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ANSWERS ON QUESTIONS
Main part
A 23-year-old patient went to the polyclinic to a local physician
complaints of general muscle weakness, fatigue, headaches, a sharp decrease
performance, dry mouth, increased thirst, frequent profuse
urination. Sick about a month ago after a nervous shock (attack
bullies). Thirst and itching of the skin appeared. I began to lose weight (over the past two weeks I lost
about 8 kg), despite the fact that the appetite was maintained, and he ate quite a lot. I noticed that
began to wake up several times at night to urinate, which had never happened before.
On examination: depleted, dry, rough skin. On the back - traces of scratching. The tongue is red
sticky. From the mouth - a sweetish-sour smell. Heart sounds are muffled, moderate
tachycardia (up to 90 beats per minute). The stomach is calm. Liver increased by 2 cm.
The spleen is not palpable.
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 most common complications that can occur with this disease?
Situational task 186 [K002039]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 50-year-old patient went to the polyclinic to a local general practitioner. Of
anamnesis: in the last year notes at night pain in the upper third of the sternum,
which lasts about 15 minutes, pass on their own or after taking
Nitroglycerin. HELL - 120/80 mm RT. Art., pulse - 62 beats per minute. ECG alone without
pathological changes. Exercise test negative at high
load tolerance. During an attack of pain on an ECG taken by an emergency doctor
assistance, ST segment elevation in leads II, III and AVF with
discordant decrease in this segment in leads V1 and V2 and atrioventricular
blockade of the II degree. From the anamnesis it is known that for 10 years the patient is noted
increase in blood pressure up to 170/100 mm RT. Art. at optimal blood pressure for
patient 130/80 mm RT. Art. Father died suddenly at the age of 57, mother suffers
arterial hypertension and ischemic heart disease. The patient smokes up to 20 cigarettes per day for 25 years.
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 187 [K002040]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 19-year-old patient was referred by a local general practitioner for examination in
endocrinology department of the hospital with suspected diabetes, as in
lately he developed a strong thirst (drank up to 5 liters of water per day),
I got up to drink at night, but drinking water did not quench my thirst. I especially wanted
very cold water. At the same time, he began to urinate frequently and profusely. Urine was
light "like water." He began to lose weight. In the past was in a car accident with a bruise
heads. On examination - the correct physique, reduced nutrition. The skin is dry.
Turgor tissue reduced. The mucous membranes are also rather dry. HELL - 120/70 mm RT. Art. Pulse - 88
beats per minute. Vesicular breathing. The stomach is calm. Liver and spleen not
enlarged. Fasting blood glucose - 5.3 mmol / L. Glucose tolerance test -
normal. Sugar in urine and acetone were not detected. Noteworthy low
urine density in the sample according to Zimnitsky (in all portions its specific gravity was not
more than 1005). Computed tomography of the pituitary gland revealed a formation in its posterior lobe,
suspicious of adenoma.
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 188 [K002041]
Дата: 2019-12-10, просмотров: 264.