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ANSWERS ON QUESTIONS

Main part

A 42-year-old man with a first-time attack came to the clinic

intense compressive sternal pain without distinct irradiation,

accompanied by nausea, profuse sweating, shortness of breath. To the moment

treatment duration of the attack is about 3 hours. Smokes for many years, 10-15 cigarettes a day.

Arterial hypertension and other diseases of the cardiovascular system,

diabetes, neurological diseases, head injuries, coagulopathies and

there is no significant bleeding history. Consciousness is clear. The skin is pale,

hyperhidrosis. The vesicular breathing, no wheezing. NPV - 18 per minute. Heart sounds

rhythmic. Heart rate - 90 beats per minute, blood pressure - 130/80 mm RT. Art. The stomach is soft

painless in all departments. The liver is not enlarged.

ECG emergency shot:

Questions:

1. Assume the most likely diagnosis.

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

formulate an ECG conclusion.

3. What is the tactic of a general practitioner in this situation?

 

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

diagnosis?

5. Which laboratory markers are recommended for confirmation?

the diagnosis?

 

Situational task 145 [K001985]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 42-year-old patient, a housewife, turned to a general practitioner

the following complaints: for several years periodically noted the general

weakness, unmotivated rise in temperature to subfebrile digits. A month ago

after acute respiratory infections, moderate pain and swelling of the II and III metacarpophalangeal

joints, II, III, IV proximal interphalangeal joints of both hands, wrist

joints morning stiffness for 3 hours. Joint syndrome was accompanied

an increase in body temperature to 37.3 ° C. Performs homework with difficulty.

Objectively: the skin of normal color, clean. Vesicular breathing

no wheezing. The left border of relative cardiac dullness along the midclavicular line.

Heart sounds are rhythmic. HELL - 130/80 mm RT. Art. Configurable

of the above joints due to exudative-proliferative phenomena, spilled

soreness, active and passive movements are limited, painful.

General blood test: white blood cells - 9.0 × 10 9 / l, ESR - 35 mm / hour.

Biochemical blood test: rheumatoid factor (RF) - 1:80. Antibodies to

cyclic citrulline peptide (ADC) - 375.8 U / ml.

X-ray of the joints of the hands: detected periarticular osteoporosis, narrowing

joint space, single bone usages.

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 will be the tactics for treating this disease?

5. What basic drug is appropriate in this case and why?

 

Situational task 146 [K001986]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient Yu. 53 years old turned to the district physician with complaints of

weakness, pain throughout the spine (mainly at night), in both hips,

knee joints, morning stiffness up to 40 minutes, passing after physical

exercises.

Anamnesis: sick since 35 years, at first there were pains in the lower back and sacrum (especially

at night), later joined morning stiffness, passing after

short charge, temperature increase up to 37-37.5 ° С.

Objectively: satisfactory condition, active position. HELL - 150/100 mm

Hg. Art. Heart rate - 74 beats per minute. NPV - 18 per minute. Body temperature 37.3 ° C. Is celebrated

severe chest kyphosis and cervical hyperlordosis, smoothness of lumbar lordosis,

pain on palpation along the spine, paravertebral lines and

hip joints. Active and passive movements cause pain.

Samples: the symptom of Kushelevsky I, II is positive, the Tomeyer test is 65 cm,

Forestier - 22 cm, a test of the chin-sternum - 5 cm, a tour of the chest - 100-96 cm

(4 cm).

X-ray of the spine and ileosacral joints: Deforming

spondylosis, bilateral sacroiliitis, stage 3.

Complete blood count: red blood cells - 4.2 × 10 12 / l, Hb - 122 g / l, platelets -

220 × 10 9 / l, white blood cells - 10 × 10 9 / l, stab neutrophils - 1%, segmented

neutrophils - 63%, monocytes - 4%, eosinophils - 2%, lymphocytes - 30%, ESR - 18 mm / h.

Immunological tests: C-reactive protein - 5 mg / l, rheumatoid factor -

negative.

Urinalysis is the norm.

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 will be your tactics for treating this disease?

5. Which drugs should be preferred if the patient has

non-axial manifestations of the disease?

 

Situational task 147 [K001987]