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Нажимая кнопку "Продолжить", я принимаю политику конфиденциальности

ANSWERS ON QUESTIONS

Main part

Woman 35 years old. Over the past year, notes a 10 kg weight gain. Worries

muscle weakness, pain in the spine, moderate thirst and polyuria, change

appearance - redistribution of fat occurred: a lot of fat on the stomach, a little on

limbs, decreased muscle mass, red face, facial hair growth and

limbs, bruises easily occur. There are no monthly periods for six months. Arterial

hypertension - blood pressure 180/100 mm RT. Art. The condition is satisfactory. Excessive nutrition

weight - 92 kg, height - 168 cm, waist circumference - 100 cm. A lot of fat on the upper half

torso, abdomen, few on the limbs. The skin is dry, wide crimson striae on the side

body surface. Pulse - 96 per minute, rhythmic. HELL - 180/90 mm RT. Art. Tones

muffled. Vesicular breathing. There are no fathers.

Clinical blood test: hemoglobin - 168 g / l, red blood cells - 5.4 × 10 12 / l,

white blood cells - 10.5 × 10 9 / l, ESR - 12 mm / h. Fasting plasma glucose - 8.4 mmol / L, total

cholesterol - 7.2 mmol / l, triglycerides - 2.6 mmol / l, K - 3.8 mmol / l, Na - 145 mmol / l,

Ca ++ 1.01 μmol / L. In daily urine, free cortisol is 1028 mmol / l (normal up to 250

mmol / l). The plasma cortisol level at 22.00 is 648 mmol / L. Nightly suppression test

with 1 mg and 8 mg of Dexamethasone - suppression of cortisol secretion did not occur. Level

ACTH in plasma is significantly lower than normal. MRI of the adrenal gland - detected

adenoma of the left adrenal gland 4 cm.

Questions:

1. Formulate a presumptive diagnosis.

2. Indicate the diagnostic criteria for the underlying disease.

3. Specify treatment tactics.

4. What is the prevention of acute adrenal insufficiency?

5. Determine the patient management tactics after surgical treatment.

 

Situational task 211 [K002080]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 71-year-old local therapist was called to the patient. Complaints of shortness of breath, weakness,

dizziness and heart palpitations within 15 minutes.

Medical history: suffered Q myocardial infarction of the posterior lower left wall

ventricle in 2012, was treated stationary. Suffers from hypertension with

figures HELL 180/90 mm RT. Art. for 10 years. With a little physical exertion

(walking at a distance of 200 meters with a calm step) there are chest pains that

removed by taking Nitroglycerin. Attacks during the last six months have not

become more frequent. Marks swelling of the lower legs more in the evening. Takes periodically cardipin

XL, Furosemide, Digoxin.

Objectively: a state of moderate severity. In the mind. Lies with a high headboard.

The skin is pale, moist. Acrocyanosis. Pulse - 120 in 1 minute, weak

filling, rhythmic. HELL - 90/60 mm RT. Art. The boundaries of relative heart dullness

left in the V intercostal space from lin.medioclavicularis sin. + 2 cm. Heart sounds are muffled, I tone

at the top is weakened. Emphasis II tone on the pulmonary artery. Respiratory rate - 26 in 1

a minute. In the lungs, harsh breathing, small moist rales in the lower sections. Liver + 5

see below the edge of the arc. Swelling of the legs.

On an ECG taken immediately after examination of the patient in order to assess the nature of violations

rhythm:

Questions:

1. Give a description of the changes on the electrocardiogram.

2. Formulate a presumptive diagnosis.

3. Conduct a rationale for your presumptive diagnosis.

4. Make and justify a plan for an additional examination of the patient.

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

 

Situational task 212 [K002679]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 39-year-old female patient complained of sore throat when swallowing, tickling,

increase in body temperature to 37.2 ° C. Sick for 3 days.

Objectively: the mucous membrane of the posterior wall is hyperemic, determined

enlarged lymphoid granules and lateral ridges. Palatine tonsils of 1 degree

pink, no raids. From the anamnesis it is known that such phenomena occur frequently,

about once a month.

The patient smokes 1 pack of cigarettes per day for 10 years.

In the blood test: white blood cells - 7.5, red blood cells - 3.9, Hb - 126, stab

neutrophils - 1, segmented neutrophils - 69, lymphocytes - 26, monocytes - 2,

eosinophils - 2, ESR - 5.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Make and justify a patient treatment plan

4. What are the main diagnostic methods needed?

5. Suggest measures to prevent exacerbation of the disease.

 

Situational task 213 [K002692]