Контрольная работа по "Иностранному языку"

Situational task number 1

A patient, 30 years old, a waitress, turned to a local therapist with complaints of malaise, weakness, fever up to 37.3 °C, discomfort, burning sensation in the chest area on the right. The day before I noticed the appearance of bubble rashes on the skin of the back. History: herpes zoster 3 years ago. The presence of chronic diseases denies.

Objectively: a state of moderate severity. The background of the skin is not changed. On the back on the right under the scapula there are many vesicles with transparent contents on an infiltrated erythematous base with an area of 4.0x4.0 cm. The mucous membrane of the oropharynx is pink, clean. Palpable small, slightly painful axillary lymph nodes on the right. On the part of the respiratory, circulatory, and digestive systems, no pathology was detected. Consciousness is clear. There are no meningeal and focal neurological symptoms. In the study of blood, urine changes were not detected. The results of a blood test for the Wasserman reaction, HIV negative. The patient was diagnosed with herpes zoster.

1. Make a diagnosis.

2. Carry out differential diagnostics.

3. Give treatment.

Situational task number 2

A 28-year-old patient was hospitalized with complaints of severe weakness, nausea, vomiting after eating, hiccups, dizziness, insomnia, yellowness of the skin and sclera, dark urine, nosebleeds, fever, pain in the knee and wrist joints.

She fell ill a week ago when she noticed the appearance of weakness, fatigue, an increase in body temperature up to 38 ° C. Fever all day. In the following days, nausea and vomiting arose, the color of urine darkened, pain in the joints appeared. The day before, the sclera turned yellow, she did not sleep well at night, there was nosebleed.

Epidemiological history: 1.5 months ago, the patient had an urgent delivery with blood loss and subsequent transfusion of blood and plasma. In the past, she suffered from viral hepatitis B.

On examination: consciousness is clear. Sluggish, dynamic. Body temperature 37.2 °C. The skin and sclera are brightly icteric. Petechial rash on the skin of the trunk and inner surface of the shoulders. Vesicular respiration in the lungs. Heart sounds are muffled. BP 100/60 mm Hg, pulse 92 per minute. The tongue is coated with white. The abdomen is soft, painful in the right hypochondrium. The edge of the liver at the level of the hypochondrium. The spleen is palpable. Kal is aholic. Urine is dark.

1. Make a preliminary diagnosis.

2. What research needs to be done?

3. Assess the severity of the course of the disease and determine the tactics of treatment

Situational task number 3

Patient I., 35 years old. He went to the clinic on January 25 with complaints of headache, muscle aches, insomnia, fever, rash on the body, nosebleeds, pain in the left hypochondrium.

Sick for 2 weeks. A few days after returning from a business trip, I felt general weakness, pain in the joints, headache, adynamia, dyspeptic and dysuric phenomena. Then the condition sharply, in the first half of the day, worsened. There was an amazing chill, followed by a feeling of heat, headache. The temperature reached 39°C. The maximum body temperature was observed on the 2-3rd day of illness. The patient noted pain in the muscles, especially in the lower extremities, severe weakness, nausea, double vomiting. Sometimes there was pain in the left hypochondrium. He took ibuclin, paracetamol, ascorbic acid. After 3-4 days, the body temperature returned to normal, the patient's condition quickly improved, but after 6 days the attack recurred.

Objectively: a state of moderate severity. The tongue is dry, densely coated with white coating, has acquired a "milky", "porcelain" appearance. The skin of the face is hyperemic. There is an injection of scleral vessels, their subictericity. There is a pronounced tachycardia, a decrease in blood pressure, deafness of heart tones. Integuments with an icteric shade. A petechial rash is noted on the lateral surfaces of the chest. Enlarged spleen and liver.

Epidanamnesis. The truck driver returned about 17 days ago from a distant business trip. Lived in a hotel.

Make a diagnosis. Schedule an examination. Patient management tactics.

Situational task number 4

Patient K., 28 years old. She went to the clinic on July 1 with complaints of headache, muscle aches, insomnia, high fever.

Sick for 10 days, the disease began acutely with severe chills, headache, fever up to 40ºС. Has addressed to the doctor in the first day, the flu is diagnosed; took panadol. After 3 days the temperature returned to normal, she sweated profusely, her state of health improved significantly, but 2 days later the temperature rose again to 39ºС, the above symptoms resumed.

From the epidemiological anamnesis - during June she visited relatives living in Kazakhstan, in the village; took off the ticks, bitten by mosquitoes.

On examination, the state of moderate severity, slight flushing of the face. There is petechial hemorrhage, papules on the right leg. Heart sounds are muffled, rhythmic, not quickened. The tongue is wet, lined. The enlarged liver and spleen are palpable. Stool 3 times a day, liquid. Restless, delirious at night.

1. Make a diagnosis.

2. With what diseases is it necessary to make a differential diagnosis?

3. Schedule an examination.

4. Tactics of patient management.

Situational task number 5

A 3-year-old child fell ill acutely when the body temperature rose to 39 0 C , there was a sharp pain in the throat, inability to swallow, shortness of breath, pallor with a cyanotic tint, swelling of the wings of the nose. Hoarse voice, profuse salivation. When examining the oropharynx, a bright, cherry-red epiglottis is visible. In the lungs, rales of a wired nature. The boundaries of the heart are not changed, muffled tones, tachycardia. Meningeal symptoms are negative.

In the blood test: Hb - 120 g / l., L - 12.4 * 109 / l. X-ray of the chest - without pathology Examination of the ENT - doctor - hyperemia and edema of the larynx, edema of the subglottic space.

1. Make a clinical diagnosis.

2. What is the etiology of this process?

3. What needs to be done urgently?

4. Give treatment.

5. Prevention.

Situational task number 6

Patient S., 22 years old, a student, during the summer holidays rested with relatives in the Perm region. He fell ill 3 weeks after returning to Kazan and self-removal of a tick from the scalp. The disease began acutely with fever up to 39 C°, severe headaches, and malaise. At 3 d.b. joined by fever and swelling in the area of the right knee joint.