internal state 3

54問 • 1年前

問題一覧

A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 20. Define the stage of chronic kidney disease:

Stage 4- severe loss of kidney function

A middle aged man consulted a local general practitioner complaining of dryness,thirst, polyuria, blurred vision. He thinks that he is ill for 2 years. He did not follow the diet. Self-monitoring of glycemia was not performed. What disease would you suspect:

diabetes mellitus type 2

A young male patient has thirst, polyuria, general weakness, blood sugar level of 17 mmol/l, level of ketones in the urine is 3 mmol/l. The type of diabetes the patient has:

diabetes mellitus type 1

A middle-aged obese woman has a fasting glycaemia of 9.7 mmol/l, HbA1c- 8%, in urine - no detectable acetone. Patient's sibling has diabetes mellitus. Type of diabetes in the patient:

diabetes mellitus type 2

A young man has been suffering from type 1 diabetes for several years. He receives insulin. A few days ago he fell ill with the flu and developed pneumonia. The condition is accompanied by a fever. GP's tactic:

increase the dose of insulin

In a patient who has had a chronic illness for many years, laboratory tests: Glycemic profile: fasting glycemia - 9.0 mmol / l, postprandial - 12 mmol / l. Biochemical blood test: Total cholesterol - 6.9 mmol / L, creatinine - 101 μmol / l HDL- 1.0 mmol / L. Urine analysis: Color – yellow, Specific gravity - 1.021 g / l, Glucose – present, Erythrocytes – 1, Leukocytes – 3, GFR - 70.9 ml / min, albuminuria - 102 mg / day. Preliminary diagnosis:

diabetes mellitus type 2. diabetic nephropathy

Fasting plasma glucose – 6 mmol/L, 2-h plasma glucose – 8 mmol/L, HbA1c – 6%. Which condition is characterized by these data:

prediabetes

Fasting plasma glucose – 6,5 mmol/L, 2-h plasma glucose – 9 mmol/L, HbA1c – 6,2%. Which condition is characterized by these data:

prediabetes

Fasting plasma glucose – 5,9 mmol/L, 2-h plasma glucose – 10 mmol/L, HbA1c – 6,4%. Which condition is characterized by these data:

prediabetes

Biochemical test: Free T4 – 0,046 ng/dL (0.9–1.7 ng/dL), TSH – 100 µlU/ml (0.4–4.0 μU/mL), antiTPO antibodies – 1160/ml. Which state is characterized by these data:

Hyporthyroidism

Nervousness, anxiety, increased perspiration, heat intolerance. hyperactivity, palpitations, tachycardia or atrial arrhythmia, systolic hypertension with wide pulse pressure, warm, moist, smooth skin, lid lag or lid retraction (delay in lowering the upper eyelid when looking down), stare (goggle), hand tremor, muscle weakness, weight loss despite increased appetite. Which condition is characterized by these signs and symptoms:

Hyperthyroidism

Fatigue, loss of energy, lethargy, weight gain, decreased appetite, cold intolerance, dry skin, hair loss, sleepiness, muscle pain, weakness in the extremities, emotional lability, mental impairment, forgetfulness, impaired memory, inability to concentrate, constipation, menstrual disturbances, impaired fertility, decreased perspiration, paresthesia and nerve entrapment syndromes, blurred vision, decreased hearing, fullness in the throat, hoarseness. Which condition is characterized by these signs and symptoms:

Hyporthyroidism

Elevated TSH with decreased T4 or elevated TSH with normal free T4. Which condition is characterized by these signs and symptoms:

Hyporthyroidism

A middle-aged female complained of nervousness, mood swings, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating. She used oral contraceptives and her menstrual periods were regular. Pulse is 92/minute and BP is 130/60. She appeared anxious, with a smooth, warm, and moist skin, a fine tremor. Thyroid gland was diffusely enlarged, soft, mobile, without nodularity and there was no lymphadenopathy. Her eyes were not prominent (pyroptotic) and she had no focal skin thickening. Your further tactics:

prescribe thyroid function tests

A middle-aged female complains of progressive weight gain of 20 pounds in 1 year, fatigue, slight memory loss, slow speech, dry skin, constipation, and cold intolerance. Physical examination: Vital signs include a temperature 96.8oF, pulse 58/minute and regular, BP 140/100. She is moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. The thyroid gland is slightly enlarged, firm, not nodular, mobile, and not tender. The deep tendon reflex time is delayed. Which condition is characterized by these signs and symptoms:

Hyporthyroidism

TSH: 6.1 μU/mL (0.4–4.0 μU/mL), Free T4: 0.4 ng/dL (0.9–1.7 ng/dL ), Free T3: 56 ng/dL (100–200 ng/dL). Which state is characterized by these data:

Primary hypothyroidism

Patient is a juvenile. His analyses: Free thyroxine (FT4)- 2.87 ng/dL (prepubertal 0.73-1.77 pubertal/adult 0.73-1.84), Total triiodothyronine pediatric (T3)- 374.00 ng/dL (123-211), Thyroid-stimulating hormone (TSH) <0.018 uU/ml, Thyroxine (T4)- 18.2 ug/dL (5.0-12.0), Antithyroglobulin antibodies >3000 IU/ml (Negative <60 IU/mL Equivocal 60-100IU/mL Positive >100 IU/mL), Antithyroid peroxidase antibodies - 2667 IU/mL (<60) Anti-TSH receptor antibodies- 69.6 % Inhibit. (<=16.0 Unit: %). Which condition is characterized by these signs and symptoms:

Hyperthyroidism

A middle-aged woman turned to the district therapist with complaints of heartburn, pain behind the sternum, appearing after eating and physical exertion. She also notes an increase in pain when bending and in a horizontal position. It is known from the anamnesis that heartburn has been bothering for about 20 years. She was not examined. The last 2 months, there were data of pain behind the sternum. What disease can be suspected:

GERD

Analysis of gastric juice: basal secretion of hydrochloric acid flow rate0.8 mmol, stimulated secretion-1.2 mmol. PH-metric: The pH in the body department is 7.2; The pH in the antrum is 7.7; there is no reaction after histamine stimulation. Gregersen's reaction is negative. Antibody testing: Determination of antibodies in the blood to parietal cells of the stomach. X-ray -the pronounced smoothness of the mucosal folds, the large curvature of the stomach at the level of the scallop line is determined. EGD -the esophagus is not changed. The cardia closes. There is a moderate amount of fluid and mucus in the stomach. The folds of the mucosa are not thickened. The gastric mucosa is pink, spotted. The duodenal mucosa is not changed. Helicobacter was not detected in smears-prints obtained from biopsies.What is the likely diagnosis:

Type A gastritis

EGD data: the esophagus is freely passable, the mucous membrane is not changed, the cardiac pulp is closed. The stomach is of normal shape and size. The mucous membrane is hyperemic, folds of the usual shape and size, in the cardiac section along the greater curvature, an ulcerative defect of 1.0-1.5 cm is determined, with smooth edges, shallow, the bottom is covered with fibrin. The duodenal bulb is of normal shape and size, the mucous membrane is pale pink. Revealed Helicobacter pylori. What is the likely diagnosis:

Peptic ulcer, exacerbation stage, HP-associated

A middle-aged woman presented to an outpatient clinic with complaints of general weakness and aching lower back pain on the right side. Two hours ago she had an attack of right-sided renal colic accompanied by fever, chills, followed by a rapid decrease in temperature, sweating and disappearance of lower back pain. On examination, the tapping symptom is weakly positive on the right side, the kidneys are not palpated, urination is not disturbed, the urine is clear, and the body temperature is 37.2 C. The doctor's tactics in this case include:

urgent hospitalization

A middle-aged woman complained of frequent and painful urination, right lumbar pain, turbid urine and a body temperature of 37.6°C. Medical history: The patient first experienced these symptoms 10 years ago during pregnancy. Antibacterial therapy was administered in a hospital, childbirth - without complications. No exacerbation of the disease was observed subsequently. Condition worsened 5 days ago after hypothermia. Objectively: state of moderate severity. Skin of usual colour, no peripheral oedema. Peripheral lymph nodes are not enlarged. Thorax is of normal shape. Respiratory rate is 20 per minute. Breathing in the lungs is vesicular. Borders of relative cordial dullness are within normal limits. Heart tones are muffled, rhythm is correct. Heart rate - 90 per minute. BP - 140/90 mm Hg. The abdomen is soft and painless. The liver is at the edge of the rib cusp. The tapping symptom is positive on the right side. CBC: Hb- 118 g/l, RBC 4.0×1012/l, WBC 14.0×109/l, eosinophils - 1%, stab neutrophils - 10%, segmented neutrophils - 65%, lymphocytes - 20%, monocytes - 4%, platelets - 200.0×109/l, ESR - 24 mm/h. Biochemical blood test: creatinine - 0.08 mmol/l, urea - 6.5 mmol/l. Urine test: specific gravity - 1010, protein - 0.07 mg/l, acidic reaction, leukocytes - 15-20, erythrocytes - 0-1. Renal ultrasound: kidneys of normal shape and size. The renal tubular-pelvic system is deformed and thickened. No concrements. What diagnosis is more likely:

pyelonephritis

An adolescent girl came to an outpatient clinic with complaints of fever, pain in the lumbar region, more on the right side, of moderate intensity. She had been ill for 5 days, after hypothermia she had frequent urination, on the 6th day her temperature rose to 39°C, chills, headache, but no catarrhal symptoms. Past medical history: she had frequent acute respiratory infections, had rachitis as a child, received a course of iron drugs due to mild anaemia. No abnormalities in urine tests. On admission: Condition, moderate severity. The girl was lethargic and had a fever up to 38.8 ° C. Malnutrition. Skin is pale, shadows under the eyes, no edema. Auscultation of the lungs is vesicular, no rales. Heart sounds are rhythmic and sonorous. Heart rate - 120 p/m. Tapping symptom is positive on the right side. The liver and spleen are not palpable. BP - 90/50 mmHg. Urination is not difficult, painless. Urine is cloudy. The stools are clear. CBC: Hb - 104 g/l; RBC - 4.0×1012/l; blood clots- 420×109 /l; WBC - 18.5×109 /l, ESR-37 mm/hour. Urine test: colour - yellow, transparency - turbid, reaction - neutral, specific gravity - 1011, protein - 0.2 g/l., WBC- a lot, RBL - 12-15, bacteria - a lot; mucus - a lot. Biochemical blood test: total protein - 72 g/l; albumin - 40 g/l; urea - 5.4 mmol/l; creatinine - 54 µmol/l; CRP - 15 g/l. Ultrasound: The kidneys are typically located, slightly enlarged in size: left -78×38×32 mm; right -77×36×30 mm. Parenchymal layers are not clearly differentiated. The calyx-pelvic system was without deformities and ectasia. The right pelvis wall is thickened. The bladder wall is not thickened. Diagnosis and tactics:

Acute glomerulonephritis, hospitalisation

A middle-aged man complains of an increase BP 220/120 mm Hg. Headaches, palpitations, interruptions in the heart, nausea, dry mouth, itching of the skin. Considers himself a patient for about 15 years, when edema appeared under the eyes, during an outpatient examination, the presence of protein and erythrocytes in the urine were revealed. During the last year, he began to notice headaches, dizziness, which the patient associated with an increase BP 190/110 mm Hg. He did not receive permanent antihypertensive therapy. A month ago, nausea, a tendency to diarrhea appeared, and 2 weeks ago, itching of the skin covers. Examination:The general condition is severe. The skin is pale, dry, puffiness of the face, pasty feet, legs, anterior abdominal wall. BP - 220/120 mm Hg. The apical impulse is displaced 1 cm to the left of the left midclavicular line. Heart sounds are muffled, the rhythm is incorrect (5-7 extrasystoles per minute), I tone is weakened above the apex, base of the xiphoid process, the accent of the II tone is above the aorta; to the left of the sternum in V intercostal space is heard the noise of friction of the pericardium.The tongue is dry, the abdomen is soft, painless. The liver is not enlarged, painless. The tapping symptom is negative on both sides. The catheter received 150 ml of urine. CBC: RBC - 2.6×1012/l, Hb-72g/l, color index-0.9;WBC-5.7×109/l, eosinophils-2%, stab neutrophils-3%,segmented neutrophils-68%, lymphocytes-25%, monocytes2%; ESR-40 mm/h. Urine analysis: color-yellow, pH neutral, specific gravity-1005, protein-3.8 g/l, leukocytes-2-4, erythrocytes-10-12, granular cylinders- 3-4, waxy2-3. Biochemical blood test: AST-0.43 mmol/l, ALT-0.45 mmol/l, sugar-3.8mmol/l, cholesterol-7.5 mmol/l; creatinine-1.4 mmol/l, urea-38.2 mmol/l. GFR - ECG:sinus rhythm, 96 pm, the electrical axis of the heart is deflected to the left, single ventricular extrasystoles, hypertrophy and systolic overload of the left ventricular myocardium. Ultrasound: right kidney - 80×36 mm, mobile, smooth contour, indistinct parenchyma thickness-11 mm; left kidney-84×44 mm, contours are smooth, indistinct parenchyma thickness- 9 mm. The parenchyma of both kidneys is "heterogeneous", with hyperechoic inclusions. Suggest the most likely diagnosis.

Chronic glomerulonephritis, mixed form, active phase. Symptomatic arterial hypertension, degree of hypertension 3, risk 4 (very high), ventricular premature beats. CKD C5. Secondary anemia of moderate severity. Uremic colitis. Uremic pericarditis.

A young man complains of headache, general weakness and fatigue, decreased appetite. Anamnesis: at the age of 13 years after flu, the patient had facial edema, subfebrile temperature persisted for 3 or 4 months, there were changes in urine. He was treated by a district pediatrician for about a year from “nephritis”, received Prednisone. He has been feeling well for the last year, there was no noticeable edema. Examination: BMI=22 kg/m2, pale, dry skin, with a yellow or "earthy" shade and there are traces of scratching, swelling of the face and hands. The tongue is dry, with a brownish tint. In the lungs, the breathing is vesicular, there are no wheezes. The boundaries of relative cardiac dullness are expanded to the left by 1.5 cm from the mid-clavicular line. HR - 77 bpm. BP is 145/90 mm Hg. The abdomen is soft, painless with palpation in all departments. The tapping symptom is negative. Notes a decrease in the excreted urine. There is no edema on the lower extremities. CBCt: RBC-3.1×1012/l, Hg-106 g/l, WBCs-5.4×109/l, stab neutrophils4%, segmented neutrophils-65%, eosinophils-3%, monocytes-5%, lymphocytes23%, ESR–12 mm/h. Biochemical blood tests: total cholesterol-7 mmol/l, blood creatinine-170 mmol/l, blood urea-11 mmol/l. Urinalysis: specific gravity-1009, protein-1.1%, WBCs-2-4, erythrocytes–7-10, hyaline cylinders–2-3. Albuminuria - 250 mg/day. GFR (according to the formula CKD-EPI) – 55 ml / min. X-ray: no shadows of calculi were noted. The contours of the kidneys are not clearly defined. Kidney Ultrasound: size is 3-9 cm (normally=5–11) and thickness is 9mm (normally 14-18mm). What diagnosis is more likely:

Chronic glomerulonephritis, latent form, remission. Chronic renal failure, stage 3A. Symptomatic arterial hypertension 1 stage. Anemia of first degree.

A middle-aged man complains of nausea, occasional vomiting, lack of appetite, weak skin, severe itching, Urination at night 3 times, painless. Chronic kidney disease was diagnosed over 20 years ago. The patient was worried about general weakness, an increase in BP to 180/100 mmHg, changes in urine (hematuria) were detected, also there was swelling of ankles. During the last 6 months notes a persistent increase in blood pressure, a decrease in visual acuity. General condition of moderate severity, low nutrition, height - 162 cm, weight - 47 kg. The skin is pale, dry, with traces of combs. RR – 18/min. lungs - vesicular breathing, no wheezing. BP - 180/100 mm Hg. Borders of relative cardiac dullness: the right one is 2 cm from the right edge of the sternum, the upper one along the third intercostal space, the left one is 1.5 outward from the left midclavicular line. Heart sounds are muffled, rhythmic, heart rate – 100/m, in the region of the apex of the heart and in the second intercostal space on the right, there is a soft systolic murmur. There are no symptoms of peritoneal irritation, palpation of the abdomen is slightly painful in the epigastrium. The liver and spleen are not palpable. Percussion is negative. CBC: RBC - 3.2×1012 / l, HG - 106 g/l, color index - 0.78, WBC - 9.2 × 109/l, ESR - 28 mm/h. Urine test: specific gravity - 1010, WBC and RBC - single. Biochemical blood test: glucose - 4.0 mmol / l, urea - 20.2 mmol / l, creatinine - 0.54 mmol / l, total protein - 55 g / l, potassium - 5.2 mmol / l, GFR - 25 ml / min. In daily urine: diuresis - 650 ml / day, protein - 1.659 g / l. What diagnosis is more likely:

Chronic Renal Failure. Stage 4. Symptomatic arterial hypertension, degree of hypertension 3, risk 4 (very high). Secondary anemia of mild severity

A middle-aged woman (weight 99 kg, height 163 cm) was examined for the following: fasting glycemia 7.5 mmol/l, urine analysis - specific gravity 1015, yellow, transparent, protein - 0.15 g/l, sugar - present, erythrocytes 1-2, leukocytes 3-5, squamous epithelium 3-5. She had no complaints. Over the last 6 months periodically noted BP increase up to 145/95 - 155/100 mmHg. She did not receive hypotensive therapy. Family history: mother has hypertension, type 2 diabetes, father died at age 58, MI. She denies concomitant diseases. She denies any bad habits. Objectively: His condition is satisfactory. Body proportions were correct. BMI - 39 kg/m². Waist circumference - 109 cm. Skin of normal colour, clean. Visible mucous membranes were pale pink. Peripheral l/nodes not palpated. Breathing is vesicular, no rales. Breath rate- 15. Heart tones are clear, rhythm is correct. HR is 70 per minute. BP - 145/90 mm Hg. The abdomen is soft and painless in all parts. The liver is on the edge of the rib cusp. Spleen is not palpable. Tapping symptom is negative on both sides. Physiological signs are normal. Suggest the most likely diagnosis:

diabetes mellitus type 2

A middle-aged woman presents to GP complaints of persistent dry mouth, thirst, frequent urination, general weakness and itching of the skin. She has been ill for six months after onset of dry mouth and thirst. A week ago she began to have skin itching. Has a history of chronic pancreatitis. Mother has a history of diabetes mellitus. Physical examination: condition is satisfactory. BMI is 36 kg/m2. Waist circumference - 106 cm. Skin was clean, there were signs of scratches on her hands. In the lungs vesicular breath sounds, no rales. Cardiac murmurs are rhythmic. Heart rate - 70 beats pm. BP - 120/70 mmHg. The abdomen is soft, painless on palpation in all parts. The liver and spleen are not enlarged. No dysuria. Laboratory tests: fasting plasma glucose - 6.8 mmol/l, total cholesterol - 6.1 mmol/l, TG -2.7 mmol/l, HDL-C - 1.0 mmol/l. Suggest the most likely diagnosis:

Diabetes mellitus type 2. Obesity of the 2nd degree. Hyperlipidaemia (metabolic syndrome)

A middle-aged woman Complains of overweight, increased fatigue. Body weight increased significantly 5 years ago after childbirth. Developed normally. Menses from 12 years of age, regular. Loves flour products, sweets. Father and mother are obese 1-2 degree. The younger brother is obese 1 degree. Height - 167 cm, body weight - 97 kg, BMI – 35, waist circumference – 98 сm. The deposition of subcutaneous adipose tissue is uniform. Skin of normal color and moisture. Pulse - 77 beats pm, rhythmic. BP - 135/85 mm Hg The left border of relative cardiac dullness in the V intercostal space by 1 cm. outward from the midclavicular line. Heart sounds are weakened. Breathing is vesicular. Secondary sexual characteristics are developed normally. The thyroid gland is not enlarged. Laboratory tests: fasting plasma glucose - 5.5 mmol / l, 2-h PG - 7.5 mmol / l. Biochemical blood test: total cholesterol - 8.8 mmol / l, HDL - 3.1 mmol / l, LDL - 2.8 mmol / l, triglycerides - 2.8 mmol / l, glucose - 4.58 mmol / l, urea - 4.4 mmol / l. Instrumental examination: ultrasound of the abdominal organs is normal. Suggest the most likely diagnosis:

Alimentary-constitutional obesity of the II degree. Hyperlipidaemia. Metabolic syndrome.

A middle-aged woman is brought to the physician by her son because of progressive memory loss for the past year. She feels tired and can no longer concentrate on her morning crossword puzzles. She has gained 10.3 kg (24 Ib) in the last year. She has a history of drinking alcohol excessively but has not consumed alcohol for the past 8 years. She is oriented but has short-term memory deficits. Physical examination: Vital signs include a temperature 35.2oC, pulse 56/minute and regular, BP 105/65. She is moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. She has losed lateral third of eyebrows. The thyroid gland is not palpable. The deep tendon reflex time is delayed (Achilles' tendon reflex). What disease can be assumed:

Hyporthyroidism

A middle-aged male turned to the therapist with complaints of moderate headache, increased general excitability, anxiety, fussiness, interrupted sleep, sweating, weakness, palpitations. Anamnesis morbi: considers himself ill for about 2 months when the above complaints first appeared. According to the patient, during this time she lost 8 kg. Anamnesis vitae: Denies bad habits. Allergic history was unremarkable. There were no injuries, operations, or blood transfusions. The patient's mother suffers from hypertension, type 2 diabetes mellitus. General condition of moderate severity. The patient is undernutrition. The face is hyperemic, the skin is elastic, moist. Peripheral lymph nodes are not palpable, hand tremors. Vesicular respiration in the lungs. Respiratory rate 18 per minute. Heart sounds are arrhythmic, clear, systolic murmur is heard at the apex and at the pulmonary artery. Percussion: the borders of the heart are normal. BP - 170 /40 mm Hg. Heart rate 110 beats / min. Pulse - 80 per minute, arrhythmic. Pulse deficit = 30 beats per minute. The liver along the edge of the costal arch, soft, painless. Stool, urination without peculiarities. The symptom of tapping in the lumbar region is negative on both sides. There are no peripheral edema. General blood analysis: Hb - 90 g / l, erythrocytes - 3.7 ×1012 / l, leukocytes - 4.0 ×109 / L, E -3%, n - 3%, c- 42%, l -45%, m - 7%. ESR - 30 mm per hour. Make a preliminary diagnosis:

Hyperthyroidism, thyrotoxicosis, atrial fibrillation, tachysystolic form. Secondary arterial hypertension. Anemia of moderate severity

A middle-aged female came to the outpatient department with complaints of a gradual progression of a painless anterior neck swelling for a 2-year duration. Two months following the onset of the swelling, she experienced excessive sweating even at sedentary moments. Her appetite has been consistently good but she had lost 4 kgs over 7 months. She has history of tremors and palpitations. She even mentioned of her pulse beating faster at night sleep. Physical examination revealed 56 Kg female with anxious and sweating appearance in her palms. Her fingers are well felt with fine tremors, palpitations is observed, blood pressure is 155/85 mmHg, pulse of 109 beats per minute. Examination: she had a diffusely enlarged smooth goiter that is sift with regular borders. T3 : 210 ng/dl (100–200 ng/dL), T4: 15.6 ng/dl (0.9–1.7 ng/dL), TSH: 0.1 uIU/ml (0.4- 4 uIU/ml). Make a diagnosis:

nodular goiter

An older woman was referred to GP with complaints of consistent discomfort and weight loss. She presented with a 2-month history of burning pain in the epigastric abdomen and chest which radiated toward her back. Her pain worsened after taking aspirin and drinking coffee, and was relieved after taking antacids. She had previously lost 10 pounds in 2 months due to decreased intake caused by the feeling of bloating, early fullness and stomachaches between meals. She also reported nausea and vomiting. She also reported doubling her NSAID intake due to increased knee pain. She looked pale and exhausted when she entered the clinic. BP: 135/85 mm Hg, HR: 99 bpm, RR: 21 b / min, t 36.1 ℃, oxygenation: 99%, Height: 167 cm, Weight: 58.2 kg. Past medical history: Gastritis, diagnosed 5 years ago. Resolved with pharmacotherapy, frequent recurrence. Osteoarthritis, diagnosed 3 years ago. Long-term use of the non-steroidal anti-inflammatory drug (NSAID) since diagnosis. No surgical history. Family history: Mother died from gastric cancer. Brother has a history of duodenal ulcers. Heavy smoker. Social history: Hobbies include drinking and eating spicy food. Has smoked for 30 years, Lab Test- RBC- 110 g/l, Hb- 3.3 *10^12/l, WBC - 19.6×109/L, Band Neutrophil- 10%, Segmented Neutrophil- 93%, CRP- 0.2 mg/L, ESR- 30 mm/h, Gastrin test: +, Stool antigen test: ++, Urea breath test: >CO2. Make a diagnosis:

Peptic ulcer

A middle-aged patient complains of feeling severity and distention in the epigastrium immediately after eating, decreased appetite, general weakness, constipation, alternating with diarrhea. More than 10 years was treated for some kind of stomach disease. On dispensary observation is not consists. Worsening of the condition notes in during the week. Do not get medical help addressed. Physical examination: The condition is satisfactory. BP - 120/80 mm Hg. Heart rate-80 beats per minute. Respiratory rate – 18 per min. The skin is clean. Peripheral lymph nodes are not enlarged. Tongue coated with white bloom. The abdomen is outwardly unchanged, active participates in the act of breathing, soft on palpation, slightly painful in the epigastric region. Big the curvature of the stomach is 2 cm below the navel. Liver in the edges of the costal arch. Bowel sections normal palpation properties. What is the likely diagnosis:

Type A gastritis

A middle-aged patient came to the clinic with complaints of aching pain in the epigastric region, which occurs 30-50 minutes after eating; nausea and vomiting of gastric contents, arising at the height of pain and bringing relief; to reduce appetite. From the anamnesis of the disease: for the first time such complaints arose about 6 years ago, but the pains were stopped by taking Almagel and drotaverin (no-shpa). He has not previously sought medical help. Notes the springautumn exacerbations of the disease. Deterioration of health for about two days, after drinking alcohol and fried foods. Works as a taxi driver. Eats irregularly, often drinks alcohol. Smokes up to 2 packs of cigarettes a day for 20 years. Hereditary history: the father - stomach ulcer. What is the likely diagnosis:

Peptic ulcer

What disease is characterized by the following symptoms? In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees, or elbows. The rash is patchy and usually a bluishpurple color. A rash on the chest is known as a “shawl sign” because it appears in a shawl-like pattern. A rash on the hands is known as “mechanic’s hands“, because it makes the skin appear rough and dirty.

Dermatomyositis

The man has a pronounced edematous syndrome, fever, joint and muscle pain. After the examination, the patient was diagnosed with systemic lupus erythematosus. Choose the right treatment strategy:

glucocorticosteroids, cytostatics

A 20-year-old patient has complaints of swelling, soreness and a local increase in temperature over the joints of the hands. Presence of antinuclear antibodies, positivity for anti-ds-DNA antibody, serum lymphocytopenia, and urine protein of 2.0 g/day. Your estimated diagnosis:

SLE

A 35-year-old patient complains of frequent, loose stools (up to 12 times a day), and at night, with an admixture of blood and mucus, cramp-like pain in the left iliac region, periodically throughout the abdomen . The pains increase before defecation and decrease after stool. Also complains of weight loss, loss of appetite, weakness. Sick for about 4 months. Objectively: a state of moderate severity. Tongue wet, lined with gray coating. The abdomen is somewhat swollen, soft, painful on palpation in the area of the projection of the sigmoid colon. The size of the liver according to Kurlov is within the normal range. The spleen is not palpable. Complete blood count: hemoglobin - 92 g / l, leukocytes - 11.2 thousand, ESR - 26 mm / h. Urinalysis, biochemical blood test - no significant changes. Coprological analysis: an admixture of blood and mucus, many epithelial cells and leukocytes are determined macroscopically. Most likely diagnosis:

nonspecific ulcerative colitis

A 28-year-old patient came to the clinic with complaints of loose stools with blood 5-6 times a day, fever up to 37.5°C, weakness, dizziness, pain in the ankle, elbow, and shoulder joints. He fell ill about 2 months ago, when the body temperature rose, pains appeared in the joints. Several courses of antibiotic therapy were carried out, against which a liquid stool appeared. Objectively: the skin is pale, clean. On palpation, the abdomen is soft, painful in the iliac regions. The liver does not protrude from under the edge of the costal arch. The size of the liver according to Kurlov is 10×9×8 cm. The spleen is not palpable. In the general blood test: erythrocytes - 3.2×1012/l, hemoglobin - 61 g/l, leukocytes - 11×109/l, platelets - 350×109/l, ESR - 30 mm/h.

nonspecific ulcerative colitis, moderate

Patient K., 32 years old, a soldier, complains of constant pain in the right iliac region (often wakes up at night with pain). Against this background, attacks of pain like colic periodically occur. Worried about severe weakness, weight loss, diarrhea - stool 3-4 times a day in the form of a liquid slurry, without pathological impurities, plentiful. Notes an increase in temperature to 37.6 ° C daily, especially in the evening. Anamnesis of the disease: fell ill 1 year ago, when suddenly, in the midst of full health, intense pain appeared in the right iliac region, the temperature rose to 38.0°C. He was taken to the emergency department, where he was examined by a surgeon, who was diagnosed with acute appendicitis. A blood test revealed leukocytosis, the patient was taken for surgery. The revision revealed a thickened ileum with an edematous loose wall, enlarged mesenteric lymph nodes. The appendix is not changed. An appendectomy was performed. In the postoperative period, hyperthermia appeared up to 38.5°C; on the background of the introduction of antibiotics, the temperature decreased to subfebrile numbers, but did not completely disappear. Pain in the right iliac region persisted, began to wear a dull permanent character. The patient began to notice an increase in stools, at first up to 2 times a day, then 3-4, the feces initially had the character of a thick porridge ("cow feces"), then they became liquid. Small amounts of mucus and blood occasionally appeared in the stools. Gradually, weakness increased, during the year of illness the patient lost 6 kg of body weight. On palpation, pain is noted in the right lower quadrant, a compacted painful caecum and somewhat higher swollen rumbling loops of the small intestine are palpated here. Specify the preliminary diagnosis:

Crohn's disease in the form of ileocolitis

A 62-year-old patient was transferred from an infectious disease hospital with a diagnosis of obstructive jaundice. Conducting a complex of laboratory and instrumental studies revealed that the cause of jaundice is volumetric changes in the pancreas, the nature of which is not entirely clear. Which of the laboratory parameters is the most informative for the differential diagnosis of chronic pancreatitis and pancreatic cancer?

indicators of tumor marker СА-19-9

During a medical examination in a 50-year-old patient, ultrasound examination for the first time revealed the formation of increased echogenicity in the right lobe of the liver with uneven contours in the 7th segment measuring 4 x 5 cm . There are no complaints. What should be the management of such a patient?

immediate additional examination to clarify the diagnosis and nature of education

Patient A., 28 years old. Complaints of periodic aching, arching pains in the right hypochondrium, lasting up to 30-40 minutes, radiating under the right shoulder blade, not associated with a change in body position, defecation, taking antacids, sometimes appearing at night. Also concerned about bitterness in the mouth, nausea, and occasionally vomiting. Considers himself ill for 2 years. Objectively: the condition is satisfactory, increased nutrition. Breathing in the lungs is vesicular, there are no side breath sounds. Heart tones are rhythmic with a number of 68 per minute. AD 120/80 mm. rt. Art. Tongue dry, coated with white. The abdomen is soft, slightly painful on palpation at Roger's point, Kera's symptom is negative. General and biochemical blood tests: normal. Abdominal ultrasound: gallbladder 68*25 mm, wall 2 mm, homogeneous contents. Dynamic gamma scintigraphy with technetium-99: gallbladder ejection fraction - 15%. What is the expected diagnosis?

cholelithiasis, chronic calculous cholecystitis

A 38-year-old patient came to the clinic with complaints of general weakness and subicteric sclera. Objectively: moderate hepatomegaly. In blood tests: AST - 36 units/l, ALT - 49 units/l, markers of viral hepatitis B - negative, anti-HCV - positive. To verify the diagnosis, the patient must:

HCV RNA detection

A 36-year-old patient consulted a doctor with complaints of general weakness, nagging pain in the right hypochondrium, occasional bitterness in the mouth and nausea, more in the morning. On examination: subicteric sclera. In blood tests: albumin - 35 g / l, total bilirubin - 47 μmol / l, AST - 75 units / l, ALT - 98 units / l. Viral hepatitis markers: HBsAg - positive, Anti-HBcIgG - positive, AntiHBcIgM - negative, Anti-HBe - positive, Anti-HCV - negative.

chronic viral hepatitis B

A 39-year-old patient complains of severe weakness, constant drowsiness, weight loss of 6 kg in six months, gingival and nasal bleeding, abdominal enlargement, and itching. From the anamnesis - long-term alcohol abuse. Moderate condition. On examination, yellowness of the skin, mucous membranes, sclera, spider veins in the neck, chest, palmar erythema, Dupuytren's contracture is revealed. There is atrophy of the muscles of the upper shoulder girdle, weight deficit (weight 58 kg, height 177 cm; BMI - 17). Subcutaneous hematomas on the arms and legs are determined. The abdomen is enlarged. Percussion revealed fluid in the abdominal cavity. The liver is palpated 4 cm below the level of the costal arch, the edge is sharp, dense. Percussion dimensions - 13 cm × 11 cm × 6 cm. Increased percussion dimensions of the spleen 17 × 12 cm. Total protein - 59 g / l, albumins - 28.5 g / l, globulins - 52%, gamma globulins -28.5 %. Suggest the most likely diagnosis.

Alcoholic cirrhosis of the liver, Child-Pugh class B. Portal hypertension: hepatomegaly, splenomegaly, grade 2 ascites

Patient A., 42 years old, was admitted to the clinic with complaints of shortness of breath, palpitations during daily exertion, periodic pain in the heart of a dull nature, heaviness in the right hypochondrium, swelling of the legs, more in the evening. He fell ill at the age of 14, when three weeks after suffering a sore throat, general weakness, fever, pain and swelling in the knee joints appeared. A diagnosis of acute rheumatic fever was made. On examination at the time of admission: the apex beat is palpated in the VI intercostal space . At the Botkin point and II intercostal space on the right - systolic and diastolic murmur. A systolic murmur of a coarse tone is conducted into the jugular fossa and carotid arteries. Palpation is determined by systolic trembling in the II intercostal space to the right of the sternum, I and II tones are weakened. Diagnostic signs of what valvular heart disease are present in this patient?

Aortic stenosis. Aortic insufficiency

A 25-year-old woman, a teacher, complains of difficulty breathing when walking, climbing to the 2nd floor, dry cough, fever up to 38.6 °C , palpitations, weakness. Two years ago, after a sore throat, there were stabbing pains in the region of the apex of the heart without connection with physical activity, of varying duration and intensity; there were flying pains in the knee and shoulder joints. On examination: The pulse is small, weakened on the left radial artery, 90 beats per minute. BP - 110/70 mm Hg . The boundaries of relative cardiac dullness: right - 2 cm to the right of the right edge of the sternum, the top - the lower edge of the II rib, the left - 0.5 cm medially from the left midclavicular line. Heart sounds are rhythmic, three -membered rhythm, at the apex of the heart there is a clapping I tone, diastolic murmur, in the second intercostal space to the left of the sternum - an accent of the II tone, over the xiphoid process - a weakening of the I tone. Suggest the most likely diagnosis.

rheumatic heart disease with the formation of a defect (mitral valve stenosis)

A 37-year-old man at the appointment of a district general practitioner complains of shortness of breath, palpitations, cough. Slight shortness of breath and periodic palpitations noted for 6 years. About a week ago, he fell ill with a sore throat with high fever and cough. On the night before going to the doctor, he could not sleep because of severe shortness of breath, aggravated in a horizontal position. In adolescence, there were frequent sore throats, against which pain in large joints bothered. Was observed at the neuropathologist concerning a chorea. Objectively: orthopnea , acrocyanosis , respiratory rate - 28 per minute, swelling of the lower extremities, lifting the apex beat. Pulse weak filling, arrhythmic, 96 beats per minute. Heart rate according to auscultation - 110 per minute. Blood pressure - 100/60 mm Hg , body temperature - 37.3°C. The liver is enlarged, slightly painful on palpation. On percussion, the heart is enlarged to the left and to the right. In the lower parts of the lungs fine bubbling rales. On auscultation of the heart - arrhythmia with the absence of periods of the correct rhythm. At the top there is a three-part melody with a low deaf additional component, the accent of the II tone on the pulmonary artery. A three-part melody is heard at the Botkin point. Systolic and protodiastolic murmur at apex. The systolic murmur at the apex intensifies on expiration, is carried out in the axillary region. Complete blood count: ESR - 35 mm/h, leukocytes - 12300 in 1 mm3 . Biochemical analysis of blood: C - reactive protein (++++). Your presumptive underlying diagnosis.

Chronic rheumatic heart disease

Patient A., 45 years old, upon admission to the clinic, complained of pain and swelling in the small joints of both hands, feet, large joints of the limbs, limited mobility in them, morning stiffness up to lunch. Sick for 7 years. Repeatedly treated in the hospital. Constantly took 7.5 mg of prednisolone per day, NSAIDs (50-75 mg/day Voltaren or 0.5 g/day naproxena). On examination: defiguration of the wrist, metacarpophalangeal, proximal interphalangeal and elbow joints. BA: erythrocytes - 3.6*1012/l, Hb - 116 g/l, leukocytes - 9*109/l, ESR - 50 mm/h. X-ray of the hands: periarticular osteoporosis, narrowing of the joint spaces, multiple erosions and usura in the area of the proximal interphalangeal joints. Formulate a preliminary diagnosis.

Rheumatoid arthritis, seropositive (negative), 3rd degree of activity, stage III

Patient P., aged 43, an entrepreneur, complained of swelling and sharp pain in the first toe of the right foot. He fell ill acutely 2 days ago: after visiting the sauna and a plentiful feast at night, there was a very strong pain in the first toe of the right foot. The pain was perceived as unbearable even from the touch of a blanket. In the morning the patient noticed swelling of the first toe of the right foot and purple coloration of the skin above it. During the next day, I could not even go to the toilet because of the sharp pain. Body temperature increased to 37.8°C, and therefore applied to the clinic at the place of residence. On examination, the condition is satisfactory, the constitution is hypersthenic, increased nutrition. Height - 172 cm. Weight - 100 kg. BP - 160/105 mm Hg. The belly is rounded; increased in volume due to excessive development of subcutaneous adipose tissue; soft, painless. The left lobe of the liver protrudes 1.5 cm from under the costal arch; the edge of the liver is soft, painless. Severe deformity of the first metatarsophalangeal joint of the right foot due to exudative phenomena; sharp pain on palpation of this joint (the patient withdraws his leg), hyperemia of the skin over it and an increase in local temperature, the range of motion in the first metatarsophalangeal joint on the right is sharply limited. Other joints during examination were not changed, their palpation was painless, movements in other joints were preserved in full. Subcutaneous and intradermal nodules are not detected. Clinical blood test: Hb - 140 g/l; erythrocytes - 4.8x1012; leukocytes - 10.1x109, ESR - 32 mm/h. Biochemical blood test: glucose - 4.5 mmol/l, cholesterol - 6.8 mmol/l, creatinine - 78 mmol/l, urea - 7.2 mmol/l, uric acid - 540 mmol/l, total protein - 68 g/l, ALT - 84 U/l, AST - 67 U/l. X-ray of the feet: narrowing of the joint spaces, mainly metatarsophalangeal joints on both sides. State the main diagnosis.

Gout: acute gouty arthritis, hyperuricemia

Patient A., 27 years old, was admitted to the clinic with complaints of pain in the metacarpophalangeal, radiocarpal, knee joints, swelling of these joints, limitation of movement in them. In the morning he notes stiffness in the affected joints until 12 noon. The disease arose 7 months ago after a sore throat. On examination: defiguration of the metacarpophalangeal, radiocarpal, knee joints, limited mobility, and reduced hand compression force. The pulse is rhythmic (84 beats/min), blood pressure - 120/80 mm Hg. The borders of the heart are normal. Heart sounds are rhythmic, satisfactory sonority. No changes were found in the lungs and abdominal organs. KBT: ESR - 36 mm/h, CRP +++, α2-globulins - 11.6%, γglobulins - 25%. X-ray of the hands: signs of periarticular osteoporosis in the area of the metacarpophalangeal joints. Present the standards for examining patients with this pathology.

KBT, total protein and protein fractions, blood for rheumatoid factor, radiography of the hands

The patient is 53 years old, complains of numbness and pain in the fingers, swelling throughout the body, she feels skin hardening and scarring especially on the face, dryness in the eyes and mouth, feeling of severe dryness of the skin. According to the patient, the complaints began to bother within a month. Independently applied to the polyclinic at the place of residence. During the examination, it was noted: an increase in blood pressure 170/100 mmHg. SpO2 - 94%, pulse - 59 times per minute. During auscultation of the heart, the emphasis is 2 tones on the pulmonary artery and tricuspid valve. In laboratory tests: Total blood count- RBC- 1.44, HGB-80 g/l, PLT-280, WBC-13 g/l. Total urine analysis: quantity-30 ml, pH-6.5, leukocytes- 15 g/l. Passed an analysis for antinuclear antibodies , there is 1.2 u/t.Scl-70- positive. Specify the preliminary diagnosis based on clinical and laboratory data.

Overlap syndromes

internal disease

Abuhussin Alsaeed · 100問 · 1年前

internal disease

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internal disease 2

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internal disease 2

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internal disease 3

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internal disease 3

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internal 3

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internal 3

15問 • 1年前

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internal state 1

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internal state 1

100問 • 1年前

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internal state 2

Abuhussin Alsaeed · 100問 · 1年前

internal state 2

100問 • 1年前

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internal state 3

Abuhussin Alsaeed · 70問 · 1年前

internal state 3

70問 • 1年前

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pediatric

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pediatric

100問 • 1年前

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pediatric 2

Abuhussin Alsaeed · 68問 · 1年前

pediatric 2

68問 • 1年前

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surgery 2

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surgery 2

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問題一覧

A middle-aged patient has been suffering from chronic glomerulonephritis for a long time. His GFR is 20. Define the stage of chronic kidney disease:

Stage 4- severe loss of kidney function

diabetes mellitus type 2

A young male patient has thirst, polyuria, general weakness, blood sugar level of 17 mmol/l, level of ketones in the urine is 3 mmol/l. The type of diabetes the patient has:

diabetes mellitus type 1

A middle-aged obese woman has a fasting glycaemia of 9.7 mmol/l, HbA1c- 8%, in urine - no detectable acetone. Patient's sibling has diabetes mellitus. Type of diabetes in the patient:

diabetes mellitus type 2

increase the dose of insulin

diabetes mellitus type 2. diabetic nephropathy

Fasting plasma glucose – 6 mmol/L, 2-h plasma glucose – 8 mmol/L, HbA1c – 6%. Which condition is characterized by these data:

prediabetes

Fasting plasma glucose – 6,5 mmol/L, 2-h plasma glucose – 9 mmol/L, HbA1c – 6,2%. Which condition is characterized by these data:

prediabetes

Fasting plasma glucose – 5,9 mmol/L, 2-h plasma glucose – 10 mmol/L, HbA1c – 6,4%. Which condition is characterized by these data:

prediabetes

Biochemical test: Free T4 – 0,046 ng/dL (0.9–1.7 ng/dL), TSH – 100 µlU/ml (0.4–4.0 μU/mL), antiTPO antibodies – 1160/ml. Which state is characterized by these data:

Hyporthyroidism

Hyperthyroidism

Hyporthyroidism

Elevated TSH with decreased T4 or elevated TSH with normal free T4. Which condition is characterized by these signs and symptoms:

Hyporthyroidism

prescribe thyroid function tests

Hyporthyroidism

TSH: 6.1 μU/mL (0.4–4.0 μU/mL), Free T4: 0.4 ng/dL (0.9–1.7 ng/dL ), Free T3: 56 ng/dL (100–200 ng/dL). Which state is characterized by these data:

Primary hypothyroidism

Hyperthyroidism

GERD

Type A gastritis

Peptic ulcer, exacerbation stage, HP-associated

urgent hospitalization

pyelonephritis

Acute glomerulonephritis, hospitalisation

Chronic glomerulonephritis, latent form, remission. Chronic renal failure, stage 3A. Symptomatic arterial hypertension 1 stage. Anemia of first degree.

Chronic Renal Failure. Stage 4. Symptomatic arterial hypertension, degree of hypertension 3, risk 4 (very high). Secondary anemia of mild severity

diabetes mellitus type 2

Diabetes mellitus type 2. Obesity of the 2nd degree. Hyperlipidaemia (metabolic syndrome)

Alimentary-constitutional obesity of the II degree. Hyperlipidaemia. Metabolic syndrome.

Hyporthyroidism

Hyperthyroidism, thyrotoxicosis, atrial fibrillation, tachysystolic form. Secondary arterial hypertension. Anemia of moderate severity

nodular goiter

Peptic ulcer

Type A gastritis

Peptic ulcer

Dermatomyositis

The man has a pronounced edematous syndrome, fever, joint and muscle pain. After the examination, the patient was diagnosed with systemic lupus erythematosus. Choose the right treatment strategy:

glucocorticosteroids, cytostatics

SLE

nonspecific ulcerative colitis

nonspecific ulcerative colitis, moderate

Crohn's disease in the form of ileocolitis

indicators of tumor marker СА-19-9

immediate additional examination to clarify the diagnosis and nature of education

cholelithiasis, chronic calculous cholecystitis

HCV RNA detection

chronic viral hepatitis B

Alcoholic cirrhosis of the liver, Child-Pugh class B. Portal hypertension: hepatomegaly, splenomegaly, grade 2 ascites

Aortic stenosis. Aortic insufficiency

rheumatic heart disease with the formation of a defect (mitral valve stenosis)

Chronic rheumatic heart disease

Rheumatoid arthritis, seropositive (negative), 3rd degree of activity, stage III

Gout: acute gouty arthritis, hyperuricemia

KBT, total protein and protein fractions, blood for rheumatoid factor, radiography of the hands

Overlap syndromes