Justify your choice.
5. Who is subject to compulsory influenza vaccination? What are the modern
vaccines for the prevention of influenza.
Situational task 86 [K000321]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient M., 16 years old, was sent from the clinic to the infectious diseases hospital
August 20 with complaints of poor appetite, aching pain in the right hypochondrium, darkening
urine, icteric coloration of the skin and sclera.
Anamnesis of the disease: fell ill on August 14, when the temperature rose to 38 ° C,
appeared headache, nausea, double vomiting. All subsequent days remained
temperature within 37.6–38 ° С, general weakness, headache, nausea worried
poor appetite. On August 19, he noticed a darkening of urine and lightening of feces. August 20
yellowness of the skin and sclera appeared.
Epidemiological history: lives in a student dormitory in room 4
person. Periodically eats in the dining room at the place of study.
Objectively: general state of moderate severity. Temperature 37.5 ° C.
The skin and sclera are moderately icteric, no rash. Peripheral lymph nodes
not palpable. In the lungs, vesicular breathing, no wheezing, BH - 16 per minute. Tones
hearts are muffled, the rhythm is correct. Pulse - 64 beats per minute, blood pressure - 100/60 mm RT. Art.
The tongue is moist, coated at the root with white coating. The stomach is not swollen, soft,
painless. The liver protrudes 2 cm from under the edge of the costal arch, sensitive
on palpation. The spleen is palpated. Lumbar
negative on both sides.
Biochemical parameters: total bilirubin - 160 mmol / l, direct - 102
mmol / L, indirect - 58 mmol / L, Alt - 640 IU / L, ACT - 488 mmol / L, alkaline
phosphatase - 102 units, prothrombin index - 60%.
In the analysis of urine, bile pigments are determined.
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. Tactics of patient management. Justify your choice.
5. What are the methods of prevention of this disease.
Situational task 87 [K000323]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient E. 32 years old, businessman, hospitalized on day 2 of the disease with a diagnosis
"Flu, hypertoxic form." The disease began acutely, even suddenly. On the background
chills appeared, head fell ill, body temperature increased
up to 40.2 ºС. He noted photophobia, lay with his eyes closed, asked to turn off
TV. In the evening there was twice vomiting, the "throbbing" headache remained.
The next morning, his health worsened: he did not understand where he was, sought
go to work, while trying to get up fell.
Upon receipt, the condition is serious, the consciousness is darkened. Disoriented but
responds to his name, complains of a severe headache. Body temperature 39.2 ° C.
The face is very pale. On the skin of the abdomen, buttocks and lower extremities, small stellate
a rash of blue-violet color, there are also petechial elements on the hands. Sharp
stiff neck and Kernig symptom. Pulse - 116 beats per
minute, rhythmic, blood pressure - 130/90 mm RT. Art. Heart sounds are clear. With spinal
puncture obtained under high pressure turbid liquid with a high neutrophilic
(99%) pleocytosis - 15400 cells / ml; protein - 2.64 g / l; Pandy reaction (++++).
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. Indicate the treatment plan for this patient.
5. After 1 month, the patient complains of moderate weakness, moderate headache
pain, decreased performance, sometimes dizziness. Tonsils not
increased, no raids. HELL - 100/60 mm RT. Art., pulse - 76 beats per minute.
The control bacterial culture of the smear from the oropharynx and from the nose is negative. IN
urinalysis increased ESR - 26 mm / hour. What is the next tactic
patient management?
Situational task 88 [K000324]
Дата: 2019-12-10, просмотров: 279.