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5 year examination card

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Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №1
The patient of 30 years old was admitted to the infectious hospital on the 9th
day of the disease with complaints of weakness, headache, nausea, increase of the
temperature up to 39.3C, constipations. The onset of the disease was gradual.
Weakness, increase of the temperature, decreased appetite and headache were
marked.
Objectively: the condition of the patient is severe. The dermal integuments are
pale. The tongue is coated by white fur. The peripheral lymphatic nodules are no
palpated. The pulse rate is 72 beats per minute, rhythmical. Heart sounds are muffled.
On percussion of the lungs a clear sound is determined. The respiration is harsh. The
rales are absent. The abdomen is soft, painless on palpation. The liver is below rib
arch by 2 cm, painless. The spleen is no palpated. There are four pale roseolas on the
skin of the abdomen. Stool is absent for 3 days. Diuresis is preserved. Meningeal
sings are no determined.
Tasks:
1. What is the preliminary diagnosis?
2. What are materials for research and methods of the laboratory diagnostics for
confirmation of diagnosis?
3. What etiotropic and pathogenetic therapy should be administered?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №2
The patient of 47 years old is present in the infectious hospital due to typhoid
fever. The diagnosis was confirmed by isolation of hemoculture. The patient was
treated with chloramphenicol on scheme. The condition of the patient was worsened
on the 14th of the disease. The temperature decreased critically up to 36.0ºС. The
weakness was intensified. There is no vomiting and nausea.
Objectively: the condition of the patient is extremely severe. Expressed
paleness of the dermal integuments is marked. The face is pinched. The tongue is
moist, coated by white fur. The pulse rate is 120 beats per minute, rhythmical. Heart
sounds are dull. Systolic hum is heard on the apex of the heart. On percussion of the
lungs clear respiratory sound is determined. The respiration is harsh. The rales are
absent. The stomach is soft. It takes part in the act of the respiration actively,
painless. The symptoms of the irritation of the peritoneum are absent. The liver is
below rib arch by 2 cm. The spleen is no palpated. Stool was 1 time, glueled, without
pathological admixtures.
Tasks:
1. What is the cause of the worsening of the condition of the patient?
2. What researches are necessary to perform immediately?
3. What therapy should be administered for the treatment of the complication of
the main disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №3
A student of 20 years old, living in the hostel, was admitted to the infectious
hospital with complaints of increase of the temperature up to 39ºС, pains in the left
iliac area, fluid stool up to 20 times a day, scantly with admixtures of the mucus and
fibers of blood, tenesmus, “fecal urgency”. He fell ill acutely, when the temperature
increased up to 40ºС, chill, spastic abdominal pains, diarrhea developed. It was
established from epidemiological anamnesis that he drank unboiled milk bought at
the market.
Objectively: the condition of the patient is mild severe. The dermal
integuments are pale. The rash is absent. The peripheral lymphatic nodules are no
palpated. The tongue is moist, coated by white fur. Turgor of the skin is no changed.
The pulse is rhythmical. Heart sounds are muffled. On percussion of the lungs a clear
sound is determined. The rales are absent. The stomach is soft, painful in the left iliac
area. Spastic, painful and dense sigmoid is palpated. The liver and spleen are no
palpated. Diuresis is preserved.
Tasks:
1. What is the preliminary diagnosis?
2. What methods of the laboratory diagnostics are necessary to use for
confirmation of diagnosis?
3. What etiotropic and pathogenetic therapy should be administered with account
of the severity of the course of the disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №4
The condition of the patient is extremely severe. He fell ill 6 hours ago. The
frequent watery stool without pathological admixtures developed and then a vomiting
joined. There is no arising of the temperature.
Objectively: the face is pinched. The eyes are deeply sunken in the orbits. The
dermal integuments are pale and cyanotic. The tongue is dry. The dermal fold is no
smoothed. The muscular cramps of the upper and low extremities are marked
periodically. There is dyspnoe. The arterial pressure is no determined. Heart sounds
are dull. The lungs are without peculiarities. The abdomen is retracted. The liver and
spleen are no palpated. There is anuria. The temperature is 35.5ºС.
Tasks:
1. What is the preliminary diagnosis?
2. What is the degree of dehydration?
3. What are urgent measures to the patient?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases.
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №5
The patient of 35 years old complains of headache, increase of the temperature
up to 39C, pains in the muscles, especially in calf muscles. The onset of the disease
is an acute. The temperature increased up to 40C 6 days ago. The chill, headache
developed. There was high fever and nasal bleeding in the following days. It was
established that the patient went to fishing 2 weeks ago.
Objectively: the condition of the patient is severe. The dermal integuments and
scleras are icteric. There are injection of scleras and hemorrhagic rash on the skin.
The face is edematous. The pharynx is clear. The tongue is moist coated with white
fur. The pulse rate is 100 beats per minute, rhythmical. The arterial pressure is 110/70
mm Hg. Heart sounds are muffled. The lungs are without peculiarities. The abdomen
is soft, painless on palpation. The liver is below rib arch by 3 cm, painless. The
spleen is no palpated. A quantity of urine decreased to 300 ml per day. Meningeal
sings are no determined.
Tasks:
1. What is the preliminary diagnosis?
2. What changes of blood count are typical in this disease?
3. What are the main principles of the therapy of this disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №6
The woman of 28 years old fell ill 7 days ago, when weakness, decrease an
appetite, increase of the temperature up to 38ºС, a little cough developed. The
temperature decreased on the 3d day, nausea and periodical vomiting joined. Urine
became dark on the 5th day, jaundice developed. Epidemiological anamnesis: it was
established that the woman is teacher at school. Three schoolchildren fell ill with
jaundice.
Objectively: the condition of the patient is mild severe. The temperature is
36.6ºС. The dermal integuments and scleras are moderately icteric. The tongue is
coated by white fur. The peripheral lymphatic nodules are no palpated. The pulse rate
is 70 beats per minute, rhythmical. Heart sounds are muffled. The lungs are without
peculiarities. The abdomen is soft, painless on palpation. The liver is below rib arch
by 3 cm, painless. The spleen is no palpated. Stool is acholic. Urine is dark.
Tasks:
1. What is the preliminary diagnosis?
2. What researches are necessary to perform for confirmation of diagnosis?
3. What are the main principles of the therapy of this disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases.
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №7
The patient of 30 years old was admitted to the infectious hospital on the 6 th
day of the disease. The onset of the disease was gradual. The general weakness, rapid
fatigue, feeling of heaviness in the right hypochondium, subfebrile temperature,
decreased appetite developed. The vomiting was marked 2 times on the second day of
the disease. The dark urine and acholic stool developed on the 5th day of the disease.
Objectively on admission: the moderate yellowness of the skin and scleras is
marked. The pulse is rhythmical. Heart sounds are muffled. The lungs are without
peculiarities. The abdomen is soft, slightly painful in the right hypochondrium. The
liver is below rib arch by 3 cm, moderate density. Jaundice was intensified on the 14 th
day of the disease. The sleep in a day and sleeplessness at night, then excitement
developed. The pulse rate is 100 beats per minute. The temperature is subfebrile. The
liver diminished in the size considerably (on palpation it is no determined, on
percussion – near rib’s arch). Tender reflex are increased.
Tasks:
1. What is the preliminary diagnosis of the basic disease and complication?
2. What biochemical investigations are necessary to perform at first?
3. What are principles of the urgent therapy?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №8
The nurse of the surgical department was admitted to the infectious hospital with
complaints of nausea, vomiting, general weakness, subfebrile temperature, pains in the
joints. The disease began near 3 weeks. Icteric of scleras and dark urine developed 2
days ago.
Objectively: the condition of the patient is mild severe. Jaundice of the skin and
scleras is marked. The rash is absent. The peripheral lymphatic nodules are no
palpated. The pulse rate is 78 beats per minute, rhythmical. Heart sounds are muffled.
The lungs are without peculiarities. The abdomen is soft, moderately painful in the
right hypochondrium.. The liver is below rib arch by 3 cm. The spleen is no palpated.
Urine is dark. Stool is acholic .
Tasks:
1. What is the preliminary diagnosis?
2. What investigations are necessary to perform for confirmation of the diagnosis?
3. What are the principles of the therapy of this disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 9.
The patient of 25 years old, living at home, fell ill acutely 2 days ago. The
complaints of the patient are increase of the temperature up to 38.5С with chill,
severe headache, mainly in the area of the forehead marked pain in the movements of
eyeballs, dry cough.
Objectively: the condition of the patient is severe. The skin of his face and
conjunctiva are bloodshot. The dry cough developed. His throat is bloodshot, granular
enanthema and punctate hemorrhages are on the soft palate. The rash is absent. The
peripheral lymphatic nodules are no palpated. The pulse rate is 80 beats per minute,
rhythmical. Heart sounds are muffled. On percussion of the lungs a clear sound is
determined. The respiration is harsh. The rales are absent. The abdomen is soft,
painless on palpation. The liver and spleen are no palpated. Diuresis is preserved.
Stool is normal. Meningeal sings are no determined.
Tasks:
1.
What is the preliminary diagnosis?
2.
What are the principles of the therapy of this disease?
3.
What are possible complications of the disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseasesм
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD 10.
In admission to the hospital a woman of 26 years old complaints of high
temperature (39.5С), very strong headache, dizziness, repeated vomiting general
weakness. She fell ill 3 days ago, when the temperature increased up to subfebrile
figures. The pain in throat, catarrh developed. The temperature increased suddenly up
to 39,5С on the 3d day of the disease. Chill, vomiting developed. Headache
intensified. It is know from anamnesis that the patient had personal contact with
neighbor who also marked high temperature and catarrh.
In hospitalization the condition of the patients is extremely severe. The patient
is inert. There is a high fever. The dermal integument are pale. The plentiful
hemorrhagic “star-like” rash of the different form with necrosis in the centre is
marked. The pulse rate is 110 beats per minute. Arterial pressure is 95/60 mm Hg.
Meningeal sings are positive. In blood count: leukocytes – 25.5 10 9 /l, ESR – 48 mm
/ h.
Tasks:
1.
What is the preliminary diagnosis?
2.
What researches are necessary to perform for confirmation of diagnosis?
3.
What is urgent therapy?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 11.
The patient of 27 year old drug-addicts complaints of rapid fatigue, decrease of
the body mass, increase of the temperature up to 38.0°С for 1,5 months, diarrhea. He
found enlarged axillary lymphatic nodules 3 weeks ago.
Objectively: the temperature is 37,4°С. The dermal integuments are pale. The
rash is absent. The mucous membrane of stomatopharynx is pure. The enlarged
axillary, cervical, cubital, unquinal lymphatic nodules are palpated. The pulse rate is
98 beats per minute, rhythmical. Heart sounds are muffled. On percussion of the
lungs a clear sound is determined. The respiration is harsh. The rales are absent. The
abdomen is soft, painless on palpation. The liver is below rib arch by 3 cm, painless.
The spleen is no palpated. In blood count thrombocytopenia, lymphopenia,
eosinophilia are revealed.
Tasks:
1. What is the preliminary diagnosis?
2. What investigation is necessary to perform on the first stage?
3. What preventive measures are necessary to perform in the taking of material
from the patient?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 12.
A women of 40 years old complaints of moderate pain in the throat, increase of
the temperature up to 38°C. She fell ill 2 days ago.
Objectively: the patient is inert. She answers to questions hardly. The dermal
integuments are pale. The rash is absent. The moderate hyperemia of the mucous
membrane of the stomatopharynx with cyanotic tint is marked. The tonsils are
edematous. There is filmed coat on the left tonsil, it is taken out hardly. The
lymphatic nodules are enlarged, moderately dense and lightly painful. The pulse rate
is 100 beats per minute, rhythmical. The arterial pressure is 120/60 mm Hg. Heart
sounds are muffled. On percussion of the lungs a clear sound is determined. The
respiration is vesicular. The liver and spleen are no palpated. Diuresis is preserved.
Tasks:
1. What is the preliminary diagnosis?
2. What methods of the laboratory diagnostics are necessary to perform for
confirmation of diagnosis?
3. What is the main method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №13
The patient of 30 years old was admitted to the infections hospital in severe
conditions with assumed diagnosis typhus-paratyphoid disease. He fell ill acutely.
Chill, the temperature 39,5С, headache, pains in the muscles of the extremities
developed. The temperature decreased suddenly. The decrease of the temperature was
accompanied by sweating. The repeated increase of the temperature was marked in a
day with chill.
Epidemiological anamnesis: the patient works as mechanic of the ship. At the
last time attended the row of the ports of Eastern Africa.
Objectively: the patient is inert. The dermal integuments and mucous
membranes are subicteric, dry. The peripheral lymphatic nodules are no palpated.
The pulse rate is 84 beats per minute, rhythmical. Arterial pressure is 110/60. Heart
sounds are muffled. On percussion of the lungs a clear sound is determined. The
respiration is harsh. The rales are absent. The abdomen is soft, painless on palpation.
The liver is below rib arch by 4 cm, painless. The spleen is below rib arch by 2 cm.
Meningeal sings are no determined.
Tasks:
1.
What is the preliminary diagnosis?
2.
What research is necessary to perform at first?
3.
What therapy should be administered?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №14.
The patient of 46 years old fell ill 2 days ago, acutely. At first the pains in the
epigastria area, watery stool 2 times a day without pathological admixtures, vomiting
developed. At the next day the patient marked decrease of the vision, doubling in his
eyes (diplopia), thirst and dryness in the mouth. The vomiting is no repeated. Stool is
absent. Epidemiological anamnesis: the day before he took homemade canned
mushrooms.
Objectively: the condition of the patient is severe. The dermal integuments are
pale. The rash is absent. The tongue is dry. The voice is hoarse. The speech is
inaudible. There is disorder of swallows. The pupils are widening. The reaction to the
light is weak. The pulse rate is 54 beats per minute, rhythmical. Heart sounds are dull.
The lungs are without peculiarities. The abdomen is inflated, slightly painful in the
epigastria area on palpation. The liver and spleen are no palpated. Diuresis is
preserved.
Tasks:
1. What is the preliminary diagnosis?
2. What are the main principles of the treatment?
3. What is urgent therapy?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №15
A woman of 50 years old was addressed to the hospital with complaints of
increase of the temperature up to 38,5С, painful of the occipital muscles, cramps of
the muscles in the area of the low jaw. She fell ill 3 days ago, when headache,
increase of the temperature up to 38С, sweating developed. Epidemiological
anamnesis: there was a wound of the foot in a work in the country. She didn’t address
to doctor.
Objectively: there is sardonic smile on the face. The patient opens the mouse
hardly. The pulse rate is 100 beats per minute, rhythmical. Heart sounds are clear. On
percussion of the lungs a clear sound is determined. The respiration is harsh. The
rales are absent. The abdomen is retracted. The rigidity of the occipital muscles is
determined. Kerning’s symptom and Brudzinsky’s symptom are negative.
Tasks:
1. What is the preliminary diagnosis?
2. What is the main method of specific therapy?
3. What are methods of specific prophylaxis?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №16
The woman of 25 years old was admitted to the infectious hospital on the 6 th
day of the disease with complains of headache, chill, pains in the left hypogastrium.
The onset of the disease is an acute. The chill developed. The temperature increased
up to 39.9C. The temperature decreased up to 37.2C in 8 hours. At the next day the
chill repeated the temperature arose again up to 40C.
Epidemiological anamnesis: the patient came back from Congo 11 days ago.
Objectively: the dermal integuments are pale. The rash is absent. The
stomatopharynx is clean. The tongue is moist, coated by white fur. The peripheral
lymphatic nodules are no palpated. The pulse rate is 100 beats per minute,
rhythmical. Heart sounds are muffled. The lungs are without peculiarities. The
abdomen is soft, painful in the left hypogastrium on palpation. The liver is below rib
arch by 2 cm, painful. The spleen is below rib arch by 1 cm. Meningeal sings are no
determined.
Tasks:
1. What is the preliminary diagnosis?
2. What research is necessary to perform at first?
3. What therapy should be administered?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №17
The patient of 22 years old complains of weakness, headache, decrease of
appetite, heaviness in epigastrium area, periodical spastic pains in the low part of the
abdomen, watery scantly stool. Stool is getting a kind of raspberry-jelly. The
temperature is 37.5C. He had been sick more than 1 month. The patient came back
from Ethiopia 2 months ago.
Objectively: the condition of the patient is mild severe. There is
undernourishment in the patient. The dermal integuments are pale. The
stomatopharynx is clean. The rash is absent. The tongue is coated by white fur. The
peripheral lymphatic nodules are no palpated. The pulse rate is 78 beats per minute,
rhythmical. Heart sounds are muffled. The lungs are without peculiarities. The
abdomen is soft, painful in right iliac area on palpation. The liver is below rib arch by
1 cm, painful. The spleen is no palpated. Meningeal sings are no determined.
Tasks:
1. What is the preliminary diagnosis?
2. What is the principal method of diagnostics?
3. What therapy should be administered?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №18
The patient of 42 years old, citizen of Sudan, complains of weakness, pains in
the right hypogastrium, who are intensified in deep respiration, increase of the
temperature up to 39C and more for 2 weeks. The fever is accompanied by chill. In
decrease of the temperature the plentiful sweating is observed. He had been sick for 2
years. The watery stool with mucus is marked periodically. There is loss of weight.
Objectively: the patient is inert. There is undernourishment in the patient. The
face is pinched. Turgor of the skin is decreased. The peripheral lymphatic nodules are
no palpated. The pulse rate is 100 beats per minute, rhythmical. The arterial pressure
is 100/60 mm Hg. Heart sounds are dull. The lungs are without peculiarities. The
abdomen is moderately inflated, painful in the right hypogastrium on palpation. The
liver is below rib arch by 8 cm, painful. Tumor-like formation till 10 cm is palpated
on the surface of the liver. The spleen is no palpated. Diuresis is preserved. In the
blood count marked leukocytosis, neutrophillosis with deviation to the left, ESR 30
mm/h are determined.
Tasks:
1. What is the preliminary diagnosis?
2. What is the principal method of examination?
3. What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №19
The patient 20 years old was admitted on the 5th day of the disease. Vomiting (45 times), plentiful stool up to 10 times, chill, spastic pain in the epigastrium
developed suddenly at night. Objectively: temperature is 39C. The general condition
is serious. The face is pinched. The pale skin, cyanosis of nasal-mouth triangle and
fingers of the hands and toes of the legs, cramp of calf muscles are marked. Cardiac
sounds are dull. Рulse rate is 120 beats her minute, weak. Blood pressure is 80/40
mm Hg. The breathing is vesicular. The stomach is inflated, painful in the
epigastrium. The liver and spleen are without alterations. The day before the patient
took meat-jelly.
Tasks:
1. What is the preliminary diagnosis?
2. What is the principal method of examination?
3. What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №20.
The patient of 30 years old complaints of increase of the temperature up to
39C, pain in the left inguinal area. He fell ill 10 hours ago. The onset of the disease
is an acute.
Objectively: the condition of the patient is severe. The dermal integuments are
pale. The rash is absent. The stomatopharynx is clean. The tongue is coated by white
fur. The painful lymphatic node is determined is the left inguinal area with
periadenitis. The skin over lymphatic node is red and glistening. The pulse rate is
100 beats per minute, rhythmical. Heart sounds are dull. The lungs are without
peculiarities. The abdomen is soft, painless on palpation. The liver and the spleen are
no palpated. Stool is absent for 2 days. Diuresis is preserved.
Tasks:
1. What is the preliminary diagnosis and what is the form of the disease?
2. What are the methods of diagnostics?
3. What are more effective remedies of etiotropic therapy?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №21.
The patient, citizen of Pakistan, complaints of weakness, watery stool, thirst.
He fell ill 8 hours ago. The rapid watery stool developed, then vomiting joined. Stool
was getting a kind of rice water-like. The temperature is not increased.
Objectively: the condition of the patient is severe. The voice is hoarse. The
face is pinched. The eyes are deeply sunken in the orbits. The tongue is dry.
The muscular cramps of the upper and low extremities are marked periodically.
The pulse rate is 120 beats per minute, threading, rhythmical. Heart sounds are dull.
The arterial pressure is 60/40 mm Hg. The lungs are without peculiarities. The
abdomen is retracted. The liver and the spleen are no palpated. Diuresis is decreased.
Tasks:
1. What is the preliminary diagnosis? What is degree of dehydration?
2. What nutritive medium is used for feci culture?
3. What is the main method of therapy?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №22.
The patient of 39 years old complaints of chill who is changed by heat,
increase of the temperature, then sweating in 6 hours. He fell ill acutely 6 days ago.
The temperature increased up to 39C, headache, pains in muscles and joints were
marked. The increase of the temperature is marked every 48 hours.
Epidemiological anamnesis: the patient was in Africa for 3 months. He came
back 2 weeks ago.
Objectively: there is reddening of the face, glistening of the eyes. The
temperature is 40C. The rash is absent. The tongue is moist, coated by white fur.
Peripheral lymphatic nodules are no palpated. The pulse rate is 100 beats per minute,
rhythmical. Heart sounds are muffled. The lungs are without peculiarities. The
abdomen is soft, painless on palpation. The liver is below rib arch by 1.5 cm,
painless. The spleen is below rib arch by 1 cm, painful. Stool is normal. Diuresis is
preserved. Meningeal sings are no determined.
Tasks:
1. What is the preliminary diagnosis?
2. What research is necessary to perform at first?
3. What therapy should be administered?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №23.
The patient of 32 years old was admitted to the clinic on the 9 th day of the disease
with complaints of chill, sweat, headache, bad appetite. The disease began acutely
with chill, high temperature (39C), spastic pains in the epigastrium, nausea,
vomiting 4-5 times, watery plentiful stool 8-10 times per day. He did not consult a
doctor. Objectively: the temperature is 39,5C. the temperature fluctuations were
from subfebrile till high (39-40C). It is accompanied by chill and sweat. Dermal
integuments are pale, yellowish. The tongue is dry, coated whit thick white fur. The
borders of heart are extended to the left by 1,5 cm. Cardiac sounds are dull. The
pulse rate is 120 beats per minute, rhythmical, of satisfactory fillings. Blood pressure
is 100/60 mm Hg. The respiration is vesicular. The stomach is lightly inflated. The
spleen is enlarged by 1,5 cm. The liver is enlarged by 1,5 cm. Stool is watery
without mucus and blood. Blood analysis: Нв-150, L-25,2х109 g/l E-0%, B-23 % S57%, L-15%, М-5%. ESR-45 mm /h.
Tasks:
1. What is the preliminary diagnosis?
2. What is the principal method of examination?
3. What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №24.
The patient of 24 years old was admitted with complaints of increase of the
temperature up to 37,2-38,0C, weakness, stool 2-3 times a day without pathological
admixtures, loss of the body mass. He has been sick for 5 months. He didn’t address
to the doctor.
Objectively: there is undernourishment in the patient. The dermal integuments
are pale. The rash is absent. On the skin of forearm there are plural sings from
injections. The patient is drug addict. The cervical, subaxillary peripheral lymphatic
nodules are enlarged, painful on palpation. The pulse rate is 98 beats per minute,
rhythmical. Heart sounds are muffled. The lungs are without peculiarities. The
abdomen is soft, painless on palpation. The liver is below rib arch by 2 cm, painless.
The spleen is no palpated. Diuresis is preserved. Meningeal sings are no determined.
In the blood count: erythrocytes – 3.21012, hemoglobin – 100 g/l, leukocytes –
3.1109, lymphopenia.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №25.
The general state of the patient is extremely serious. He hardly answers
questions. His voice is hoarse. The dermal integuments are pale. The face is
pinched, eyes are deeply sunken in the orbits. The lips and finger-nails are cyanotic.
The tongue is dry. Scleras lack luster. The skin folds are not smoothed out. The pulse
is thready, blood pressure is not determined. The heart sounds are weak. The stomach
is retracted. Frequent cramps of the low extremities, coercible vomiting, watery stool
are observed. The body temperature is 35C.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №26.
. The patient of 72 years old was operated on for adenocarcinoma of the rectum
5 months ago. The condition improved considerably after radical operation. However,
weakness became to increase gradually 3 weeks ago. His appetite decreased.
Anorexia, nausea, poor sleep, arthralgia, feeling of heaviness in the right
hypochondrium, dark urine developed in one week. Then itching developed too. He
marked white stool and jaundice two days ago. The patient was directed to the
oncologic center. On examination: the signs of intoxication are clearly marked. The
abdomen is soft and painless on palpation. The liver is enlarged by 5 cm, firm. Its
borders are regular. The spleen is enlarged, soft. L-3,9109 g/l, ESR - 6 mm / hour.
Bilirubin of the blood is 60 mkmoll/l. АlАТ - 4,2 mmoll/l, thymol test - 8 un. The
high contents of HCV-RNA. Anti-HCV IgM (+).
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №27.
The patient of 16 years old was admitted to the infectious hospital on 9 th day of
disease. The disease began acutely with increase of the temperature to 38,5C, then
pains in the throat, weakness, headache developed. Objectively: temperature is
38,3C. The condition is of moderate severity. Slight jaundice of the skin and sclera
is marked. The tongue is coated with a little fur. Hyperemia of the pharynx and
tonsils, white fur in lacunas are observed. The cervical, axillary and inguinal
lymphatic nodules are enlarged. The pulse rate is 96 per minute. The cardiac sounds
are clear. The respiration is vesicular. The liver and spleen are enlarged. Urine is
darker than usual.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №28.
The patient was admitted to the hospital with complaints of high temperature,
sleeplessness, irritability, pain in the muscles, joints, loin, general weakness, marked
sweating on the second month of the disease. The disease developed gradually. The
general condition was slightly affected. The temperature has a wave-like character. It
is known from epidemiological anamnesis that the patient works on the cattlebreeding farm. The animal abortions have been observed on this farm for several
month. On examination: enlarged lymphatic nodules, hypotonia, small
hepatomegaly, tenderness of the hands and legs in active and passive movements are
revealed.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №29.
In the patient of 61 years old, pneumonia was diagnosed on the 5 th day of the
disease. She fell ill acutely. The patient complained of general weakness, fatigue,
headache, increase of the temperature to 38 - 39С. Hyperemia of the face is marked.
The tongue is coated, “stumbles” in pushing it out . There are single roseolas on the
lateral surfaces of the trunk. Tachycardia, signs of the left-side pneumonia are
revealed. The soft, painful spleen is palpated. It is known about epidemic typhus in
anamnesis.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №30.
The patient of 50 years old was admitted with complaints of acute abdominal
pains, vomiting, headache, frequent watery stool with blood. The patient’s condition
is grave. The temperature is 40C. the skin is cyanotic. The pulse is 130, thready, BP70/40 mm Hg. The stomach is soft, painless. The liver is enlarged by 1 cm, spleen – 2
cm. The rumbling is marked in the stomach. Pasternatsky symptom is positive. It was
known that the patient had eaten beef the day before. The meat of the cow was taken
without veterinary control. Carbuncle developed in 2 days.
1.
2.
3.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №31
The patient of 21 years old was admitted to the hospital on the 7 th day of the
disease with complaints of weakness, pain in the muscles and joints, headache,
nausea. The disease began with a sore throat, catarrh, general weakness. He didn’t
take the temperature. The condition has worsened for the last two days. The
weakness, pain in the muscles increased. Objectively: the temperature is 37,5C, the
condition is extremely grave. The dermal integuments are pale. The lips and phalanx
nails are cyanotic. The hemorrhagic rash is marked on the skin of extremities and
buttocks. The heart borders are extended to the left by 1,5 cm. The sounds are dull.
The pulse rate is 130 beats per minute, of weak filling, rhythmical, BP – 80/40 mm
Hg. There are manifestations of pharyngitis with purulent coats. The cervical
lymphatic nodules are enlarged. The stomach is painless. The liver and spleen are not
enlarged. Meningeal signs are determined. The patient is adynamic. The
consciousness is preserved.
1.
2.
Tasks:
What complication is the cause of the severity of the patient’s condition?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №32
The patient К. was admitted to the hospital on the 10 th day of the disease. He
marked pain in the ear, subfebrile temperature during the first 5 days. Then the
condition was worsened. The temperature increased up to 40 - 41С with daily
fluctuation in the 2 - 3С. The increase of the temperature was accompanied by chill
and plentiful sweating. Objectively: paleness, slight jaundice of the skin, pustular
rash on the body, enlarged liver and spleen were marked. Decreased hemoglobin,
leukocytosis, accelerated ESR developed.
1.
2.
Tasks:
What complication is the cause of the severity of the patient’s condition?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №33
The nurse fell ill on September 16. the general weakness, nausea, vomiting,
pain in the joints developed. On September 21 urine became dark, the skin became
icteric. She was hospitalized on September 21. Objectively: the condition is of
moderate severity. The temperature is 38,2С. The jaundice of the skin and mucous
membranes is expressed. The edge of the liver comes out by 3 cm lower the rib arch.
Hematomas at the sites of injections, single petechias, hepatic smell from the mouth,
edema of the feet and loin area developed on September 27. The liver is not palpated.
3.
4.
Tasks:
What complication is the cause of the severity of the patient’s condition?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №34
The patient of 52 years old fell ill acutely, when stiffness, impossibility to open
the mouth, painful cramps, temperature, dyspnea, sleeplessness developed. There
was the stab wound one day before the disease. The patient sought medical aid. The
condition is grave. His consciousness is preserved. The position in bed is passive.
The head is thrown back. The face is pinched. The mouth is stretched. The painful
cramps of the muscles with disorder of respiration, cyanosis developed every 10-15
minutes. The pulse rate is 120 beats per minute. The respiration rate goes up to 40 per
minute. There are crepitation, moist rales in the lower portion of the lungs on
auscultation and dullness on percussion. The temperature is 39,2С.
5.
6.
7.
Tasks:
What is the preliminary diagnosis?
What are the methods of the treatment?
What are prophylactic measures ?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseasesю
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD №35
A woman of 26 years old complains of bad headache, giddiness, vomiting,
weakness, increased temperature. She fell ill 3 days ago, when catarrh, pains in the
throat developed. Then the temperature suddenly increased up to 39,1С, chill, bad
headache, vomiting arose. She lives at the hostel. The neighbor was sick with
nasopharyngitis. The condition of the patient is grave. There is plentiful hemorrhagic
rash of the different sizes, star-like on the buttock,thighs, upper extremities. The
pulse rate is 110 beats per minute. Blood pressure – 95/60 mm Hg. Meningeal signs
are absent. In the blood count: leukocytosis is 25,3*10 9 g/l with formula deviation at
the expense of neutrophils, ESR is 48 mm / h.
4.
5.
8.
Tasks:
What is the preliminary diagnosis?
What is the principal method of examination?
What is the principal method of the treatment?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 36
The patient of 47 years old is present in the infectious hospital due to typhoid
fever. The diagnosis was confirmed by isolation of hemoculture. The patient was
treated with chloramphenicol on scheme. The condition of the patient was worsened
on the 14th of the disease. The temperature decreased critically up to 36.0ºС. The
weakness was intensified. There is no vomiting and nausea.
Objectively: the condition of the patient is extremely severe. Expressed
paleness of the dermal integuments is marked. The face is pinched. The tongue is
moist, coated by white fur. The pulse rate is 120 beats per minute, rhythmical. Heart
sounds are dull. Systolic hum is heard on the apex of the heart. On percussion of the
lungs clear respiratory sound is determined. The respiration is harsh. The rales are
absent. The stomach is soft. It takes part in the act of the respiration actively,
painless. The symptoms of the irritation of the peritoneum are absent. The liver is
below rib arch by 2 cm. The spleen is no palpated. Stool was 1 time, glueled, without
pathological admixtures.
Tasks:
4. What is the cause of the worsening of the condition of the patient?
5. What researches are necessary to perform immediately?
6. What therapy should be administered for the treatment of the complication of
the main disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 37
A student of 20 years old, living in the hostel, was admitted to the infectious
hospital with complaints of increase of the temperature up to 39ºС, pains in the left
iliac area, fluid stool up to 20 times a day, scantly with admixtures of the mucus and
fibers of blood, tenesmus, “fecal urgency”. He fell ill acutely, when the temperature
increased up to 40ºС, chill, spastic abdominal pains, diarrhea developed. It was
established from epidemiological anamnesis that he drank unboiled milk bought at
the market.
Objectively: the condition of the patient is mild severe. The dermal
integuments are pale. The rash is absent. The peripheral lymphatic nodules are no
palpated. The tongue is moist, coated by white fur. Turgor of the skin is no changed.
The pulse is rhythmical. Heart sounds are muffled. On percussion of the lungs a clear
sound is determined. The rales are absent. The stomach is soft, painful in the left iliac
area. Spastic, painful and dense sigmoid is palpated. The liver and spleen are no
palpated. Diuresis is preserved.
Tasks:
4. What is the preliminary diagnosis?
5. What methods of the laboratory diagnostics are necessary to use for
confirmation of diagnosis?
6. What etiotropic and pathogenetic therapy should be administered with account
of the severity of the course of the disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 38
The condition of the patient is extremely severe. He fell ill 6 hours ago. The
frequent watery stool without pathological admixtures developed and then a vomiting
joined. There is no arising of the temperature.
Objectively: the face is pinched. The eyes are deeply sunken in the orbits. The
dermal integuments are pale and cyanotic. The tongue is dry. The dermal fold is no
smoothed. The muscular cramps of the upper and low extremities are marked
periodically. There is dyspnoe. The arterial pressure is no determined. Heart sounds
are dull. The lungs are without peculiarities. The abdomen is retracted. The liver and
spleen are no palpated. There is anuria. The temperature is 35.5ºС.
Tasks:
4. What is the preliminary diagnosis?
5. What is the degree of dehydration?
6. What are urgent measures to the patient?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases.
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 39
The patient of 35 years old complains of headache, increase of the temperature
up to 39C, pains in the muscles, especially in calf muscles. The onset of the disease
is an acute. The temperature increased up to 40C 6 days ago. The chill, headache
developed. There was high fever and nasal bleeding in the following days. It was
established that the patient went to fishing 2 weeks ago.
Objectively: the condition of the patient is severe. The dermal integuments and
scleras are icteric. There are injection of scleras and hemorrhagic rash on the skin.
The face is edematous. The pharynx is clear. The tongue is moist coated with white
fur. The pulse rate is 100 beats per minute, rhythmical. The arterial pressure is 110/70
mm Hg. Heart sounds are muffled. The lungs are without peculiarities. The abdomen
is soft, painless on palpation. The liver is below rib arch by 3 cm, painless. The
spleen is no palpated. A quantity of urine decreased to 300 ml per day. Meningeal
sings are no determined.
Tasks:
4. What is the preliminary diagnosis?
5. What changes of blood count are typical in this disease?
6. What are the main principles of the therapy of this disease?
Head of the department, professor ______________ T.V. Chaban
Odessa National Medical University
Department of the infectious diseases
Educational qualification level- "specialist"
Specialty – " Medicine" 222
Academic discipline – «Infectious diseases»
EXAMINATION CARD № 40
The woman of 28 years old fell ill 7 days ago, when weakness, decrease an
appetite, increase of the temperature up to 38ºС, a little cough developed. The
temperature decreased on the 3d day, nausea and periodical vomiting joined. Urine
became dark on the 5th day, jaundice developed. Epidemiological anamnesis: it was
established that the woman is teacher at school. Three schoolchildren fell ill with
jaundice.
Objectively: the condition of the patient is mild severe. The temperature is
36.6ºС. The dermal integuments and scleras are moderately icteric. The tongue is
coated by white fur. The peripheral lymphatic nodules are no palpated. The pulse rate
is 70 beats per minute, rhythmical. Heart sounds are muffled. The lungs are without
peculiarities. The abdomen is soft, painless on palpation. The liver is below rib arch
by 3 cm, painless. The spleen is no palpated. Stool is acholic. Urine is dark.
Tasks:
4. What is the preliminary diagnosis?
5. What researches are necessary to perform for confirmation of diagnosis?
6. What are the main principles of the therapy of this disease?
Head of the department, professor ______________ T.V. Chaban
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