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Нажимая кнопку "Продолжить", я принимаю политику конфиденциальности

ANSWERS ON QUESTIONS

Main part

At an appointment with a general practitioner, a patient K., 50 years old, teacher.

Complaints of moderate dry mouth, thirst (drinks more than 3 liters of liquid in

day), increased appetite, itching of the skin, especially in the axillary and inguinal

areas, the appearance of pustules in the places of combing, frequent urination.

In the anamnesis: the specified complaints appeared and accrued during the year. From 45 years

suffers from hypertension (blood pressure from 160/100 to 140/90 mm Hg), took

captopril irregularly. Relatives on the part of the mother note a tendency to

obesity, mother suffered from hypertension, type 2 diabetes, died

at the age of 65 from a stroke. There were 3 pregnancies, some deliveries at 29 years old, the weight of the child with

birth 4.3 kg.

Objective examination data: satisfactory condition, calculations for

back. Skin of low humidity. Height - 168 cm, weight - 85 kg, waist circumference - 96 cm,

hip circumference - 110 cm, fold on the anterior abdominal wall - 8 cm.

vesicular breathing, no adverse respiratory sounds. NPV - 16 per minute. Tones

rhythmic hearts, reinforced 2 tone in the second intercostal space to the right of the sternum. Heart rate - 76 in

a minute. HELL - 156/94 mm RT. Art. (D = S). The abdomen is enlarged due to the subcutaneous fat layer,

soft, painless. Ripple on the arteries of the feet saved.

Complete blood count: red blood cells - 4.6 × 10 12

, Hb - 130 g / l, CPU - 0.9, platelets -

250 × 10 12 , white blood cells - 6.1 × 10 9 , eosinophils - 1%, stab - 2%, segmented -

65%, lymphocytes - 30%, monocytes - 2%, ESR - 8 mm / h.

Creatinine - 90.0 μmol \ L, GFR - 64.2 me / min / 1.73

The reaction of urine to acetone is negative.

Microalbuminuria - 100 mg / dl.

Lipid profile: total cholesterol - 6.5 mmol / L, LDL - 3.48 mmol / L, HDL - 0.9

mmol / l.

Biochemical analyzes: fasting blood glucose - 7.7 mmol / l, glycosylated

hemoglobin (HBA1c) - 7.5%.

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 reference. Regime, diet, drug and non-drug treatment.

5. What is the further tactics of patient management after correction of glycemia?

 

Situational task 101 [K000398]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 38-year-old female patient with DTZ (diffuse toxic goiter) complains of

a feeling of sand in the eyes, double vision, lacrimation, photophobia. On examination, it is noted

bilateral exophthalmos (more on the right), scleral injection.

Questions:

1. Make a diagnosis.

2. Justify your diagnosis.

3. What additional examinations is needed for eye symptoms?

4. Prescribe treatment.

5. The prognosis for the disease.

 

Situational task 102 [K000404]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient N., 28 years old, suffers from Addison's disease for three years. Gets

replacement therapy: 5 mg of prednisolone in the morning, 2.5 mg at 16.00, fludrocortisone 0.1

mg in the morning. The condition was satisfactory. Four days ago, she got the flu.

The dose of gluco- and mineralocorticoids did not change. The patient's condition deteriorated sharply

a day ago: severe weakness, adynamia, nausea, vomiting appeared. Delivered to

hospital with manifestations of vascular collapse by ambulance.

Objectively: a serious condition. Productive contact is not available. Leather

dry, dark, pronounced hyperpigmentation of the skin in the area attracts attention

nipples, on the neck, elbow bends. Pulse - 128 beats per minute, weak filling, blood pressure -

60/40 mmHg Art.

Questions:

1. State the most probable diagnosis.

2. Justify your diagnosis.

3. Determine the amount of additional surveys needed to clarify

diagnosis and treatment. Assume Expected Survey Results

in this situation.

4. Determine the patient’s treatment tactics.

5. Identify preventive measures to prevent development in

patients of this condition.

 

 

Situational task 103 [K000405]