ANSWERS ON QUESTIONS

Main part

Patient N., 60 years old, turned to the local general practitioner

pain. Recently, I noticed the appearance of a red-cyanotic color of the skin of the face,

vascular injection sclera, sweating. For two years, itchy skin has been bothering

which intensifies after taking water procedures. Headaches are periodically disturbed.

pain, which recently intensified, there was a noise in the ears. Six months ago in

the time of the clinical examination recorded an increase in blood pressure to 160/100 mm RT. Art.

I have never received continuous antihypertensive therapy. In the past considered

almost a healthy person, anamnestic information about diseases

cardiovascular system, respiratory diseases, digestive organs

are absent. There are no bad habits.

On examination: the condition is relatively satisfactory. BMI - 25 kg / m 2

.

Severe hyperemia of the skin and mucous membranes. No lymph nodes

enlarged. In the lungs, vesicular breathing, no wheezing. Heart sounds are muffled

rhythmic, accent II tone over the projection of the aorta. Heart rate - 66 beats per minute, BP - 170/100

mmHg Art. The abdomen is soft, painless on palpation in all departments. At the riber

moderately enlarged spleen (+3 cm) palpated at the edge, with palpation

painless. There are no dysuric disorders. Symptom of lumbar effusion

areas are negative.

General blood test: red blood cells - 7.5 × 10 12 / l, hemoglobin - 187 g / l; white blood cells -

12.8 × 10 9 / l, eosinophils - 4%, basophils - 4%, stab neutrophils - 12%,

segmented neutrophils - 74%, lymphocytes - 5%, monocytes - 1%, platelets -

434 × 10 9 / l, ESR - 1 mm / h. Enlarged spleen. Hematocrit - 56%, bcc - 8.5 liters. General

urinalysis without pathological abnormalities.

Questions:

1. Formulate a presumptive diagnosis.

2. Justify your diagnosis.

3. What complications of the underlying disease do you suspect?

4. Make a plan for an additional examination to clarify the main diagnosis.

5. Justify the treatment tactics, the choice of drugs.

Situational task 201 [K002065]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient K., 64 years old, was taken to the hospital unconscious. According to relatives, in

for several years complained of severe weakness, shortness of breath, poor appetite, pain in

lumbar region with sharp bends, paresthesia, periodically nausea and

discomfort in the epigastric region after eating, about which 3 years ago

was in the hospital where she was diagnosed with anemia. As a result of treatment

the patient's condition has improved. After discharge from the hospital, she lived in the village, to the doctors

not treated and not treated. A few months before admission, the patient feels

worsened, weakness, shortness of breath appeared, gait changes were noted, worsening

appetite, pallor. The patient’s condition progressively worsened: weakness increased,

lethargy. The patient was hospitalized.

On examination: the condition is very serious, the patient is unconscious, a temperature of 36 ° C,

sharp pallor of the skin and mucous membranes, the skin is clean, there is no swelling. Respiratory system

without features. The heart is somewhat widened to the right and left. The tones are muffled, unsharp

systolic murmur above the apex. Tachycardia, pulse - 120 per minute, the rhythm is correct.

HELL - 90/60 mm RT. Art. The tongue is bright red, the papillae are smoothed, the stomach is soft, the liver

increased by 3 cm, soft, palpated spleen.

Blood test: red blood cells - 1 × 10 12 / l, hemoglobin - 50 g / l, color indicator -

1.5, macrocytosis, Jolly body and Kebot rings; there are megaloblasts; platelets -

18 × 10 9 / l, white blood cells - 4 × 10 9 / l, basophils - 0%, eosinophils - 3%, stab

neutrophils - 3%, segmented neutrophils - 50%, lymphocytes - 42%, monocytes -

5%, polysegmented giant neutrophils, reticulocytes - 0.1%, ESR - 30 mm / h.

Blood sugar and creatinine are normal. Urinalysis without pathology. ECG: rhythm

sinus, negative T waves in the left thoracic leads.

Questions:

1. Assume the most likely diagnosis.

2. What are the criteria for the main diagnosis.

3. What complications of the underlying disease do you suspect?

4. Make an additional examination plan.

5. Justify the treatment tactics, the choice of drugs.

Situational task 202 [K002071]