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ANSWERS ON QUESTIONS
Main part
A 64-year-old woman consulted a local general practitioner with complaints of dryness.
integument, overweight (BMI - 28), decrease in body temperature, decrease
appetite, constipation, decreased memory, drowsiness. On examination: the skin is dry,
cold to the touch. Puffiness of the face. The vesicular breathing, no wheezing. Heart rate - 58 in
a minute. HELL - 110/70 mm RT. Art. Body temperature - 36.3 ° C. The abdomen is soft, painless.
Liver +1.5 cm from under the edge of the costal arch. The chair is irregular, prone to constipation.
According to a laboratory examination: general blood test: hemoglobin - 104
g / l, cholesterol - 9.4 mmol / l, triglycerides - 5.5 mmol / l, KFK - 247, AST - 48, TTG -
15.3 IU / L.
Questions:
1. Formulate a preliminary diagnosis.
2. What is the most likely cause of the disease?
3. Make an examination plan for this patient.
4. What is the treatment strategy for this patient?
5. Is this patient indicated for surgical treatment?
Situational task 113 [K000436]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 36-year-old woman came to the outpatient clinic with a general practitioner
complaints of severe general weakness, drowsiness, memory impairment, dryness
skin, overweight (BMI - 27.2 kg / m 2 ), the absence of menstruation.
From the anamnesis it is known that 2 years ago the patient was operated on for nodular goiter.
Substitution therapy was not prescribed. On examination: the skin is dry, pale with
icteric shade. Puffy face, tongue with imprints of teeth. HELL - 105/60 mm RT.
Art.
According to laboratory tests, anemia was detected: hemoglobin - 102 g / l,
cholesterol - 7.8 mmol / l, triglycerides - 4.7 mmol / l, blood glucose - 3.4 mmol / l.
On the ECG: bradycardia - 54 beats per minute, low voltage of the teeth.
Questions:
1. Formulate a preliminary clinical diagnosis.
2. Create a diagnostic algorithm for examining this patient.
3. Which consultations should be included in the survey plan?
4. What is the treatment strategy for this patient?
5. What is the duration of the appointment of pathogenetic therapy?
Situational task 114 [K000439]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 78-year-old patient F. summoned a local therapist at home with complaints of
palpitations, interruptions in the work of the heart, which are accompanied by weakness,
shortness of breath. Arrhythmias have bothered the past six months,
lasting several minutes, pass independently when changing
body position.
From the anamnesis it is known that the last few years, memory began to decline, rarely
notes an increase in blood pressure to 160/90 mm RT. Art. Past diseases: peptic ulcer
duodenal disease, focal pneumonia. Currently retired
He worked as a teacher at the university. Has no bad habits.
When viewed from a patient with moderate severity. Body type correct, height
- 168 cm, weight - 70 kg.
The shape of the chest is conical, breathing is free through the nose. Noticeable
throbbing of the cervical veins. BH - 17 beats per minute. With percussion, the sound is clear, easy
the boundaries of the lungs are within normal limits. During auscultation, breathing is stiff, no wheezing.
Circulatory system. Borders of relative cardiac dullness: right -
the right edge of the sternum, the left - 1 cm inwards from the left midclavicular line, the upper -
upper edge of the III rib. During auscultation, heart sounds are muffled, rhythmic. Heart rate -
112 beats per minute, heart rate deficiency. HELL - 130/80 mm RT. Art.
The abdomen is soft, painless in all departments. The liver is not palpable, dimensions
according to Kurlov - 9 × 8 × 7 cm.
General analysis of blood and urine without pathology. In a biochemical blood test
high cholesterol is determined.
An ECG was recorded: P waves in all leads are absent. Between QRS complexes,
small waves "f", the frequency of the ventricles 110-150 per minute.
Questions:
1. What is the rhythm disturbance in the patient?
2.
FROM
which
supraventricular
arrhythmias
is necessary
conduct
differential diagnosis?
3. What additional examination methods will you assign to the patient? Justify
answer.
4. Based on what parameters is the risk of stroke and systemic
thromboembolism (TEO) in this patient? Is appointment necessary
anticoagulants in this patient?
5. List what applies to cardiovascular and other conditions,
associated with atrial fibrillation. What are the conditions
associated with the development of atrial fibrillation in this patient.
Situational task 115 [K000441]
Дата: 2019-12-10, просмотров: 263.