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ANSWERS ON QUESTIONS
Main part
A 20-year-old girl complains of discomfort in her throat: tickling, burning.
These symptoms appeared after the day before she ate a large amount
ice cream.
Objectively: bright hyperemia of the mucous membrane of the posterior wall is determined
pharynx and its moderate infiltration. Other ENT organs without pathological changes.
Clinical blood test: white blood cells - 10.8 × 10 9 / l, ESR - 16 mm / hour; neutrophils
- 65.2%, lymphocytes - 21.3%, eosinophils - 3.1%, monocytes - 10%, basophils - 0.4%.
The patient requires a temporary disability certificate.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make a plan and justify the patient’s treatment plan (indicate the drugs of choice,
diet).
4. What are the main pathogens and factors contributing to the development of this
diseases.
5. Assess the patient's ability to work. Is it necessary to issue a temporary sheet
disability?
Situational task 214 [K002693]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 25-year-old man complains of a sore throat, worse when swallowing,
increase in body temperature to 37.5 ° C, general malaise. Binds this state
with recent hypothermia.
Objectively: the condition is satisfactory. The skin is moist, clean. IN
the pharynx is determined by bright hyperemia of the mucous membrane of the palatine arches and tonsils.
Tonsils loosened and protrude beyond the edges of the arches. Hyperemia extends to
back wall of the pharynx.
Clinical blood test: white blood cells - 10.8 × 10 9 / l, ESR - 17 mm / hour;
leukocyte formula: neutrophils - 65.2%, lymphocytes - 21.3%, eosinophils - 3.1%,
monocytes - 10%, basophils - 0.4%.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make and justify a patient treatment plan.
4. Define measures of sanitary-hygienic and preventive measures at
this disease.
5. Indicate the main causative agent of the disease.
Situational task 215 [K002694]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 24-year-old patient complains of severe headaches, pain when swallowing,
radiating to both ears, pain in the joints of the limbs and lower back. Ill acutely, 2 days
back. Body temperature reaches 39–40 ° С.
Objectively: regional cervical lymph nodes are enlarged, painful with
palpation. The mouth opens freely, the tongue is covered with a grayish coating, the palatines
tonsils are enlarged, hyperemic, visible on the tonsil mucosa
yellowish white dots.
Clinical blood test: white blood cells - 14.6 × 10 9 / l, ESR - 66 mm / hour;
leukocyte formula: stab - 9%, segmented - 65.2%, lymphocytes -
12.3%, eosinophils - 3.1%, monocytes - 10%, basophils - 0.4%.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. What diagnostic methods need to be carried out?
4. Indicate possible complications from the internal organs (local and
general) when repeating such conditions.
5. Indicate the recommended period of bed rest and temporary
disability in this disease.
Situational task 216 [K002888]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
Patient D., 55 years old, head of motorcade No. 1236, complained of
heartburn after eating, aggravated by torso and in a lying position; sour
belching and excessive salivation during sleep.
Medical history: has been experiencing these symptoms for three years,
heartburn first appeared after an error in nutrition, especially when bending over
torso; then there were pains in the epigastrium proper and behind the sternum burning
character accompanied by acid burping. Subsequently, heartburn began to occur.
3-4 times a week, regardless of the quality of food, belching appeared sour and bitter. IN
the last month the patient’s condition worsened significantly: pain intensified, especially
at night, excessive salivation during sleep appeared, sleep was disturbed. To relieve heartburn
and pain used soda, Almagel, Maalox. In the last month these drugs
ceased to act. Tried to relieve pain behind the sternum with nitroglycerin, however
there was no significant effect. Has been observed with hypertension since 53 years,
constantly takes cordipine retard 20 mg per day. Smokes.
Objectively: the general condition is satisfactory. High nutrition, mass
body - 106 kg. (BMI - 38). The skin is flesh-colored. Vesicular breathing
no wheezing. BH - 17 per minute. Heart region without features, percussion left border
heart in the midclavicular line. Heart sounds are rhythmic, with a frequency of 66 per minute.
HELL - 130/90 mm RT. Art. The tongue is covered in white. Abdomen enlarged due to subcutaneous
fiber, soft, painless. Palpation of internal organs is difficult due to
abdominal obesity. Liver on the edge of the costal arch. Bubble Symptoms
negative. Zones of Shoffar, Gubergrits - Skulsky are painless.
In laboratory and instrumental studies, the following
data.
Complete blood count: hemglobin - 143 g / l, ESR - 4 mm / h, red blood cells - 4.2 × 10 12 / l,
leukocytes - 8.6 × 10 9 / l, eosinophils - 2%, stab - 5%, segmented - 56%,
lymphocytes - 37%.
Biochemical blood test: total protein - 76 g / l, albumin - 38 g / l, fractions
globulins within normal limits, glucose - 5.2 mmol / l, total bilirubin - 16.3 mmol / l;
direct - 3.6 mmol / l; ALT - 21 U / L (norm 4-42 U / L); AST - 17 U / L (5-37 U / L); amylase
blood - 16 g / l (12-32 g / l per hour).
FEGDS: the mucosa of the lower third of the esophagus is somewhat edematous, moderately
hyperemic, cardia gapes, when straining in the chest cavity prolapses
gastric mucosa; a moderate amount of fluid in the stomach, mucus; gastric mucosa
and KDP without features.
Rg - graph of the esophagus and stomach: the esophagus is freely passable, can be traced
longitudinal folds throughout. Hook shaped stomach, gas bubble
small. In the Trendelenburg position, the bottom of the stomach protrudes into the chest cavity in
in the form of a rounded formation, upright the stomach takes its usual position, folds
gastric mucosa of the usual caliber, peristalsis of the stomach and evacuation in a timely manner,
duodenal bulb without features.
Questions:
1. State the most probable diagnosis.
2. Justify your diagnosis.
3. Make and justify a plan for an additional examination of the patient.
4. Which drug group for pathogenetic therapy would you recommend
to the patient as part of combination therapy? Justify your choice
5. After 2 months of recommended therapy, as well as diet, work schedule
and rest, the clinical manifestations of the disease disappeared, and in the last 2 weeks no
there were no manifestations of the disease. With FEGDS hyperemia and edema of the mucosa disappeared.
What is your future tactic? Justify your choice.
Situational task 217 [K002889]
Дата: 2019-12-10, просмотров: 269.