ANSWERS ON QUESTIONS
Main part
Patient R., 38 years old, by profession a maintenance worker, turned to the clinic to
the general practitioner physician with complaints of fever up to 38.0 ºС, cough with
profuse mucopurulent sputum, non-intense pain in the chest when coughing,
headache, weakness in limbs, sweating. Ill acutely after
hypothermia.
Bad habits: smokes for more than 15 years at 20 cigarettes per day; related
there are no diseases. In the past few years, he has not left Moscow.
Objective data: the skin is pale, moist. Draws
attention increased sweating of the patient. The tonsils are covered in whitish
bloated, hyperemic. In lungs, breathing weakened on the right, multiple
wet small bubbling rales are heard at the corner of the right scapula. BH at rest until
26 per minute. Heart sounds are muffled, rhythmic, isolated extrasystoles. Heart rate - 100
beats per minute, blood pressure - 110/70 mm RT. Art. The abdomen is soft, painless. According to others
organs and systems without visible pathological abnormalities.
Laboratory and instrumental examination methods.
Clinical blood test: hemoglobin - 135 g / l, red blood cells 4.7 × 10 12 / l,
white blood cells 11 × 10 9 / l, stab - 28%, segmented - 57%; ESR - 35 mm / hour.
Urinalysis: relative density - 1018, protein - 0.99 g / l, hyaline
cylinders.
Biochemical blood test: ALT - 58 units / l; AST - 100 u / l; creatinine - 115
μmol / l; fibrinogen - 8 g / l.
ECG: sinus rhythm, correct, heart rate - 100 beats / min, single
supraventricular extrasystoles. Focal myocardial changes, myocardial hypertrophy
not.
Chest x-ray: focal basal infiltration
departments of the right lung, deformation of the root of the right lung.
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. What groups of antibiotics are recommended to the patient for starting
antibiotic therapy? Stratify the severity of the disease and
risk factors.
5. After 3 days of therapy, body temperature returned to normal - 36.8 ° C, decreased
intoxication (decreased weakness, sweating, improved appetite), decreased
dyspnea. What is your further therapeutic tactic? Justify your choice.
Situational task 122 [K000460]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient R., 65 years old, a pensioner, when contacting a general practitioner
complains of fever up to 38 ° C, slight sputum
mucous character, headache, shortness of breath, palpitations and weakness in the limbs.
He became ill acutely after hypothermia. The patient suffers from ischemic heart disease, chronic cardiac
insufficiency; takes continuous therapy (Perindopril 2.5 mg 2 times,
Hydrochlorothiazide 12.5 mg, Veroshpiron 50 mg, Simvastatin 20 mg). Patient contacts
there was no tuberculosis and infectious diseases. In the last few years from
Moscow did not leave.
Objectively upon examination: the skin is pale, moist, cyanosis of the lips.
Body temperature 37.8 ° C. The tongue is covered with a whitish coating. In the lungs breathing
attenuated vesicular, multiple wet fine bubble rales
are heard in the lower part of the left lung. BH at rest up to 24 per minute. Heart sounds
muffled, rhythmic, isolated extrasystoles. Heart rate - 90 beats per minute, blood pressure -
110/70 mmHg Art. The liver 1 cm protrudes from under the edge of the costal arch. Dysuric
there are no phenomena. The legs are pasty. For other organs and systems without visible
pathological abnormalities.
Clinical blood test: hemoglobin - 126 g / l; erythrocytes - 4.2 × 10 12 / l;
white blood cells - 10.9 × 10 9 / l; stab - 10%, segmented - 77%; ESR - 30
mm / hour
Urinalysis: relative density - 1012, protein - 0.33 g / l, in sediment
white blood cells - 2–4 in the field of view.
Biochemical blood test: ALT - 38 units / l; AST - 35 units / l; urea - 9 mmol / l,
creatinine - 120 μmol / l.
ECG: sinus rhythm, correct, heart rate - 100 beats / min, single
supraventricular extrasystoles. Signs of left ventricular hypertrophy. Focal
no myocardial changes.
Chest x-ray: enhancement of pulmonary pattern in basal
departments of the left lung.
ECHO-KG: moderately expanded cavity of the left ventricle, posterior hypertrophy
walls of the left ventricle, ejection fraction - 45%.
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. What groups of antibiotics are recommended to the patient for starting
antibiotic therapy? Stratify the severity of the disease and
risk factors. Justify your choice.
5. After 3 days of therapy, the temperature returned to normal - 36.6 ° C, feeling good
improved (no shortness of breath). What is your further therapeutic tactic? Justify
Your choice.
Situational task 123 [K000461]
Дата: 2019-12-10, просмотров: 265.