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ANSWERS ON QUESTIONS

Main part

A 60-year-old patient was admitted to the hospital with complaints of shortness of breath, pain in the left half

chest during coughing and breathing, hemoptysis, fever up to 38 ° C,

weakness. She became ill sharply 2 days ago, when suddenly an attack of suffocation

accompanied by pain in the left half of the chest, palpitations; was

short-term loss of consciousness. An emergency doctor was offered

hospitalization, which the patient refused. Today the dyspnea attack repeated

hemoptysis appeared, hospitalized. The patient's condition is severe, skin

integument pale cyanotic. Swelling of the lower extremities is observed, more than the left,

varicose veins, hyperemia of the skin of the left lower leg with a cyanotic hue.

Respiratory rate - 26 per minute. Pulse - 110 beats per minute, rhythmic, small

filling. HELL - 90/60 mm RT. Art., I tone at the apex of the heart is weakened, the emphasis of II tone over

pulmonary artery. With percussion of the lungs, the blunting of the pulmonary sound in

left subscapular region, here is heard the noise of friction of the pleura. On an ECG

recorded an increase in Q waves in lead III and S in lead I, segment elevation

ST and negative T wave in lead III, blockade of the right bundle branch block.

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. Indications and methods of surgical treatment.

 

Situational task 189 [K002052]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 21-year-old patient called a local therapist at the doctor’s house urgently in connection with

complaints of the release of large amounts of red blood from the rectum with

bowel movements, rapid stool up to 5 times a day, fever up to 38 ° C,

general weakness.

The appearance of blood in the stool notes over the past 2 months, has gradually become

the stool becomes more frequent, the consistency has changed to a mushy, general weakness has appeared,

low-grade fever, worsening within 3 days.

On examination, the skin is pale. HELL - 110/70 mm RT. Art. Pulse - 96 per minute,

rhythmic. The tongue is covered in white. The abdomen is soft, painful in the left

iliac area. Symptoms of peritoneal irritation are negative.

The patient was sent to a hospital for the selection of therapy and further examination

in order to clarify the diagnosis.

Questions:

1. Formulate a preliminary diagnosis.

2. With which diseases is it necessary to make a differential diagnosis?

3. What studies need to be done for this patient?

4. What groups of drugs can be used to treat this

sick?

5. What are the possible complications of this disease?

 

Situational task 190 [K002053]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 21-year-old student turned to a polyclinic at a local physician

complaints of recurrent diarrhea, pain and bloating during the last 6

months, unexplained weight loss (about 5 kg).

She noticed that diarrhea becomes less pronounced if she stops eating

eat bread.

Also worried about the itchy rash on the extensor surfaces of both elbows,

spontaneously formed small hemorrhages in the skin.

Notes that she began to feel general weakness and malaise last

month. On examination, body temperature - 36.8 ° C, heart rate - 80 beats per minute, blood pressure - 115/75 mm

Hg. Art., NPV - 16 per minute, O 2 saturation - 99%.

From the anamnesis: sick with type I diabetes.

According to the general analysis of blood, serum iron, ferritin, free

transferrin, iron deficiency anemia is established.

Questions:

1. What is the etiology and pathogenesis of this disease?

2. What changes in stool are characteristic of this disease?

3. Name and describe a complication (syndrome) that develops with prolonged

uncontrolled course of this disease.

4. What studies must be performed to confirm the diagnosis

disease?

5. What are the basic principles for treating this disease?

 

Situational task 191 [K002054]