ANSWERS ON QUESTIONS

Main part

A 37-year-old man turned to a district physician with complaints of headaches

pains. From the anamnesis it is known that headaches appeared two years ago. Appearance

connects headaches with transfer of a sore throat. Then, after about a week

after a sore throat, noted the appearance of urine the color of "meat slops", while urinating

it was painless, there were no pain in the lumbar region. Urine color "meat

slop ”was recorded within 2 days, then acquired the usual yellow color. TO

I didn’t contact the doctors. The urine-colored urine episode recurred during the day

a year later during SARS. The survey was also not conducted. Family history: mother

- 60 years old, often sick with tonsillitis, for 2 years - hypertension. Father died in

55 years old from oncological pathology.

On examination: satisfactory condition. BMI - 24.2 kg / m 2 . Skin integument

clean, normal color. There are no fathers. In the lungs, vesicular breathing, no wheezing. Tones

hearts are muffled, rhythmic. Heart rate - 70 beats per minute, blood pressure - 160/100 mm RT. Art. Stomach

soft, painless on palpation in all departments. Liver and spleen not

enlarged. The symptom of lumbar effusion is negative.

In blood tests: red blood cells - 4.57 × 10 12 / l, hemoglobin - 137 g / l, white blood cells -

5.51 × 10 9 / l, the leukocyte formula is not changed; platelets - 254 × 10 9 / l, ESR - 26

mm / hour

Total cholesterol - 4.9 mmol / L, TG - 1.7 mmol / L, HDL-C - 1.2 mmol / L, HS-

LDL - 2.8 mmol / l; fasting glucose - 4.2 mmol / l, creatinine - 135 μmol / l, GFR (according to

CKD-EPI formula) - 58 ml / min, urea - 9.4 mmol / l, uric acid - 0.40 mmol / l,

total bilirubin - 7.4 μmol / l (indirect), ALT - 39 IU / l, AST - 28 IU / l, total protein

- 70 g / l, albumin - 36 g / l.

In urine tests: relative density - 1014, yellow, acidic reaction,

protein - 0.88 g / l, red blood cells - 10-15 in the field of view, white blood cells - 3-4 in the field of view,

flat epithelium - single cells in the field of view, bacteria are absent, no mucus,

urate +. Daily proteinuria - 500 mg.

Ultrasound of the kidneys: the position of the kidneys is normal, the size is 11 × 5.6 cm, the parenchyma is 1.7 cm.

The calyx-pelvis complex is unchanged. Additional education and

stones were not revealed.

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 drug of which group of antihypertensive drugs would you

recommended to the patient as part of combination therapy? Justify your

a choice.

5. Justify the duration of therapy in this patient.

Situational task 153 [K001993]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 66-year-old patient M. summoned a local doctor-general practitioner. The diagnosis of ischemic heart disease,

angina pectoris FC III. Postinfarction cardiosclerosis (myocardial infarction in

2013), coronary sclerosis (coronary angiography in 2013, 2014). Permanent form

atrial fibrillation. Hypertension III Art. Risk CCO4. CHF II B, FC III. "

Complaints of shortness of breath during normal physical exertion and at rest, coughing,

mainly in horizontal position and at night, edema of the lower extremities. At

examination of blood pressure - 120/70 mm RT. Art., PS - 60 beats per minute, with auscultation of lungs

moist rales on both sides, swelling of the feet and legs are noted.

ECG: atrial fibrillation, heart rate - 65 beats per minute, EOS deviation to the left,

signs of cicatricial changes in the left ventricle (a history of myocardial infarction).

ECHO-KG: total contractility of the left ventricular myocardium is reduced (PV = 30%).

Blood biochemistry: ASAT - 45 units / L, ALAT - 39 units / L, creatinine - 98 μmol / L, OXS -

4.5 mmol / L, TG - 1.4 mmol / L, HDL - 1.0 mmol / L, glucose - 4.5 mmol / L, K + - 4.0

mmol / l.

At the time of examination, the patient receives: Veroshpiron 25 mg 1 time per day; Bisoprolol

5 mg once a day; Atorvastatin 40 mg in the evening; Digoxin 0.125 mg 1 time per day; Warfarin

5 mg 1 time per day.

The patient is hospitalized.

Questions:

1. Assess the adequacy of the selected diuretic therapy for severity

the patient.

2. What are the criteria for the effectiveness of diuretic therapy for this patient.

3. Indicate the combination of drugs whose combination enhances

risk of bradycardia and AV block. List security controls

pharmacotherapy.

4. Indicate the laboratory indicator and its target value for evaluation

efficacy and safety of warfarin administration.

5. Change in what laboratory parameters and how many times can

to indicate the development of side effects on the background of taking statins?

Situational task 154 [K001994]