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ANSWERS ON QUESTIONS
Main part
Patient V., 52 years old, a civil engineer, is troubled by seizures throughout the year
pressing chest pains when walking fast and climbing to the 3rd floor lasting 5 minutes
and passing at rest or after taking Nitroglycerin. In the last 2 weeks
attacks became more frequent, began to occur when walking at a normal pace, attacks appeared
at rest. I went to the local GP at the clinic. When shooting an ECG
no pathological changes were detected. The local general practitioner recommended
taking long-acting nitrates and sent the patient to Holter
ECG monitoring. The nature of the patient’s complaints has not changed, but with Holter
ECG monitoring at the time of “habitual” pain attacks for the patient
sinus tachycardia, ventricular extrasystoles, and segment depression
ST, reaching 2 mm in leads I, V4-V6.
The day after monitoring during repeated treatment
to the GP therapist on an ECG in a patient at rest noted the following
changes.
Questions:
1. Formulate a presumptive diagnosis.
2. What are the criteria for the main diagnosis.
3. Make an additional examination plan.
4. Indicate the factors that determine the risk group for this patient.
5. Select a treatment tactic.
Situational task 208 [K002077]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 62-year-old woman consulted a local GP with complaints of
weakness, dry mouth, moderate thirst, pain in the legs, especially at night, feeling
burning, tingling feet, cramps of the calf muscles.
From the anamnesis it is known that over the past 10 years marks a gradual increase
weight of 15 kg, notes the rise in blood pressure up to 160/95 mm RT. Art. Regular
did not receive therapy. During the last visit to the therapist six months ago it was
registered blood pressure - 170/95 mm RT. Art. and albuminuria was detected.
Family history. Parents suffered from GB, obesity, type 2 diabetes. Harmful
no habits.
On examination. General condition is satisfactory. Weight - 87 kg, height - 165 cm,
BMI - 32.0 kg / m 2 , waist circumference - 102 cm, the distribution of fat is uneven, in
mainly on the abdomen and in the upper half of the body. There are no striae. Dry skin on legs
areas of pigmentation, cracks in the feet, mycosis of the feet. Pulse - 78 per minute, rhythmic.
Heart sounds are muffled, rhythmic, II tone accent over the aortic projection.
In the lungs, vesicular breathing, no wheezing. The abdomen is soft, on palpation
painless in all departments. The liver and spleen are not enlarged. There is no dysuria.
The symptom of lumbar effusion is negative.
Ripple aa. dorsalis pedis and tibialis posterior distinct. HELL - 165/95 mm RT. Art.
In a blood test: fasting glucose - 8.6 mmol / L, HbA1C - 7.9%, total cholesterol
- 6.8 mmol / L, LDL - 4.36; HDL - 0.96, triglycerides - 3.8. Urinalysis without
pathology; creatinine - 102 μmol / l, GFR (according to the formula CKD-EPI) - 71.6 ml / min;
albuminuria - 120 mg / day.
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 an additional examination of the patient.
5. Justify the treatment tactics, the choice of drugs.
Situational task 209 [K002078]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient M., 21 years old, became ill after hypothermia. The disease began with
temperature increase to 39 ° C, pain and swelling in the knee, ankle and
elbow joints, enlargement and tenderness of the submandibular lymph nodes. On the cheeks
bright blush. Concerned about acute pain in the lower parts of the lungs with a deep breath,
coughing.
On examination: a serious condition, the skin is pale, submandibular
the lymph nodes are enlarged, slightly painful and tight. Swelling of the knee
ankle and elbow joints, the skin above them is hot. Movements in these joints
painful. In the area of the decollete, disk-like rashes. Pulse - 118 per minute,
rhythmic. HELL - 190/40 mm RT. Art. Right border of relative dullness of the heart per 1 cm
shifted to the right of the right edge of the sternum, the upper reaches the III rib, the left - by 1.5 cm
to the left of the left midclavicular line. Heart sounds are weakened, systolic murmur on
top, gallop rhythm. In the lower back of the lungs - hard breathing, the noise of friction
pleura. Peripheral edema of the lower extremities. In blood tests - anemia,
thrombocytopenia, leukopenia. In urine tests, pronounced proteinuria, altered
erythrocytes, granular and waxy cylinders, daily protein loss of 4 g.
Questions:
1. Formulate a presumptive diagnosis.
2. Indicate the diagnostic criteria for the underlying disease.
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 210 [K002079]
Дата: 2019-12-10, просмотров: 286.