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ANSWERS ON QUESTIONS
Main part
Patient P., 70 years old, went to the clinic with complaints of increased
fatigue, unmotivated weakness, a feeling of heaviness in the left hypochondrium,
weight loss of 8 kg in the last month. History: arterial hypertension,
duodenal ulcer.
On examination, an increase in lymph nodes in
areas of the front surface of the neck, in the supraclavicular and axillary cavities.
Lymph nodes are painless, non-stressed, mobile, have elastic
consistency. The spleen is enlarged (+5 cm).
In blood tests: hemoglobin - 98 g / l, white blood cells - 30 × 10 9 / l, of which 50%
lymphocytes, platelets - 130 × 10 9 / l, ESR - 16 mm / h.
In a blood smear, normal sized lymphocytes are detected, “smeared”
cells, the shadows of Humprecht.
Questions:
1. Assume the most likely diagnosis.
2. Create and justify a plan for additional examination of the patient. Which method
Do you need to conduct an examination first? Justify the answer.
3. Determine the stage of the disease in this patient. Justify the answer.
4. The purpose of which drug is optimal in this case?
5. What are the possible causes of death for patients with this disease.
Situational task 133 [K001948]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient G., 26 years old, at an appointment with a GP, complains about
shortness of breath with little physical exertion. A history of frequent sore throats in childhood. IN
at the age of 12 years, the patient had an episode of pain in the knee joints for a week. On
with Diclofenac, pain disappeared after 1 week. Over the past three years
notes a deterioration in exercise tolerance due to shortness of breath. Tolerance to
loads decreased sharply over the past 6 months: shortness of breath began to occur when walking with
normal speed. I did not contact the doctors. A week ago, I noticed an attack of frequent
irregular heartbeat, stopped on its own after 5 hours.
On examination: the skin is of normal color, marked cyanosis of the lips, tip
nose, “blush” of cheeks, no light rales, NPV - 24 per minute, percussion - upper
the border of the heart is at the level of II intercostal space, the remaining borders are within normal limits. On
at the top - a three-beat rhythm, clapping the first tone, diastolic murmur. Tones
rhythmic, heart rate - 90 beats per minute, blood pressure - 100/60 mm RT. Art. The abdomen is painless.
Liver: +2 cm from the edge of the costal arch, the spleen is not palpable.
Questions:
1. Assume and justify the most likely diagnosis.
2. Identify and justify the most likely cause of the disease in the patient.
3. What is the reason for the three-rhythm detected during auscultation of the patient?
4. What do you expect to find in a patient with an ultrasound scan of the heart?
5. Choose and justify your further medical tactics.
Situational task 134 [K001950]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient M., 68 years old, came for a routine examination, does not show any complaints.
Two years ago, a transient ischemic attack was carried out. To doctors in the future do not
addressed. Refuses to take drugs, motivating with reluctance
take "chemistry" and well-being. In lungs with auscultation, breathing
vesicular, no wheezing. NPV - 19 per minute. Heart sounds are muffled, rhythmic,
no noise. Heart rate - 85 beats per minute. HELL - 190/100 mm RT. Art. The stomach is soft
painless on palpation, the liver is not enlarged. There are no fathers. Body mass index in
normal.
On the ECG sinus rhythm, signs of left ventricular hypertrophy.
In a biochemical blood test, cholesterol is 8.5 mmol / L.
Questions:
1. Assume and justify the most likely diagnosis.
2. What studies should be assigned to the patient in the first place in this
situations?
3. What are the long-term goals of treating this patient?
4. Determine the optimal treatment tactics for this patient.
5. Indicate a clinical sign that requires in-depth examination for
exclusion of secondary (symptomatic) arterial hypertension.
Situational task 135 [K001951]
Дата: 2019-12-10, просмотров: 270.