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ANSWERS ON QUESTIONS
Main part
Patient M., 50 years old, consulted a local GP with complaints of
nausea, acute nightly and hungry pains in the epigastrium, decreasing after taking
food, nausea, vomiting of "coffee grounds", once black "tarry" stool.
It is treated for rheumatoid arthritis, for a long time (more than 3 months) took
Indomethacin 1 tablet 3 times a day. I haven’t noted these complaints before;
appealed.
Objectively: a state of moderate severity. The skin is pale. Lowered
nutrition. Tongue coated with white coating, wet. In lungs, vesicular breathing, BH -
16 per minute. Heart sounds are clear, rhythmic, heart rate - 88 beats per minute, blood pressure - 110/70 mm
Hg. Art. The abdomen is tense, sharply painful locally in the Shofar zone. Symptoms
peritoneal irritations are negative. The chair is black "tarry". Urination
not broken.
Clinical blood test: hemoglobin - 100 g / l; erythrocytes - 3.0 × 10 12 / l;
white blood cells 8.4 × 10 9 / l; stab - 4%; segmented - 61%; eosinophils - 1%;
lymphocytes - 30%; monocytes - 4%; ESR - 20 mm / hour.
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. Which group of anti-ulcer drugs would you recommend to a patient in
starting therapy? Justify your choice.
5. After 2 weeks of therapy, signs of ulcer scarring were detected. What is your
further treatment tactics? Justify your choice.
Situational task 124 [K000919]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient S., 25 years old, was admitted to the hospital with complaints of cough with a large
the amount of mucopurulent sputum (up to 300 ml / day) with an unpleasant odor;
hemoptysis, fever up to 39 ° C, malaise, shortness of breath. Known
that about 2 weeks ago he was treated for pneumonia, but left on his own
department and continued treatment on an outpatient basis. Deterioration about 2 days ago.
Objectively: low nutrition, pale skin. Pulse - 94 in
minute, rhythmic, blood pressure - 100/70 mm RT. Art. The borders of the heart are shifted to the right by 1.5 cm,
heart sounds are muffled, emphasis II tone over the pulmonary artery. Above the lungs on the left
percussion determined box sound. Vesicular breathing, weakened. Left to
the lower sections are heard sonorous moist medium and small bubbling rales. BH
- 24 per minute.
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. Justify the treatment tactics of the patient.
5. Does the patient have indications for surgical treatment? Justify.
Situational task 125 [K000926]
Instructions: READ THE TERMS OF THE TASK AND GIVE
DETAILED ANSWERS TO QUESTIONS
Main part
Patient R., 45 years old, turned to a local doctor-general practitioner with complaints of
a feeling of heaviness, overflow in the stomach, occurring 40-50 minutes after eating,
nausea
For 20 years, suffers from chronic gastritis, exacerbations 1-2 times a year. In
exacerbations usually take proton pump inhibitors, antacids.
I did not receive eradication therapy. Real deterioration - within 2 weeks on
background of errors in the diet. I took Almagel on my own when it occurs
discomfort.
On examination: satisfactory condition. Height - 166 cm, weight - 64 kg. Skin
integuments are clean, ordinary color. In the lungs, vesicular breathing, no wheezing. Tones
hearts are clear, rhythmic. Heart rate - 70 beats per minute, blood pressure - 120/70 mm RT. Art. Stomach
soft, painful in the epigastrium and pyloric-duodenal zone. Symptoms of cholecystitis
negative. The liver is not changed. There is no dysuria. Symptom of striking
lumbar region negative. Chair once a day, decorated, without pathological
impurities.
On fibrogastroscopy: the esophagus is freely passable, its mucosa is not changed.
The cardia closes completely. The mucous membrane of the stomach is hyperemic, with patches
atrophy in the antrum, folds are smoothed out, straightens with air well.
The gatekeeper is going through. Duodenal mucosa and bulbous
department is not changed. Biopsy sample from antrum: quick urease test
positive. The result of a histological examination of a biopsy: gastric mucosa with
atrophy and chronic polymorphic cell infiltration.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make a plan for additional examination of the patient.
4. Prescribe medication, justify your choice.
5. Develop a follow-up plan for the patient.
Situational task 126 [K000933]
Дата: 2019-12-10, просмотров: 275.