Clinical Task №34

for practical-oriented state exam on

Internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Female aged 38, during 14 years has been working at furniture plant in contact with solvents. After 5 years from the beginning of work she began to experience general weakness, decrease of capacity for work, periodical nasal bleedings. During last year signs of asthenia increased, pains and numbness in hands joints.

On objective examination: paleness of skin, heart tones are dull, tachycardia, blood pressure 100/60 mm Hg. Liver is palpated at 2-3 cm below costal margin. Spleen could not be palpated. Cuff test is positive.

CBC: Er-3,3x10¹²/l, Hb-84 g/l, CI-0,7, L-2,9x10⁹/l, Tr-130x10⁹/l. Bleeding time - 5 minutes.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №35

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient V., 54 years, is admitted to a hospital with complaints of general weakness, fever up to 38,6°C, moist cough, dyspnea at slight physical exertion, aching pain in hear region, bad appetite. He is occupied at plastic production for 15 years.

Objectively: condition is moderately grave. Skin is dry and pale. BR-24/min, breathing is vesicular, acutely weakened in lower regions, focus of small-bubbling moist rales. PR-96/min, weak, AP-100/60. Heart tones are muffled. Abdomen is swollen, soft and sensible in right subcostal region at palpation. Liver is found 2 cm lower than right rib arc, its rim is round, soft and painful.

CBC: Er-2,3x1012/l, Hb-100g/l, reticulocytes-0,4%, L-2,4x109/l, e-1%, n-1%, s-45%, l-38%, m-15%, Tr-110x10⁹/l, ESR-32mm/h.

Bone marrow: moderate bone marrow hypoplasia.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №36

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient B., 35 years, was admitted to a hospital by ambulance car with complaints of expiratory dyspnea with frequent attacks of asphyxia, headache, vomiting, pain in abdomen, weakness of muscles of lower extremities, general weakness.

Objectively: skin is pale, general hyperhydrosis, hypersalivation. Pupils are narrowed, reaction to light is inert. Speech is monotonous. Tendon reflexes are decreased, fibril twitching of mimic muscles. Breathing is frequent, firm, vesicular, with prolonged expiration, dry whistling rales. PR-52/min, AP-110/60. Heart tones are muffled, clear. Abdomen is sensible in epigastrium region at palpation.

Activity of cholinesterase in blood is decreased to 70%.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk