The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical an Medical Pedagogical Faculty
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2. PA man, 43 years old, working as a painter for 22 years. Recently began to bother aching pain and tightness in his right side, loss of appetite, nausea, weakness, fatigue, bleeding gums. For the 6 months has lost 10 kg. Objectively: the patient malnutrition, skin pale, icteric sclera. The body temperature of 38.40 C. Auscultation: over easy in the lower divisions decreased breath. Heart sounds, rhythmic, blood pressure 110/70 mmHg Liver Kurlov 12-18-8 see Spleen 2 cm protruding from under the costal margin. Symptom fluctuation positive. 1. List at least five probable diseases, which are the above symptoms-20 points. 2. Your initial diagnosis, 30 points. 3. List the possible complications of the disease (at least three) -20 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points.
1. List at least five probable diseases, which are the above symptoms-20 points. 2. Your initial diagnosis, 30 points. 3. As manifested neurological disorders and changes in the kidney in a patient with this disease, 20 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. 4. The patient S., 52, a mechanic, turned to the GP complaining of yellowing of the skin and eyes, itching, heaviness in the right upper quadrant, dark-colored urine. He considered himself a little healthier. 3 years ago was treated in hospital for infectious hepatitis. 3 Months worried fatigue in the evening and periodic darkening of the color of urine, to which he was not paying attention. Objectively: the patient's general condition of moderate severity. Skin is jaundiced, icteric mucous visible traces of scratching. Heart sounds. Blood pressure 120/70 mm Hg. Art. Heart rate and heart rate 66 bpm. per min. Abdomen moderately swollen, painless. Liver + 8 cm thick, a little sensitive, uplifting. The spleen is not enlarged. 1. List at least five probable diseases, which are the above symptoms-20 points. 2. Your initial diagnosis, 25 points. 3. List at least four changes in blood chemistry that can be expected in this patient (select normal levels of these analyzes) -25 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. 5. 55 year old patient complains of fever and chills, pain in the right upper quadrant, bitter taste in the mouth, nausea, vomiting, itching of the skin. From history we found that over the past 4 years, the patient periodically observed attacks of pain in the right upper quadrant radiating to the right shoulder with increasing temperature. Were stopped after taking shpy, spazmalgona. Condition deteriorated sharply after the common cold. An objective examination marked yellow skin and sclera. Above mild vesicular breathing, no wheezing. Heart sounds, rhythmic, heart rate and heart rate 100 beats per minute. Liver +3 +4 cm, painful. UAC: HB-110 g / l; leyk.-11 5h109 / l p/ya-11% s/ya-68% limf.-15% 6% mon-,-ESR 30 mm / hr In the blood, there is an increase of bilirubin and cholesterol. 1. List at least five possible conditions under which the above symptoms occur, 20 points. 2. Your complete a preliminary diagnosis of 25-points. 3. Which of the following types of treatment can not be applied in this patient: 1) surgical 2) watchful waiting 3) duodenal intubation 4) antispasmodics 5) analgesics 6) tyubazh 7) holenzim 8) liobil 9) Corn Silk 10) plentiful hot drink 11) Hungry Diet 12) antibiotics-25 points. 4. The tactics of the GP-10 points 5. Principles of treatment of 20-points. 6. Patient D., 22 years old, student, turned to the GP with complaints of fever up to 38,50 C, yellowing of the skin, weakness, nausea, itchy skin. He considers himself a patient for a week, when they began to bother nausea, fever. Since yesterday noted yellowing of skin and sclera of the body. Upon closer questioning revealed that before the phenomenon was preceded by pain in the joints. Patient satisfactory supply. Of the heart, lungs, there is no change. Pulse is prone to bradycardia. BP 110/70 mmHg The abdomen is swollen, sensitive to palpation in the right upper quadrant. The liver appears from under the costal margin of 3 cm, soft to palpation edges are smooth. The spleen was not palpable. B / x blood tests: increased performance of enzymes and thymol.
2. Your initial diagnosis of 35 points. 3. Informative research methods-25 points. 4. The tactics of the GP-20 points.
7. 54 year old patient is turned to the GP with complaints of fever up to 38,40 C, chills, headaches, pain in the right upper quadrant radiating to the right shoulder blade, nausea, vomiting, dry mouth. From history: the above complaints emerged in the last 2 days. The deterioration of the state of ties with taking solid food. Over the past 4 years, the patient periodically observed paroxysmal pain in the right upper quadrant with increasing temperature. An objective examination of the sclera is marked jaundice, signs of scratches on the back. Liver + 2 + 3 cm, painful. From other organs revealed no abnormalities. UAC: HB-110 g / l; leyk.-9 5h109 / l p/ya-11% s/ya-68% limf.-15; Mon 6% SOE 30 mm / hr In the biochemical analysis of blood: cholesterol-8 7mmol / L, total bilirubin 32.2 mmol / L, direct-19, 7 mmol / L, direct-12, 5 mmol / l, increased transaminases, alkaline phosphatase, seromucoid, fibrin.
2. Your initial diagnosis, 25 points. 3. Additional research tools necessary for the diagnosis, 15 points. 4. What objective symptoms are observed in a patient with this disease, 20 points. 5. Tactics GPs and treatment guidelines (not medicated and drug treatments) -25 points. 8. Patient A., 44 years old complains of pain in the right and left hypochondria worse when walking, fever up to 38,20 C, chills, frequent nosebleeds, rapid weight loss. 10 years ago suffered a severe flu, after which there were abdominal pain and dyspepsia. On examination, icteric sclera, skin with a bronze tint, oral mucosa, skin armpit, arms dark. The abdomen is swollen, massive ascites, which is difficult due to palpation of the liver and spleen. +4 +5 Cm liver, spleen, 3 cm In a blood test signs of anemia, leukopenia and SOE-40 mm / h, an increase of ALT, thymol, reduced 17-and 11-ACS ACS blood sugar 7.5 mmol / l. OAM oud. weight 1024, Protein 1,2 g / l, glucose 1%. 1. List at least four diseases in which symptoms are observed above 15-points. 2. Your initial diagnosis, 25 points. 3. Additional research is needed to establish the diagnosis of 20-points. 4. List at least 6 clinical and laboratory signs characteristic of this disease, 20 points. 5. Tactics GPs and treatment-20 points.
9. A young man 32 years old, concerned about stabbing pains in the heart area radiating to the left arm, disruption of the heart, palpitations and shortness of breath on exertion, dizziness, pain and heaviness in the right hypochondrium. History of the patient's father died suddenly at the age of 42 years. Objectively: general state of moderate severity. Pale skin. Above the light in the lower congestion wheezing. Heart sounds are muffled, the tone at the top I relaxed, systolic murmur at the apex and III-IV m / d on the left, is held by the neck vessels, increases in the standing position. Blood pressure 110/80 mm Hg, heart rate 96 per minute, at the expense of arrhythmic beats. Liver 4 cm, painful. On the lower leg edema. Echocardiography: interventricular septum more than 14 mm, it hypokinesia, hypertrophy of the walls of the ventricles with a decrease in their cavities. Abnormal motion of the mitral valve anterior leaflet. 1. Your complete a preliminary diagnosis of 35 points; 2. Plan Survey, 25 points; 3. Enter a bloodless method of additional research, which is crucial in the diagnosis of the disease, 15 points; 4. The tactics of the GP-10 points. 5. The principles of treatment, 15 points; 10) 38 year old man last 5-6 months. began to disturb the pain and heaviness in the right hypochondrium, decreased urine output, swelling in the legs, fatigue. From history: the patient's father died suddenly at the age of 42 years, 40 year-old uncle suffering from heart failure. Objectively: general state of moderate severity. Pale skin, acrocyanosis, jugular venous distention on inspiration. Above the simple release of vesicular breathing, no wheezing. Border of the relative dullness of the heart is normal. Heart sounds are muffled, arrhythmic, gallop rhythm, systolic murmur on the basis of the xiphoid process. Blood pressure 110/70 mm Hg, heart rate of 110, pulse 90 beats. 1 min. Liver 6 cm, painful, spleen not palpable. Symptom fluctuation positive. On the lower leg edema. Echocardiography: the size of the ventricles in the normal range. The valves are not changed, moderate regurgitation of blood through the valve trikuspipidalny. Early diastolic filling velocity = 1.4 m / s (1 m / s), the rate of diastolic filling during systole = 0.3 m / s (0.5 m / s). In the left atrium has a parietal thrombus. 1. List at least 5 diseases are accompanied by the above symptoms and ECG changes, 20 points. 2. Your complete a preliminary diagnosis of 30-points. 3. Plan Survey-20 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points.
1. List 3 signs of cytolysis in the pathology of the liver: a) hepatomegaly b) elevated hemoglobin c) bilirubinemia d) jaundice e) there is no right answer e) All answers are correct Tests with two or more correct answers 1 .. By the indicators cytolytic syndrome in liver pathology are: a) AST (aspartate aminotransferase) b) ALT (alanine aminotransferase) b) lactate dehydrogenase (LDH) d) alkaline phosphatase e) povysheie hemoglobin e) leukocytosis
a) thymol test and trial sulemovaya b) alkaline phosphatase c) bromsulfaleinovaya trial d) γ-globulin serum d) serum immunoglobulins f) lactate
a) in cirrhosis of the liver b) in chronic hepatitis persestiruyuschem c) in infective endocarditis g) in chronic myeloid leukemia d) at Gilbert's disease e) in chronic hepatitis B
a) the presence of cholestatic syndrome b) clinical signs of activity (jaundice, fatigue, low-grade fever, etc.) c) the increase in aminotransferase levels to more than 5 times d) increase of γ-globulin more than 25-30 g / l. e) uvelechenie direct bilirubin e) uvelechenie prothrombin index
a) the long latency period of the disease b) acute onset a) the relevant history of life (alcohol abuse) d) clinical and biochemical parameters, typical for cirrhosis of the liver is characterized by: a) Ascites b) spider veins c) the veins of the esophagus g) hyperfibrinogenemia e) giperalbunemiya e) alkaline phosphatase
a) liver failure b) bleeding from esophageal varices c) violation of the atrioventricular conduction g) encephalopathy d) hyperglycemia e) left bundle branch block
a) stubborn itchy skin b) jaundice c) xanthelasma g) reduction of alkaline phosphatase e) normal levels of cholesterol e) reduction of cholesterol
a) in the rejection of alcohol b) the exclusion of hepatotoxic drugs c) does not pass medical check-up g) controlling periodic biochemical liver function tests e) androgen e) The use of corticosteroids
a) drugs rauvolfii a) a salt-free diet b) veroshpiron c) furosemide g), calcium channel blockers f) iron supplements
a) to hypoalbuminemia c) a venous thrombosis g) a pronounced hypotension d) to hypertension e) to arovotechenii of esophageal veins
a) anemia b) leukocytosis c) Thrombocytopenia g), leukopenia e) eosinophilia e) thrombocytosis
a) increase in ALT, AST b) bilirubinemia c) increasing the levels of alkaline phosphatase d) a significant increase in γ-globulin proteinogram e) increased cholesterol e) increased AST
a) jaundice appears in the early stages of the disease b) portal hypertension, liver failure, ahead of the functional c) liver failure occurs in the early stages of the disease d) the presence of star-telangiectasia, s aggressive hepatitis d) at similar acute persistent hepatitis, including biochemical parameters e) a sharp decline in prothrombin index
15. For hepatic coma is characterized by: a) severe hepatomegaly b) hemorrhagic syndrome c) "liver" Breath d) jaundice, neuropsychiatric symptoms, including a major tremor d) reducing the amount of bilirubin in the blood e) a high index of prothrombin 16. Name 3 causes of hepatic jaundice? a) acute viral gepatit073. List the three biochemical parameters in enterocolitis? a) an increase of fibrinogen b) reducing the ESR c) the occurrence of C-reactive protein d) increase of alpha 2 globulin e) increases unbound bilirubin e) an increase in bilirubin 17. The following judgments concerning alcoholic fatty liver disease are true except: a) is completely reversible in the case of abstinence from alcohol b) shows the prednisolone c) is accompanied by an increase in liver d) an increase in acid phosphatase d) is accompanied by increased activity of transaminases e) The good performance of cytostatics
1.2.2 Graphic Organizer: "fishbone" 1.2.3 Allows one to describe the whole range of (field) problems and try to solve it. Develops and activates the system, creative, analytical thinking. Acquainted with the rules of construction of the scheme. Individually in pairs recorded on the top of "bone" formulation for sub-problems and on the bottom - is evidence that these sub-problems exist. Together in small groups, compare and complement their schemes. Reduce the overall scheme. Presentation of the results: the presentation of the completed scheme to demonstrate the relationship of sub, their complex nature. "Fish’s bone" on theme: hepatomegaly. Possible reasons for the formation of liver cirrhosis autoimmune hepatitis Vascular lesions of the liver Viral hepatitis B, C, D biliary diseases ways Medicinal liver Cryptogenic cirrhosis Alcoholc liver Metabolic liver disease 4.3. The practical part The list of skills that GPs should possess after completing training on the subject 1. Perform a visual inspection of patients with hepatitis. 2. Interpret laboratory and instrumental in patients with hepatomegaly. Pain in the epi-, meso-and gipogastralnoy areas
• In writing • The decision of situational problems • Demonstration of practical skills mastered 5. 1. Criteria for evaluation of knowledge and skill to practical skills of students.
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