ANSWERS ON QUESTIONS

Main part

A 64-year-old patient consulted a local GP with complaints of

swelling and pain in the right ankle joint and small joints of the right foot,

redness of the skin above them, restriction of movements in them.

Anamnesis: suffers from sudden bouts of pain in the joints of the right foot about 8

years, when for the first time against the background of relative prosperity at night, intense

pain in the first toe of the right foot. Subsequently, arthritis repeatedly

recurred. Pain in the right ankle joint joined during

last 6 months. Repeatedly painless urine calculi

yellowish-drill color up to 3-4 mm in size.

Objectively: the physique is correct, of increased nutrition. In area

the cartilaginous part of the auricles is palpated painless dense formations

0.3 0.2 cm, whitish on a bend. Bone deformities are noted in the area

1 and 2 metatarsophalangeal joints of the right foot, combined with swelling,

redness of the skin and an increase in local temperature over the same joints.

The right ankle joint is swollen, painful on palpation. Skin over

the joint glistens, bluish-purple, hot. HELL - 170/105 mm RT. Art. Heart rate - 84

shock per minute. The boundaries of relative cardiac dullness are extended to the left 2 cm from

midclavicular line. Heart sounds are rhythmic, muffled.

Uric acid - 780 mmol / l, blood cholesterol - 6.7 mmol / l, triglycerides -

2.7 mmol / L, HDL - 1.0 mmol / L; fasting glucose - 6.2 mmol / l, 2 hours after

intake of 75 g of glucose - 6.4 mmol / l.

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 treatment tactics during an acute attack and interictal

period?

5. Which drugs should be preferred for arterial correction

hypertension and hypercholesterolemia and why?

Situational task 148 [K001988]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 47-year-old woman complains of weakness, fatigue, shortness of breath and

palpitations with little physical exertion, pallor of the skin,

fragility of nails, heavy menstruation.

From the anamnesis it is known that the patient's menstruation became plentiful about 6

months ago, a gynecologist revealed uterine fibroids of small size, requiring

only observations. The rest of the above complaints appeared 2-3 months ago with

slow rise; noted addiction to pungent odors (varnish, acetone), desire

there is chalk (otherwise the usual food); dizziness occasionally bothered me. Earlier in

during two pregnancies and childbirth, mild anemia was noted. She was not a donor.

On examination: satisfactory condition, average nutrition. Integuments and

mucous membranes are moderately pale, shallow cracks in the corners of the mouth, brittle nails, with

pronounced longitudinal striation and emerging concavity. In the lungs

vesicular breathing, no wheezing. Heart sounds are slightly muffled, rhythmic, heart rate -

78 beats per minute, blood pressure - 100/60 mm RT. Art. The abdomen is soft, painless on palpation

in all departments. The liver and spleen are not palpable. Chair, diuresis without features.

In the general analysis of blood: red blood cells - 2.9 × 10 12 / l, hemoglobin - 70 g / l, color

the indicator is 0.73; anisocytosis ++, poikilocytosis ++, microcytosis ++; white blood cells - 3.8 × 10 9 / l,

stab neutrophils - 1%, segmented neutrophils - 54%, eosinophils -

5%, lymphocytes - 33%, monocytes - 6%, basophils - 1%; platelets - 200 × 10 9 / l; ESR - 15

mm / h

Urinalysis is within normal limits.

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 drug of the iron group would you recommend to the patient?

What is the route of administration of the drug? Justify your choice.

5. After 1 month of regular therapy with an iron-containing drug, well-being

the patient improved significantly, in a blood test, hemoglobin rose to 110 g / l.

What is your further therapeutic tactic? Justify your answer.

Situational task 149 [K001989]