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ANSWERS ON QUESTIONS

Main part

Patient A., 18 years old, a student, was admitted on the 12th day of illness in serious condition.

Ill acutely. The temperature rose to 39 ° C, there were sore throats when swallowing.

Then she noticed an increase in cervical lymph nodes. Treated on an outpatient basis, however

the condition did not improve, weakness increased. The skin and mucous membranes are pale,

speaks with difficulty. Body temperature up to 40 ° С. Cervical, posterior cervical and submandibular

lymph nodes are enlarged (3 × 6, 4 × 8 mm), painful. Hemorrhagic on the skin

spots. The gums are loosened. The pharynx is hyperemic, tonsils are enlarged, swollen, covered

purulent plaque, there are necrotic ulcers. Lungs - percussion-lightweight sound,

vesicular breathing. The boundaries of the heart are not changed. Systolic murmur at the apex

tones are loud. Pulse - 120 per minute, rhythmic. The tongue is red. The stomach is soft

painless. The spleen and liver are not palpable.

Blood test: red blood cells - 2.5 × 10 12 / l, hemoglobin - 83 g / l, reticulocytes - 0.1%,

color indicator - 1.0; platelets - 5.0 × 10 9 / l; white blood cells - 0.8 × 10 9 / l; eosinophils -

0%, stab neutrophils - 1%, segmented neutrophils - 7%, young forms -

90%, monocytes - 2%, ESR - 72 mm / hour. Punctate puncture: total

myelocaryocytes - 6.8 × 10 9 / L. There are no granulocytes. Blast cell groups make up

70%

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 a plan for additional examination methods.

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

 

Situational task 205 [K002074]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient B. 24 years old turned to the clinic with complaints of weakness,

dizziness, jaundice. Sick from 5 years of age.

On examination: the skin and sclera are icteric. Noteworthy is the "tower

skull ”and“ gothic sky ”. Trophic ulcers on the skin of the legs. Pulse - 98 per minute,

rhythmic. Heart sounds are muffled, systolic murmur above all points. Breath

vesicular. The abdomen is soft, the liver protrudes 3 cm from under the edge of the costal arch,

spleen - by 6 cm. Hyperregenerative type anemia (reticulocytosis) in the blood.

Bilirubin - 48 μmol / L, indirect - 40 μmol / L. Red blood cell microspherocytosis.

Questions:

1. Formulate a presumptive diagnosis.

2. What are the criteria for the main diagnosis.

3. Make a differential diagnosis of jaundice.

4. Make a plan for additional examination methods.

5. Select a treatment tactic.

 

Situational task 206 [K002075]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 66-year-old patient suffers from attacks of angina pectoris with moderate

physical activity for 4 years. From the same time he knows about arterial

hypertension I have not received regular therapy. Woke up in the morning due to a sharp burning pain

behind the sternum, which was not stopped by Nitroglycerin. I called an ambulance after 2

hours from the onset of pain, when the burning pain behind the sternum intensified, became

radiating to the left hand and shortness of breath appeared, interruptions in the work of the heart.

On examination, the state of moderate severity, shortness of breath at rest. Skin integument

covered with sticky sweat, cold to the touch, acrocyanosis. Pulse - 92 per minute,

arrhythmic, 5-6 extrasystoles per minute, blood pressure - 160/90 mm RT. Art. Heart sounds are deaf

emphasis 2 tones on the pulmonary artery. Respiratory rate - 28 per minute. Are heard

moist rales in the lower parts of the lungs. Liver at the edge of the costal arch, peripheral

no edema.

The patient was urgently hospitalized in the intensive care unit.

On the ECG: sinus rhythm, in leads V1-4 - ST segment elevation 3 mm higher

contours, solitary polytopic ventricular extrasystole with full compensatory

a pause. Leukocytosis - 10,000. Troponin - 16 μmol / L.

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. Select additional examination methods.

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

 

Situational task 207 [K002076]