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ANSWERS ON QUESTIONS
Main part
A 47-year-old patient M. turned to the local general practitioner with complaints of general
weakness, lethargy, poor appetite, a feeling of heaviness in the epigastrium after eating.
Such complaints harass for a long time, previously not
was surveyed.
In addition, in the last 4 months began to notice the emergence of instability in
walking, a feeling of "goosebumps" in the lower extremities, burning tongue.
From the anamnesis it is known that from a young age he knows about the presence of an autoimmune
thyroiditis (regularly observed by an endocrinologist, TSH level within
normal values).
Objectively: the condition is satisfactory. The skin is slightly pale,
normal humidity.
From the cardiovascular, respiratory systems without features.
The tongue is coated with white coating at the root, the papillae are smoothed.
The abdomen is not swollen, soft, slightly sensitive in the epigastrium.
There are no fathers.
In a clinical blood test: hemoglobin - 106 g / l, red blood cells - 2.9 × 10 12 / l,
color indicator - 1.09, MCV - 130, reticulocytes - 1%, white blood cells - 4.9 × 10 9 / l, ESR -
15 mph, macrocytosis, anisocytosis, Jolly body.
In the biochemical analysis of blood: ALT - 32 U / l, AST - 30 U / l, amylase - 60 U / l,
alkaline phosphatase - 59 units / liter.
Questions:
1. Formulate a preliminary diagnosis.
2. Suggest a plan for further examination.
3. What specific immunological markers can confirm the diagnosis?
4. What changes in the endoscopic picture can be expected with FGDS?
5. Offer a treatment plan.
Situational task 195 [K002058]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient K., 29 years old, consulted a local general practitioner with complaints of frequent
mild aching pains in the epigastric region, decreasing after eating,
feeling of quick satiety, burping sour. Also notes a general weakness,
stool instability.
These complaints periodically concern over the past 5 years, the current
worsening of well-being - 1.5 weeks ago.
I took antacids with short-term positive on my own
effect.
An objective examination: the condition is satisfactory. Integuments and
visible mucous membranes of normal color, clean. From the cardiovascular
respiratory systems without features. The tongue is moist, covered with white coating. Stomach
normal form, palpation soft, painful in the epigastric region.
In the clinical analysis of blood: red blood cells - 4.8 × 10 12 / l, hemoglobin - 140 g / l,
color indicator - 0.87, platelets - 380 × 10 9 / l, white blood cells - 7.2 × 10 9 / l, ESR - 16 mm / h.
In the biochemical analysis of blood: ALT - 21 units / liter, AST - 18 units / liter, amylase - 53 units / liter,
alkaline phosphatase - 78 units / liter.
Performed FGDS: in the lumen of the stomach a large amount of mucus. Phenomenon
moderate atrophy in the pyloric stomach, edema and hyperemia in the fundus
section of the stomach. Active peristalsis. The stomach expands well.
Help-test +++.
Questions:
1. State the most probable diagnosis.
2. Is there a need for eradication therapy in this case?
3. Offer a treatment plan.
4. What are the factors of natural protection of the gastric mucosa and factors
aggression do you know?
5. What complications of this disease are possible in the absence of
specific treatment?
Situational task 196 [K002059]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
The general practitioner in the outpatient clinic called an ambulance
possible hospitalization for a 45-year-old woman who suggested
the diagnosis of coronary heart disease. Acute coronary syndrome. Bronchial
asthma, exacerbation. "
From the anamnesis it is known that over the past 10 years, after a significant
decrease in physical activity, notes a constant increase in body weight, on
background of which paroxysmal, mostly dry, painful
cough accompanied by a feeling of lack of air.
After a while, she also began to notice pain behind the sternum during physical
the load most pronounced during work in the garden (weeding the beds).
Was examined on an outpatient basis. Diagnosed with severe bronchial asthma,
continuously recurrent course. CHD: angina pectoris III f. K. Obesity
II art. "
Prescribed treatment - Prednisone, inhaled glucocorticoids,
bronchodilators - had a negligible effect.
The intake of nitrates, according to the patient, was effective, leading to relief
chest pain for half an hour.
During the last 2-3 weeks, the appearance of chest pain at night
time in the first half of the night, especially after a heavy late dinner, what became
reason to seek medical help.
Ambulance team according to the clinical picture, as well as according to
ECG and highly sensitive troponin test, the diagnosis of "ACS" rejected.
During auscultation, breathing is stiff, no wheezing.
Chest x-ray - no pathology.
Questions:
1. State the most likely diagnosis of a disease that combines
complaints of the patient.
2. What complications are possible with this disease?
3. What special research methods are used for this disease?
4. What recommendations for changing lifestyle and nutrition need to be given
to the patient?
5. What drugs are used to treat this disease (indicate group and
name of the drug)?
Situational task 197 [K002060]
Дата: 2019-12-10, просмотров: 273.