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ANSWERS ON QUESTIONS

Main part

Patient B. 38 years old was admitted to the clinic in connection with the development of about 5 days ago

shortness of breath during normal physical exertion, rapid irregular heartbeat. IN

childhood suffered from frequent sore throats, which ceased as a teenager;

tonsillectomy was not performed. Tolerates acute respiratory viral annually

infection (SARS), has repeatedly noted the appearance of herpetic rash on the lips. Per

a month before the occurrence of these complaints suffered herpes zoster, about

which was symptomatic therapy. She endured physical activity

OK.

On examination: the condition is relatively satisfactory. Body temperature

37.2 ° C, no chills. The constitution is normostenic. The skin is clean. There are no fathers.

BH - 22 per minute, hard breathing in the basal sections, no wheezing. Heart rate - 115 beats per

minute, the rhythm is wrong, the pulse deficit is up to 10 per minute. HELL - 110/70 mm RT. Art.

The abdomen is soft, painless, the liver and spleen are not enlarged.

In blood tests: CRP - 5.6 mg / L, ASLO - 125 IU / L (normal 0-125 IU / L).

ECG.

Questions:

1. Decipher the ECG, indicate what changes you see in the patient on the ECG.

2. Suggest the most likely diagnosis.

 

3. What diseases should be used for differential diagnosis of this

patient, given the clinical picture and ECG data?

4. Make and justify a plan for an additional examination of the patient.

5. Define and justify the tactics of this patient. What kind

priority treatment measures shown to the patient?

 

Situational task 136 [K001961]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient K., 56 years old, came to the clinic with complaints of pain in the left knee

joint, aggravated while standing or under load, periodically arising

crunching with active movements in this joint. In the morning after waking up, he feels

stiffness of movements in the left knee joint, which lasts 15-20 minutes. Pain

appeared about 2 years ago and gradually intensified.

On examination: the joints are not externally changed, deformation and configuration are not

are marked. The volume of active and passive movements is slightly reduced in the left

the knee joint. Atrophy of the surrounding tissue is not.

Blood test: without deviations from normal values, ESR - 22 mm / h, RF -

negative.

Radiographs of the knee joints are shown in the figure.

Questions:

1. What changes are visible on radiographs?

2. Assume the most likely diagnosis. Justify the answer.

3. Indicate the risk factors for this disease.

4. List slow-acting symptom-modifying drugs

illnesses. Justify the answer.

5. Assign treatment to the patient in this clinical situation. Justify the choice.

 

Situational task 137 [K001964]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient I., 39 years old, came to the clinic with complaints of palpitations, weakness

in the left arm and leg.

From the anamnesis: it is known that 6 months ago the patient suffered a transient

ischemic attack. 3 months ago - stroke in the middle cerebral artery basin,

Obstetric history: 2 pregnancies, 1 birth. 1 pregnancy at the age of 22 years

normal, gave birth to a healthy full-term baby; 2 pregnancy at the age of 36

ended in fetal death at 12 weeks of gestation (normal confirmed

fetal morphology).

On examination: the patient's condition is moderate. Motor aphasia.

Marked skin spotting cyanotic shade, resembling a "lace",

localized in the thighs and buttocks (reticulum). Peripheral

lymph nodes are not enlarged. Joint configuration is not changed, range of motion

full. Above the lungs a percussionly lung sound, auscultatory rales are not

are listened to. Heart sounds are sonorous, the rhythm is correct. Heart rate - 96 beats per minute. HELL -

120/75 mmHg Art. Liver, spleen are not enlarged. On palpation, the abdomen is soft,

painless.

Clinical blood test: hemoglobin - 112 g / l, white blood cells - 9 × 10 9 / l,

platelets - 100 × 10 9 / l, ESR - 46 mm / hour.

Antibodies to native DNA are negative. Lupus anticoagulant

positive - 2.4 conventional units (norm 0.8-1.2 conventional units).

Urinalysis: relative density - 1010, protein - 0.033 g / l, white blood cells - 5-7,

red blood cells - 0-2 in the field of view.

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 drugs would you recommend to the patient for treatment and

prevention of vascular complications? Justify your choice.

5. Are there any indications for hospitalization of this patient? Justify.

 

Situational task 138 [K001966]