ANSWERS ON QUESTIONS

Main part

A 45-year-old woman consulted a local GP with complaints of heartburn,

belching sour, intensifying in a horizontal position after eating and with

leaning forward. These symptoms appeared about three months ago, about which

previously not examined, did not take medications. Smokes 10 cigarettes per

day, alcohol is consumed in minimal quantities.

On examination: the condition is relatively satisfactory. BMI - 31 kg / m 2

.

The skin is clean, normal color. In the lungs, vesicular breathing, no wheezing.

Heart sounds are muffled, the rhythm is correct, noises are not heard. Heart rate - 72 strokes per

minute, blood pressure - 120/80 mm RT. Art. The abdomen is soft, painless on palpation in all

departments. The liver and spleen are not enlarged. There is no dysuria. Symptom of striking

lumbar region negative.

In clinical and biochemical blood tests, deviations were not detected. ECG -

sinus rhythm, heart rate - 70 beats per minute, horizontal position of the electric

axis of the heart, normal variant.

Endoscopic endoscopy was performed, in which multiple areas of hyperemia were detected.

mucous membrane and individual non-fused erosion of the distal esophagus

up to 5 mm in size.

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 are the groups of drugs and their 1-2 representatives in the composition

combination therapy. Justify your choice.

5. What recommendations on lifestyle changes should be given to the patient?

Situational task 159 [K002000]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient Sh. 45 years old turned to the local GP physician with complaints of

weakness, dizziness, hair loss, brittle nails, dry skin.

Anamnesis: considers herself sick for 3 months when she first appeared

complaints of weakness, dizziness. I did not go to the doctor. Further symptoms

began to grow, hair began to fall out, brittle nails, dry skin appeared.

Concomitant diseases: suffers from menorrhagia - heavy, prolonged, monthly

7-10 days every 28 days.

On examination: the patient's condition is moderate. Skin and mucous membranes

pale, dry, no rashes. Pronounced longitudinal stripe nails,

"Spoon-shaped." Diffuse alopecia. There are no peripheral edemas. Peripheral

lymph nodes are not enlarged. Breathing in the lungs is vesicular, no wheezing, BH - 21 per minute.

Heart sounds are rhythmic, weakening of I and II heart sounds at all points of auscultation. Heart rate

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

palpation. The liver and spleen are not palpable. The chair is decorated. Symptom

striking negative on both sides.

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. After 2 days, the patient came for a second appointment with the results of the tests:

clinical blood test: hemoglobin - 95 g / l, red blood cells - 1.12 × 10 12 / l, MCV - 75

fl, MCH - 22 pg, reticulocytes - 0.9%, platelets - 226 × 10 9 / l, white blood cells -

4.9 × 10 9 / l, stab - 4%, segmented - 51%, monocytes - 0.10 × 10 9 / l,

lymphocytes - 1.7 × 10 9 / l, ESR - 36 mm / h. Serum iron - 4.2 μmol / L, OZHSS

- 82 μmol / l, transferrin saturation coefficient - 23.5%, APTT - 26 s, PTV - 14

s, fibrinogen - 3.1 g / l. A consultation with a gynecologist is scheduled for the next

day. Prescribe a treatment.

5. After 2 months of regular therapy with an iron-containing drug, the patient

passed a repeat blood test: clinical blood test: hemoglobin - 120 g / l,

erythrocytes - 4.2 × 10 12 / l, MCV - 82 fl, MCH - 28 pg, reticulocytes - 1.2%,

platelets - 260 × 10 9 / l, white blood cells - 5.2 × 10 9 / l, stab - 6%,

segmented - 55%, monocytes - 0.10 × 10 9 / l, lymphocytes - 1.4 × 10 9 / l, ESR - 17

mm / h The patient is also observed by a gynecologist, takes therapy according to

about menorrhagia, notes the normalization of menstruation. Describe the changes

in the analyzes. Your next steps.

Situational task 160 [K002001]