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ANSWERS ON QUESTIONS
Main part
Patient M., 18 years old, played football with friends. After 1 hour from the start of the game
less active, pale, complained of a headache and trembling in the body, then
sweating appeared, began to talk incoherently, after which he lost consciousness.
From the history of the disease, it is known that for 4 months he suffers from sugar
type 1 diabetes, receives insulin therapy 32 units per day.
Objectively: satisfactory nutrition, height - 174 cm, weight - 68 kg. Consciousness
missing. The skin is pale, cold, diffuse hyperhidrosis. On the front
abdominal wall traces of injection. There are no fathers. Muscle tone is increased. Eye Tonus
apples raised. Tendon reflexes are elevated. In the lungs, a clear, pulmonary sound,
vesicular breathing, no wheezing, BH - 16 per minute. Relative cardiac
dullness: right - the right edge of the sternum, upper - the upper edge of the III rib, left - 1 cm
medially from the midclavicular line, tones are clear, rhythmic, heart rate - 100 beats per minute,
rhythmic pulse, satisfactory quality, 100 beats per minute. HELL - 130/80 mm RT.
Art. The tongue is wet. The abdomen is soft, does not respond to palpation. The liver is not palpable,
Kurlov dimensions: 10 × 9 × 7 cm, cystic symptoms are negative, the spleen is not
palpable, kidneys not palpable, striking syndrome - negative.
The thyroid gland during palpation is not enlarged, elastic, nodular formations are not
are determined.
Survey data.
Complete blood count: red blood cells - 4.5 × 10 12 / l, hemoglobin -146 g / l, white blood cells -
6.9 × 10 9 / l, eosinophils - 2%, basophils - 1%, stab neutrophils - 5%,
segmented neutrophils - 55%, lymphocytes - 31%, monocytes - 6%, ESR - 8 mm / h.
Urinalysis: color - yellow, specific gravity - 1017, protein - 0.067 g / l, sugar -
OTR, acetone - OTR, epithelium - 1-2 in the field of view, white blood cells - 1-3 in the field of view,
erythrocytes - 0-1 in the field of view.
Biochemical blood test: bilirubin - 16.9, total. protein - 69 g / l, sugar - 2.2
mmol / L, AST - 17 U / L, ALT - 23 U / L, Na + - 141.65 mmol / L, K + - 4.6 mmol / L.
ECG: rhythm - sinus, heart rate - 100 per minute. EOS - horizontal. Signs
myocardial metabolic changes.
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 and justify a treatment plan.
5. Assess the prognosis for the patient. Choose a tactic for further observation.
Situational task 177 [K002027]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient P., 24 years old, lost consciousness at home, relatives called an ambulance
help.
Anamnesis of the disease: it is known that a month ago dry mouth, thirst appeared
(drank up to 8.0 l / day), polyuria, weakness, lost 10 kg. I didn’t go to the doctors.
The last 3 days began to be disturbed by gradually increasing pulling pains in the abdomen,
spilled character, lack of appetite, nausea, the day before there was 2-fold vomiting.
This morning I became indifferent to what was happening around, answered with difficulty
questions. Gradually, she began to lose consciousness, breathing became rapid, deep,
noisy.
Objectively: a serious condition. Passive position (lying on the bed), consciousness
missing. Lowered nutrition, hypotrophy of the subcutaneous fat, muscle layer.
Growth - 154 kg, weight - 33 kg. The skin and visible mucous membranes are pale, cold,
dry, turgor reduced, cyanosis of the lips. Facial features are pointed. Striae, no hirsutism. IN
lungs with percussion - a clear pulmonary sound. Breath deep, noisy, pungent odor
acetone in exhaled air, BH - 32 per minute. In the lungs, vesicular breathing,
no wheezing. The boundaries of relative cardiac dullness: right - the right edge of the sternum,
upper - upper edge of the III rib, left - 1 cm inward from the midclavicular line, heart rate -
110 beats per minute. The tones are rhythmic, muffled, no noise, 110 per minute. Pulse
rhythmic, small filling, 110 per minute, blood pressure - 90/50 mm RT. Art. The tongue is dry, red.
The abdomen is driven up, does not participate in the act of breathing, is tense during palpation in all departments,
peritoneal symptoms are negative, the liver +2 cm from under the costal arch. Spleen
it is not palpable, the kidneys are not palpable, the striking syndrome is negative.
The thyroid gland during palpation is not enlarged, elastic, nodular formations are not
are determined. No lactorrhea.
Survey data.
Complete blood count: red blood cells - 3.7 × 10 12 / l, hemoglobin - 124 g / l, white blood cells -
10.2 × 10 9 / l, eosinophils - 4%, basophils - 1%, stab neutrophils - 7%,
segmented neutrophils - 62%, lymphocytes - 17%, monocytes - 8%, ESR - 24 mm / h.
Urinalysis: color - yellow, specific gravity - 1032, protein - 0.376 g / l, sugar -
10%, acetone - 4 ++++, epithelium - 0-1 in the field of view, white blood cells - 3-5 in the field of view,
red blood cells - 3-5 in the field of view.
Biochemical analysis of blood: total protein - 67 g / l, creatinine - 135 μmol / l,
urea - 12.7 mmol / L, sugar - 35.6 mmol / L, AST - 24 U / L, ALT - 28 U / L, Na + - 131.3
mmol / L, K + - 3.2 mmol / L, Fe2 + - 17.3 μmol / L. KHSh: pH - 7.23, BE - 8.3.
ECG: rhythm - sinus, heart rate - 110 per minute, atrial extrasystoles (3). Eos
- to the right. Metabolic changes in the myocardium.
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 and justify a treatment plan.
5. Assess the prognosis for the patient. Choose a tactic for further observation.
Situational task 178 [K002029]
Дата: 2019-12-10, просмотров: 217.