ANSWERS ON QUESTIONS

Main part

Patient S., 47 years old, at the reception of a local general practitioner

aggravated after errors in the diet of pain in the upper abdomen,

sometimes radiating to the back, losing weight.

At the age of 40, she underwent cholecystectomy for calculous

cholecystitis. Six months after the operation, almost constant, intensifying

after errors in the diet of pain in the upper abdomen, sometimes with irradiation in

your back. When using antispasmodics and dieting

improved. The last 1.5-2 years joined almost constant

unformed stool, began to lose weight (lost 8 kg in 2 years). Throughout this

at the same time, itching of the perineum arose, began to drink more fluids, became more frequent

urination.

On examination, the patient's condition is satisfactory. The physique is correct,

slightly increased nutrition. Height - 175 cm, weight - 90 kg, BMI - 29 kg / m 2 . Drumsticks

pasty. With comparative percussion of the lungs, a light sound is determined.

Auscultation is hard breathing, carried out in all departments. Heart sounds are muffled

rhythmic, noises are not heard. Heart rate - 80 beats per minute, blood pressure - 156/85 mm RT. Art.

The tongue is moist, at the root is covered with white coating. With superficial palpation of the abdomen

there is some pain in the epigastrium and in the right hypochondrium. Symptoms

no peritoneal irritation. With deep palpation, the sigmoid colon is palpated in

a moderately movable painless cylinder with a diameter of 1.5 cm.

soreness in the Shoffar zone. Positive Kerte symptom, Mayo-Robson symptom.

With percussion of the abdomen - tympanitis. The size of the liver according to Kurlov - 15 × 13 × 11 cm. Liver

protrudes from under the costal arch by 3-4 cm, the edge of moderate density, painless.

Pasternatsky’s symptom is negative on both sides.

Questions:

1. Formulate a preliminary diagnosis.

2. The defeat of which body can be assumed, and what is the reason?

3. What additional examination methods should be prescribed to the patient?

4. Determine the treatment tactics of the patient.

5. With which diseases is it necessary to make a differential diagnosis?

Situational task 116 [K000447]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 25-year-old patient, a driver, turned to a local general practitioner with complaints of

the appearance of episodes of suffocation with difficulty exhaling, cough with difficult to separate

phlegm almost daily. Choking attacks occur 2-3 times a week more often

at night and pass spontaneously after an hour with the disappearance of all symptoms. Insignificant

shortness of breath during physical exertion. I did not take any medicine. Considers himself ill about 3

months. He applied for medical help for the first time. Since childhood, frequent bronchitis with

exacerbations in the spring-autumn periods. Denies other chronic diseases.

There were no operations, injuries. Smokes 1.5 packs per day for 5 years. Mother has bronchial asthma,

father has hypertension.

An allergic history is not a burden. Has no occupational hazards.

Upon physical examination: the patient's condition of mild severity.

Body temperature 36.7 ° C. The skin is clean, moist. Height - 175 cm, weight - 81 kg.

Peripheral lymph nodes are not enlarged. The thyroid gland is not enlarged. Breast

the cell is normosthenic. On palpation, the chest is painless. BH - 18 in

a minute. With percussion - a clear, easy sound. Borders of relative dullness of heart: in

normal limits. With auscultation, vesicular breathing is carried out in all departments,

a small amount of dry, scattered, high-wheezing rattles is heard.

Heart sounds are clear, rhythmic. Pulse - 80 beats per minute satisfactory

filling and tension. HELL - 120/80 mm RT. Art. On palpation, the abdomen is soft,

painless. The size of the liver according to Kurlov: 10 × 9 × 7 cm. There are no dysuric phenomena.

Questions:

1. Make a preliminary diagnosis.

2. Make a plan for laboratory and instrumental examination.

3. Create a treatment plan.

4. Justify the implementation of medical labor examination (VTE), contraindicated

types of labor.

5. Indicate indications for emergency hospitalization in a patient.

Situational task 117 [K000449]