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ANSWERS ON QUESTIONS

Main part

A 37-year-old patient complains of severe general weakness,

dizziness, loss of appetite, severe muscle weakness in the limbs and

when chewing food. The last 3 days began to worry nausea throughout the day and

abdominal pain, accompanied by diarrhea up to 2 times a day and several episodes

vomiting Notes weight loss of 8 kg over the past 3 months.

From the anamnesis of the disease: 2 years ago, the patient was treated in tuberculosis

dispensary with a diagnosis of fibro-cavernous tuberculosis, MBT (+), multiple

drug resistance. " Abacilated on 2 series of drugs. Located in group 2

dispensary registration. 6 months ago I began to note a gradual increase in the total and

muscle weakness throughout the body, the above symptoms appeared.

Objectively: general state of moderate severity. Body weight - 63 kg, height -

169 cm. Diffuse hyperpigmentation of the skin, especially the neck, is noted

shoulders, palmar folds. The oral mucosa is pigmented. Peripheral

the lymph nodes are not palpable. There are no fathers. Breath across all pulmonary fields

vesicular, no wheezing. BH - 16 per minute. Heart sounds are rhythmic, muffled,

noises are not heard. HELL - 85/60 mm RT. Art. in a lying position, in a sitting position -

75/45 mmHg Art. Heart rate - 88 beats per minute, pulse of low filling and voltage.

The boundaries of the heart are within normal limits. The tongue is moist, slightly coated at the root with white-gray

in cash. On palpation of the abdomen, moderate

soreness. The liver and spleen are not palpable. The kidneys are not palpable. Symptom

striking is negative on both sides. The thyroid gland is not palpation

enlarged, elastic, painless, nodular formations are not palpable.

 

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 179 [K002032]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 65-year-old patient, a pensioner, turned to a general practitioner

clinic with complaints of general weakness, fatigue, palpitations, shortness of breath with

physical exertion, nausea, belching, heaviness in the epigastrium. Gastric symptoms

dyspepsia for about 15 years. In the last six months, weakness, palpitations, shortness of breath appeared

under load, numbness of the lower extremities. I didn’t go to the doctors.

Objectively: general state of moderate severity. The skin is pale, light

yellowness of the skin and lemon sclera. The face is puffy. Height - 160 cm, body weight

- 68 kg. In lungs, vesicular breathing. The borders of the heart are shifted to the left by 1 cm, tones

a little muffled, heart rate - 90 per minute, blood pressure - 130/80 mm RT. Art. Raspberry Tongue,

papillae are smoothed. The abdomen is soft, painless. The liver protrudes 1 cm from the edge

costal arch, spleen not enlarged.

Clinical blood test: hemoglobin - 70 g / l, red blood cells - 2.9 × 10 12 / l, color

indicator - 1.3, reticulocytes - 0.1%, leukocyte formula without features, ESR -

30 mm / h, MCV - 70 fl. Hypersegmented neutrophils were found in a blood smear,

Jolly's Taurus and Cabot's Rings.

Questions:

1. What is the most likely diagnosis for this patient?

2. Justify your diagnosis.

3. Make a plan for additional examination of the patient.

4. What is your further therapeutic tactic?

5. Indicate the probable causes of this disease.

 

Situational task 180 [K002033]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient 28 years old when contacting a polyclinic with a general practitioner

complains of fatigue, general weakness, dizziness episodes,

palpitations and shortness of breath during exercise. From the anamnesis: dry skin and brittleness

Nail notes for several years. Weakness, dizziness appeared a year ago

back during pregnancy. Monthly from 13 years, plentiful the first 3-4 days, 5-6 days,

regular. Currently breastfeeding a baby.

Objectively: a state of moderate severity. Paleness and dryness of the skin; nails with

transverse striation, exfoliate. The hair is brittle. Rhythmic heart sounds, heart rate - 90

beats per minute, blood pressure - 110/70 mm RT. Art. In lungs, vesicular breathing. Liver and

spleen not enlarged.

Clinical blood test: hemoglobin - 75 g / l, red blood cells - 3.3 × 10 12 / l,

leukocyte formula - without features, ESR - 12 mm / h, MCV - 70 fl., MCH - 21.0

PG, anisocytosis, poikilocytosis. Serum iron - 6 μmol / L.

Questions:

1. What is the most likely diagnosis for this patient?

2. Justify your diagnosis.

3. Make a plan for additional examination of the patient.

4. What is your further therapeutic tactic?

5. What recommendations should be given to the patient for further prevention

disease?

 

Situational task 181 [K002034]