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ANSWERS ON QUESTIONS

Main part

Patient E., 67 years old, was urgently referred by a general practitioner

hospital with complaints of suffocation, chest tightness, dry cough.

Anamnesis: over the past 15 years, suffering from hypertension,

not systematically treated. The above complaints first appeared suddenly at night

during sleep.

Objectively: a serious condition. Orthopnea position, diffuse pallor of cutaneous

integument with cyanosis of lips, acrocyanosis. Hoarse breathing, NPV - 40 per minute. In easy

all fields have wet rales of various sizes. Pulse - 120 beats per minute, rhythmic,

tense. HELL - 180/120 mm RT. Art. The left border of cardiac dullness is laterally shifted

2 cm. Heart sounds are difficult to hear due to wheezing in the lungs. The liver is not

palpable, no edema. The body temperature is normal.

Presented ECG (speed 25 mm / s):

Questions:

1. Assume the most likely diagnosis.

2. What are the abnormalities visible on the ECG presented, and

formulate an ECG conclusion.

3. What syndrome is leading in the clinical picture of this disease?

4. Among which emergency conditions is it necessary to carry out a differential

diagnosis?

5. With the introduction of which drugs should begin the relief of this emergency

condition?

 

Situational task 142 [K001982]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient K., 50 years old, turned to the local GP in connection with the first

arising heart attack, accompanied by muscle tremors, weakness,

slight breathing difficulties. The attack occurred about 2 hours ago with a strong

emotional stress. Earlier, with regular medical examination, no diseases

it was not detected, blood pressure was always within normal limits. On previously taken ECG without

pathological changes. Very significant physical activity tolerates

OK.

On examination: clear consciousness. Integuments of usual coloring and humidity. IN

easy vesicular breathing, NPV - 18 per minute. Relative cardiac

dullness within normal limits. Heart sounds are arrhythmic, no noise, heart rate - 144 beats per

minute, pulse - 108 per minute. HELL - 130/80 mm RT. Art. The liver is not enlarged.

Peripheral edema is absent. Body temperature 36.9 ° C.

Prescribed ECG lead II (speed 25 mm / s):

Questions:

1. Assume the most likely diagnosis.

2. What are the abnormalities visible on the ECG presented, and

formulate an ECG conclusion.

3. What syndrome is leading in the clinical picture of this disease?

4. Among which similar states is a differential

diagnosis?

5. With the introduction of which drugs should begin the relief of this emergency

condition?

 

Situational task 143 [K001983]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 75-year-old patient at the reception by a local GP general complains of

dizziness, sometimes with short-term loss of consciousness, frequent

during the last month. In addition, there is shortness of breath with minor

physical activity and swelling on the legs, which also appeared about a month ago and in

subsequently intensified.

Anamnesis: he considers himself ill for about 10 years, when the first appeared compressive

pain in the heart and shortness of breath when walking up to 200 m, the pain is effectively stopped

Nitroglycerin. A year ago, an attack of unconsciousness first occurred during

several minutes, accompanied by involuntary urination. At the last

month similar attacks became more frequent, there was an increase in blood pressure.

Objectively: clear consciousness. Pronounced cyanosis of the lips, the border of the relative

cardiac dullness of the heart is shifted to the left by 2 cm. Heart sounds are deaf, rhythmic.

At times, a loud (cannon) I tone is heard. Heart rate - 34 beats per minute. HELL -

180/100 mmHg Art. In lungs, harsh breathing, no wheezing. The liver protrudes from under

edge of the arch is 5 cm, its edge is dense, sensitive to palpation. Symmetrical

swelling on the legs to the upper third of the legs.

Presented ECG (speed 25 mm / s):

Questions:

1. Assume the most likely diagnosis.

2. What are the abnormalities visible on the ECG presented, and

formulate an ECG conclusion.

3. What syndrome is leading in the clinical picture of this disease?

4. Among which similar states is a differential

diagnosis?

5. What is the method of stopping this emergency condition, manifested

fainting is the most effective?

 

Situational task 144 [K001984]