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ANSWERS ON QUESTIONS
Main part
A 65-year-old woman complained of pain in the lumbar region on the right,
radiating to the right side of the abdomen, paroxysmal, lasting up to 2-3 hours,
medium strength, acute, arising and aggravating after eating large
the amount of fluid or during exercise, subsiding after taking
antispasmodics (no-spa), analgesics (analgin, ketorol) and at rest. Pains accompany
headache, dry mouth.
Considers herself ill for about 4-5 days, when acute
paroxysmal pain in the lumbar region on the right, radiating to the right side
abdomen along the ureter, medium strength. The onset of pain is associated with the fact that in
the last few days took a large amount of fluid. Pain intensified
during movement, physical activity. The pain was accompanied by headache, dry mouth.
To stop the pain, she took No-shpu, Analgin with improvement. IN
for the next three days, the intensity of pain and duration
seizures increased, in connection with which she turned to the local GP.
Objectively: a state of moderate severity. The skin of normal color and
humidity, no swelling. There are no light rales in the lungs. HELL - 130/85 mm RT. Art. Heart rate - 79 per minute,
rhythmic. The abdomen is soft, painless in all departments. Urination is not
difficult. The symptom of striking is weakly positive on the right. Palpation
ureters painful on the right.
In the analyzes: leukocytes - 10.8 × 10 9 / l, hemoglobin - 120 g / l, ESR - 17 mm / h, creatinine
- 105 μmol / L, oxalates are present in the urine.
Survey radiography of the abdominal cavity and small pelvis: in the lumen
pelvic pelvic right homogeneous shadow - calculus of the upper third of the ureter.
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. Make a differential diagnosis.
5. Your further tactics of managing the patient.
Situational task 161 [K002002]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A woman of 75 years old on May 21 went to the doctor with complaints of a heartbeat.
From the anamnesis it is known that 3 months ago the patient suffered an acute lower
myocardial infarction with ST segment elevation; the patient underwent coronarography -
revealed stenosis of the envelope of the branch 85%, (LAD stenosis 45%, OS 45%), and therefore
trans balloon angioplasty and stenting of the PKA with a stent with
drug coating. For three years, the patient has been verified constant
form of atrial fibrillation. The patient had a history of 2 recovery attempts
rhythm using electropulse therapy, which were unsuccessful.
On examination: moderate severity. The skin is clean, normal
coloring. In the lungs, vesicular breathing, no wheezing. Heart sounds are muffled
arrhythmic. Heart rate - 140 beats per minute, heart rate - 110 beats per minute. HELL - 110/80 mm RT.
Art. The abdomen is soft, painless on palpation in all departments. Liver and spleen not
enlarged. There is no dysuria. The symptom of lumbar effusion is negative.
In the analyzes: total cholesterol - 4.8 mmol / l, TG - 2.5 mmol / l, cholesterol-HDL - 1.1
mmol / l; CS-LDL - 3.2 mmol / L.
Questions:
1. Formulate the diagnosis of the patient.
2. Justify your diagnosis.
3. Make and justify a plan for an additional examination of the patient.
4. List the groups of drugs, the timing of their use, which should be
recommended for reception to the patient. Justify their application.
5. Given the patient’s complaints about the heartbeat, despite taking the drugs,
listed in the previous question, what is the further therapeutic tactic? Justify
Your choice.
Situational task 162 [K002003]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
On April 18, a 68-year-old man turned to a local doctor-general practitioner with complaints of
headache, dizziness, flickering flies before the eyes.
From the anamnesis it is known that 3 months ago the patient suffered an acute lower infarction
myocardium with ST segment elevation; the patient underwent coronarography - revealed
stenosis of the right coronary artery 90%, (LAD stenosis 35%, OB 30%), and therefore
trans balloon angioplasty and stenting of the PKA with a stent with
drug coating.
From the anamnesis it is known that for a long time suffers from arterial
hypertension with a maximum increase in blood pressure to 210/110 mm
Hg. Art., well-being at a blood pressure of 120/70 mm RT. Art.
Bad habits: smoking for 20 years at 10 cigarettes per day.
On examination: moderate severity. The skin is clean,
hyperemic. In lungs, harsh breathing, no wheezing. Heart sounds are muffled
rhythmic. Heart rate - 70 beats per minute, blood pressure - 190/100 mm RT. Art. The abdomen is soft, with
palpation painless in all departments. The liver and spleen are not enlarged. Dysuria
not. The symptom of lumbar effusion is negative.
In the analyzes: total cholesterol - 5.4 mmol / l, TG - 1.6 mmol / l, HDL-C - 1.1
mmol / l; CS-LDL - 3.6 mmol / L.
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. List the groups of drugs and the timing of their use, which should be
recommended for continuous admission to the patient. Justify their application.
5. After 2 months, the patient complained of a heartbeat;
addressed. Within 5 days, these complaints were kept, and therefore called
emergency medical assistance. Atrial fibrillation is recorded on the ECG.
What is your further therapeutic tactic? Justify your choice.
Situational task 163 [K002005]
Дата: 2019-12-10, просмотров: 363.