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ANSWERS ON QUESTIONS
Main part
Patient 20 years old when contacting a polyclinic with a general practitioner
complains of general weakness, dizziness, icteric staining of the skin
and sclera. A week ago, after hypothermia, the temperature rose to 38 ° C, there were
catarrhal symptoms for 3 days, about which he took Paracetamol.
The temperature returned to normal, but icteric staining of the skin and sclera appeared
growing weakness. There have also been episodes of jaundice in the past.
Objectively: the patient's condition is moderate. The skin is pale icteric
coloring with a lemon tint, sclera icteric. Pulse - 90 per minute, rhythmic, blood pressure -
110/80 mmHg Art. In lungs, vesicular breathing. The abdomen is soft, painless. Liver
at the edge of the costal arch, spleen +3 cm.
Clinical blood test: hemoglobin - 90 g / l, red blood cells - 3.1 × 10 12 / l, color
indicator - 0.9, reticulocytes - 3%, leukocyte formula - without features, ESR -
10 mm / hour. Blood bilirubin - 33 μmol / l, the reaction is indirect.
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 complications of the disease can develop in a patient?
Situational task 182 [K002035]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 44-year-old patient went to the polyclinic to a local physician
complaints of weakness, fatigue, shortness of breath and palpitations with a slight physical
load, burning in the tongue, numbness in the soles of the feet. The skin and mucous membranes are pale
with an icteric shade. The face is edematous, pale, gray hair. The tongue is clean, raspberry,
brilliant, papillae atrophied. Heart sounds are deaf, weak systolic murmur on
top, on the pulmonary trunk. The liver is palpated 2 cm below the right costal arch,
percussion dimensions - 15 × 10 × 8 cm. The spleen is palpated, percussion sizes -
13 × 10 cm. Reflexes are strengthened, sensitivity on feet and hands is reduced.
Clinical blood test: hemoglobin - 63 g / l, red blood cells - 2.6 × 10 12 / l,
leukocyte formula - without features, MCV - 110 fl, Jolly body and ring
Cabot, poikilocytosis. Bilirubin - 55 μmol / L, indirect - 45 μmol / L. results
sternal puncture: erythroid bone marrow hyperplasia, megaloblastic type
hematopoiesis, the ratio of erythroid and myeloid elements - 1: 1, reduced
the number of megakaryocytes, giant metamyelocytes are determined.
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 are the criteria for the effectiveness of treatment of the disease.
Situational task 183 [K002036]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A patient 55 years 5 years ago received polychemotherapy and radiation therapy according to
about lung cancer. Within six months, there was weakness, dizziness, shortness of breath
when walking. With a thorough examination of the patient, including CT of the chest and
abdominal evidence for progression of underlying disease and development
metastases not received. Clinical blood test: hemoglobin - 65 g / l, red blood cells -
2.1 × 10 12 / l, reticulocytes - 0.5%, leukocytes - 1.9 × 10 9 / l, platelets - 90 × 10 9 / l, ESR - 35
mm / h Results of sternal puncture: bone marrow is mainly represented by fat
tissue in which rare and small islets of myeloid tissue are defined.
Leukocyte formula without features.
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 diseases are diagnosed with?
Situational task 184 [K002037]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 38-year-old patient went to the polyclinic to a local physician
complaints of night pain in the epigastric region, fatigue, dizziness,
palpitations during exercise.
From the anamnesis: from the age of 17 sick with peptic ulcer of the duodenum,
about which hospitalization was twice carried out. Over the past 3
months there were episodes of deterioration, weakness, dizziness,
dark color of the chair. Objectively: the general condition is relatively satisfactory.
The skin and mucous membranes are pale in color. In lungs, vesicular breathing.
Heart sounds are rhythmic, heart rate - 80 beats per minute, blood pressure - 110/70 mm RT. Art. The stomach is soft
moderately painful in the epigastric region. The liver and spleen are not enlarged.
Clinical blood test: hemoglobin - 73 g / l, red blood cells - 3.2 × 10 12 / l, color
indicator - 0.71, reticulocytes - 1%, leukocyte formula - without features, ESR -
10 mm / h, MCV - 70 fl., Serum iron - 7 μmol / l. OZHSS - 115 micromol / l.
Conclusion FGDS: ulcer of the bulb of the duodenum duodenum with a diameter of 0.8 cm.
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 are the indications for the study of bone marrow.
Situational task 185 [K002038]
Дата: 2019-12-10, просмотров: 246.