ANSWERS ON QUESTIONS

Main part

Patient S., 50 years old, consulted a local GP with complaints of

fever up to 38 ° C, weakness, chills, cough with light sputum.

Anamnesis: ill acutely, 3 days ago, the temperature rose to 38 ° C, noted

general malaise, weakness, chills. I did not take any medicine. Yesterday joined the cough

with scanty light phlegm.

On examination: the patient's condition is moderate. Body temperature 37.7 ° C.

The skin is of normal color, without rashes. There are no peripheral edemas.

Lymph nodes are not enlarged. Breathing in the lungs vesicular, weakened in the lower half

right lung, crepitus is heard there, with percussion - dulling

percussion sound. BH - 20 per minute. The boundaries of the heart are not changed. Heart sounds

rhythmic, clear. Heart rate - 100 beats per minute. HELL - 110/70 mm RT. Art. The stomach is soft

painless on palpation. Liver, spleen are not enlarged. Symptom

striking negative on both sides. There is no dysuria. The chair is regular

decorated.

Questions:

1. Make a preliminary diagnosis, justify.

2. Assign a survey, justify.

3. The patient was taken x-ray lungs in direct and lateral projection -

revealed infiltrative changes in the lower lobe of the right lung. Assign

treatment.

4. Despite the therapy, the patient's condition worsened, sputum became

green, intoxication symptoms intensified. After 3 days, the patient appeared on

repeated appointment with the local GP. The result of the general analysis

blood: hemoglobin - 130 g / l, red blood cells - 4.2 × 10 12 / l, CP - 0.91, reticulocytes - 1.0%,

platelets - 220 × 10 9 / l, white blood cells - 0.9 × 10 9 / l, stab neutrophils - 2%,

segmented neutrophils - 8%, eosinophils - 0%, basophils - 0%, monocytes -

4%, lymphocytes - 86%, ESR - 30 mm / h. Set the final diagnosis,

justify.

5. Further tactics for treating the patient.

Situational task 157 [K001997]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 35-year-old patient P. turned to the local GP with complaints of

episodes of sudden dizziness with intense physical exertion,

episode of short-term loss of consciousness.

Anamnesis: previously not observed by doctors, denies chronic diseases.

Considers herself ill for 2 months when episodes first appeared

dizziness. The night before after an intense load (carried furniture) was

episode of short-term loss of consciousness. I did not go to the doctor.

Heredity: father - sudden death at 43 years old.

On examination: the patient's condition is satisfactory. Integuments and

mucous membranes of normal color, no rashes. There are no peripheral edemas.

Peripheral lymph nodes are not enlarged. Breathing in lungs is vesicular, no wheezing,

BH - 14 per minute. Apical impulse reinforced, concentric. Heart sounds

rhythmic, clear. Heart rate - 60 beats per minute. In the apex and along the left edge

the sternum is heard intense systolic murmur. HELL - 120/80 mm RT. Art. Stomach

soft, painless on palpation. The liver and spleen are not palpable. Chair

decorated. The symptom of striking is negative on both sides.

An ECG was taken for the patient - sinus rhythm, correct, heart rate - 64 per minute.

EOS deviation to the left. RV6> RV5> RV4. Sokolov-Lyon Index - 45 mm.

Questions:

1. Offer a plan for examining the patient, justify.

2. The patient was examined: echocardiography - the cavity of the heart is not expanded, PV -

56% The thickness of the back wall of the left ventricle is 13 mm, the thickness of the interventricular septum is

18 mm, myocardial mass index - 132 g / m 2 . Your next steps for setting

the diagnosis. Justify your choice.

3. Based on the results of self-monitoring of blood pressure and blood pressure in a patient

normal blood pressure values ​​are recorded. According to the results of laboratory

instrumental examination revealed no damage to other target organs,

no risk factors. Make a final diagnosis.

4. Justify the diagnosis.

5. Prescribe therapy, give recommendations.

Situational task 158 [K001998]