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ANSWERS ON QUESTIONS
Main part
A 47-year-old man was taken to the reception with complaints of an increase.
body temperature up to 38.5 ° С degrees, cough with hard to separate sputum “rusty”
color, pain in the right side of the chest, aggravated by coughing, feeling
lack of air, dizziness.
From the anamnesis it is known that the patient fell ill 3 days ago - after hypothermia
body temperature increased, cough appeared. Treated independently (Aspirin,
Paracetamol), but the condition worsened: the above complaints appeared.
Ambulance brigade delivered to the hospital.
On examination: serious condition. The skin is clean, cyanosis of the lips, tips
fingers. The right half of the chest lags behind when breathing. Dullness
percussion sound, increased bronchophony in the IV-V intercostal space along the midclavicular
lines to the right. With auscultation in the same section, bronchial breathing, crepitus.
Heart sounds are muffled, quickened. Heart rate - 96 beats per minute, blood pressure - 85/50 mm RT. Art.
Saturation - 80%. The abdomen is soft, painless on palpation in all departments.
In the general analysis of blood: white blood cells - 22 × 10 9 / l, young forms - 10%,
stab neutrophils - 23%, segmented neutrophils - 30%, eosinophils -
2%, lymphocytes - 30%, monocytes -5%. CRP - 125 mg / l.
Radiography of the chest in the direct and lateral projections.
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 is the tactics of treatment for this patient, call the drugs "start"
therapies and reserve drugs?
5. What is the tactics of dispensary observation of the patient after discharge from
the hospital?
Situational task 150 [K001990]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 47-year-old man called an ambulance in connection with the appearance of a crushing
pain behind the sternum. The pain appeared 40 minutes ago, at rest, did not stop with 2 doses
Isocket. The patient notes severe weakness, sweating.
Previously, the pain behind the sternum was not disturbed, the physical load was well tolerated.
Over the course of 6 children, blood pressure periodically increased to 160/100 mm Hg. Art. At
Captopril took an increase in blood pressure, and did not receive antihypertensive drugs continuously.
Smokes 25 years for 1 pack of cigarettes per day. Heredity is not burdened.
Objectively: a state of moderate severity. The skin is moist. NPV - 18 in
a minute. In the lungs, vesicular breathing, no wheezing. Heart sounds are muffled
rhythmic, heart rate - 70 beats per minute, blood pressure - 160/100 mm RT. Art. The abdomen is soft, with
palpation painless in all departments. The liver is not enlarged. Pulse on the vessels
lower limbs saved.
ECG recorded.
The patient was taken to the hospital ward with a ward
endovascular interventions for 20 minutes.
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 method of reperfusion is indicated for the patient? Justify your choice.
5. What antithrombotic therapy is indicated to the patient upon admission to
hospital, if it is known that at the prehospital stage it was not performed?
Test results: negative path test, creatinine - 0.09 mmol / l, sugar - 6.5
mmol / l.
Situational task 151 [K001991]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 55-year-old man turned to a local doctor-general practitioner with complaints of pain
compressive in nature behind the sternum, occurring when walking at a distance of 200 meters
or when climbing one flight of stairs, radiating to the left shoulder, passing
3-5 minutes after stopping. I did not use nitroglycerin. Also worries
shortness of breath during normal physical exertion, fatigue, which appeared somewhat
weeks ago.
From the anamnesis it is known that similar pains bother for a year and a half. IN
at the beginning they arose on a greater load than now, but the last few months
are of the nature described above. The patient receives Bisoprolol 5 mg per day and Cardicet
40 mg 2 times a day. Against this background, seizures persist. Smoked for 20 years at ½
packs per day. He quit smoking 5 years ago. Family history: father died suddenly in
age 59 years.
On examination: satisfactory condition. BMI - 24 kg / m 2 . Waist circumference -
96 cm. The skin is clean, normal color. In the lungs, vesicular breathing,
no wheezing. Heart sounds are muffled, rhythmic. Heart rate - 70 beats per minute, blood pressure -
130/85 mmHg Art. The abdomen is soft, painless on palpation in all departments. Liver and
spleen not enlarged. No peripheral edema. There is no dysuria. Symptom
lumbar efflux negative.
In the analyzes: total cholesterol - 6.5 mmol / L, cholesterol-LDL - 3.5 mmol / L, TG - 2.7
mmol / L, fasting glucose - 5.1 mmol / L, creatinine - 96 μmol / L, GFR (according to the formula
CKD-EPI) - 86.6 ml / min.
On the ECG: sinus rhythm, heart rate - 82 beats per minute, normal position of the EOS,
the ratio of R and S teeth in the chest leads is not broken.
VEM completed - sample terminated at 75 W due to
chest discomfort and 2 mm ST depression in leads V4, V5, V6. "Double
work ”amounted to 195.
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. The patient underwent ECHO cardiography. The ejection fraction was 40%. What kind
treatment measures should be prescribed to the patient? Justify your choice.
5. Coronary angiography was performed. Stenosis of the trunk of the left coronary artery was detected
70% What is the tactics for further patient management? Justify your choice.
Situational task 152 [K001992]
Дата: 2019-12-10, просмотров: 333.