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ANSWERS ON QUESTIONS
Main part
A 55-year-old man turned to the doctor’s general practitioner’s office,
alcohol abuser, smoker, complaining of pain in the abdomen,
spreading upward, occur more often after 1.5-2 hours after copious, acute or
fatty foods, lasting up to 3 hours, aggravated by lying on the back,
decreasing in a sitting position with an inclination forward, pulling the legs to the chest.
Sometimes pain radiates to the left half of the chest.
Also notes nausea, lack of appetite, bloating.
After each meal for 1 hour, a mushy, sometimes
watery stool containing drops of fat.
Notes weight loss.
Questions:
1. State the most probable preliminary diagnosis.
2. List the possible complications of this disease.
3. What survey methods are used to confirm and clarify
the diagnosis?
4. What are the main objectives of conservative management / treatment of patients with this
a disease?
5. List the main medical and non-medical treatment
measures shown for this patient.
Situational task 198 [K002061]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 38-year-old patient, an engineer, consulted a local GP with complaints of
repeated heart attacks that occur for no reason, without any
connection with movement, unrest, eating, accompanied by chest tightness,
lack of air, trembling of the whole body. Attacks stop on their own. After
stopping one of the attacks of the heartbeat was a short-term loss of consciousness.
Outside of an attack, weakness, fatigue, dizziness worries.
The patient considers himself within a year. It all started with ailment, long
subfebrile condition, arthralgia, interruptions in the work of the heart. Myocarditis was diagnosed,
was treated in a hospital. At discharge, doctors recommended taking medication.
belladonna, because there was a constant tendency to bradycardia - the pulse rate was
between 50-55 per minute.
Three months ago, the first heart attack occurred, then it repeated through
three weeks, and more recently, seizures occur 3-4 times a week. ECG picture in
attack time:
Anamnesis of life: in the past it’s almost healthy, there were no serious diseases,
I was always physically active, went skiing, visited the pool.
Gynecological history without features, childbirth 1 without complications.
Objectively: at the time of examination, the patient's condition is satisfactory. Pulse - 48
per minute, irregular (5-7 drops, or pauses, per minute). HELL - 130/70 mm RT. Art.
Borders of relative cardiac dullness in the V intercostal space along the midclavicular line.
In lung vesicular breathing, no wheezing. The abdomen is soft, painless with
palpation, the liver is not enlarged. There are no fathers.
On the ECG immediately after examination of the patient:
Questions:
1. Your presumptive underlying diagnosis.
2. What are the criteria for the main diagnosis.
3. What conditions should be used for differential diagnosis?
4. Indicate additional examination methods to clarify the diagnosis.
5. Select a treatment tactic.
Situational task 199 [K002062]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 39-year-old man complains about an appointment with a local GP
shortness of breath, palpitations, cough. Shortness of breath and intermittent palpitations
notes for 5 years. About a week ago he contracted tonsillitis with the appearance of high
temperature, cough. On the night before going to the doctor, I could not sleep because of severe
shortness of breath, increasing in a horizontal position. In adolescence were
frequent sore throats, against which pains in large joints bothered. Observed at
neurologist regarding chorea.
Objectively: orthopnea, acrocyanosis, NPV - 28 per minute, edema of the lower extremities,
lifting apical impulse. Pulse of weak filling, arrhythmic, 96 beats
per minute. Heart rate according to auscultation - 110 per minute. Blood pressure - 100/60
mmHg Art., body temperature - 37.4 ° C. The liver is enlarged, slightly painful with
palpation. With percussion, the heart is enlarged left and right. In the lower parts of the lungs
fine bubbling rales. With auscultation of the heart - arrhythmia with the absence of periods
the right rhythm. At the top is a three-tune melody with a low dull extra
component, emphasis II tone on the pulmonary artery. Three-tune melody is heard in
Botkin's point. Systolic and protodiastolic murmur at the apex. Systolic
noise at the apex is amplified on exhalation, carried out in the axillary region.
Complete blood count: ESR - 32 mm / hour, white blood cells - 11300 in 1 mm 3 . Biochemical
blood test: C - reactive protein (++++). DFA - 0.500 (N up to 0.200).
Questions:
1. Formulate a presumptive diagnosis.
2. What are the criteria for the main diagnosis.
3. What complications of the underlying disease do you suspect?
4. Make and justify a plan for additional examination of the patient.
5. Justify the treatment tactics, the choice of drugs.
Situational task 200 [K002063]
Дата: 2019-12-10, просмотров: 247.