ANSWERS ON QUESTIONS

Main part

Patient L., 37 years old, is in the hospital, the diagnosis of community-acquired pneumonia with

localization in the lower lobe of the right lung, moderate to severe course, DN I ”.

He became acutely ill on March 4: there was a chill, an increase in body temperature to 38.8 ° C. IN

over the next 3 days there were complaints of dry cough, pain and heaviness in

the right half of the chest, the temperature is in the range 38-38.7 ° C. Independently

took antiviral drugs (Arbidol, Ingavirin), antipyretic

funds, the GP therapist did not call home. Due to lack of

improving the condition, preserving cough, chest pain and increasing

body temperature 7.03, called an ambulance and was hospitalized in therapeutic

branch.

X-ray of lungs (March 7): signs of pneumonia of the lower lobe of the right

easy.

Complete blood count (7.03): Нb - 145 g / l, white blood cells - 18 × 10 9 / l, red blood cells -

4.5 × 10 12 / l, platelets - 240 × 10 9 / l, stab - 12%, lymphocytes - 20%,

neutrophils - 74%, eosinophils - 1%, monocytes - 3%, ESR - 25 mm / h.

Destination sheet.

Questions:

1. Evaluate the rationality of starting empirical antimicrobial therapy with

taking into account the spectrum of action of the drug.

2. Evaluate the rationality of the change of antibacterial drug with

taking into account the spectrum of action of the drug and the most common causative agents of community-acquired

pneumonia.

3. Suggest methods and time for monitoring the effectiveness of antibiotic therapy.

4. The combination of which of the prescribed drugs increases the risk of development

nephrotoxic side effects? (Justify the answer).

5. Suggest recommendations for optimizing antibiotic therapy.

Situational task 155 [K001995]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient N., 41 years old, turned to the local general practitioner with complaints of

fever up to 38.5 ° C, weakness, sore throat when swallowing.

Anamnesis: acutely ill, about a week ago - the temperature rose to 38 ° C,

I began to worry about a sore throat when swallowing. Took antipyretic with

a positive effect - the temperature dropped to 37 ° C, but a sore throat

continued to bother.

Concomitant diseases: observed in a rheumatologist with a diagnosis

"Primary osteoarthritis, local form with damage to the right knee joint."

Takes Diclofenac 75 mg 2 times a day per os.

On examination: the patient's condition is moderate. Body temperature 38 ° C.

The skin is of normal color, without rashes. No peripheral edema, with

examination of the right knee joint does not reveal any visible external changes,

a moderate limitation of the volume of active and passive movements in the joint is determined.

When examining the oropharynx, hyperemia, swelling of the pharyngeal tonsils (more

right), multiple purulent follicles, no plaque. Submandibular lymph nodes

enlarged on both sides to 1.5 cm, dense, moderately painful, not fused between

themselves and surrounding tissues. Breathing in lungs vesicular, carried out in all

departments, BH - 20 per minute. The boundaries of the heart are not changed. Heart sounds are rhythmic, clear.

Heart rate - 90 beats per minute. HELL - 100/70 mm RT. Art. The abdomen is soft, painless with

palpation. Liver, spleen are not enlarged. Symptom of striking negative with

both sides. There is no dysuria. The chair is regular, decorated.

Questions:

1. Make a preliminary diagnosis, justify it.

2. With which diseases is it necessary to make a differential diagnosis?

3. Prescribe a treatment.

4. Assign a survey, justify.

5. Against the background of the therapy, no improvement was observed, the patient came to

repeated outpatient appointment with a general practitioner. The result is received.

general blood test: hemoglobin - 118 g / l, red blood cells - 3.8 × 10 12 / l, CP - 0.93,

reticulocytes - 0.8%, platelets - 190 × 10 9 / l, white blood cells - 1.0 × 10 9 / l,

stab - 1%, segmented - 10%, eosinophils - 0%, basophils - 0%,

monocytes - 3%, lymphocytes - 86%, ESR - 23 mm / h. Make a diagnosis. What is

further patient management tactics?

Situational task 156 [K001996]