surgery examination_3-4 (question cases) [eng]

7/31/2019 Surgery Examination_3-4 (Question Cases) [Eng]

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Task 1.The patient with a gunshot wound to the right hip, obtained 15 minutes ago, complaints of pain in the rightthigh, and weakness. From a wound received red blood pulsing jet. The patient is conscious, pale, the pulsewas 120 beats per minute, blood pressure 90/60 mm Hg. Article., the frequency of 28 breaths per minute.Results of laboratory tests:

CBCRed blood cells 5,000,000 / mmHemoglobin 150 g / lHematocrit 45%Reticulocytes 1%Color index 1Leukocytes 5000/mklStab 1%70% segmentedEosinophils 3%Basophils 0%Lymphocytes 23%

Monocytes 3%Platelets 200 th / mmESR 8 mm / h

Biochemical analysis of bloodTotal protein 70 g / lAlbumin 60%Globulins 40%Urea, 5 mmol / lCreatinine 80 umol / lThe total bilirubin 10 mmol / l

Direct 2 mmol / lIndirect 8 mmol / lIron 20 umol / lPotassium 4.5 mmol / lSodium 135 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?4. Which method to stop the bleeding was to be applied to the pre-hospital?5. Which way is the final stop bleeding is the best in this situation?

Task 2.The patient complaints of loose stools in the form of raspberry jelly. Pulse 100 beats per minute, bloodpressure 100/60 mm Hg.Article., the frequency of 25 breaths per minute.Results of laboratory tests:

CBCErythrocytes 3.5 million / mlHemoglobin 100 g / lColor index 1Hematocrit 30%Reticulocytes 7%

Leukocytes 4500/mklStab 2%60% segmentedEosinophils 3%


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Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 200 th / mmESR 40 mm / h

Biochemical analysis of bloodTotal protein 60 g / lAlbumin 63%Globulins 37%Urea, 5 mmol / lCreatinine 90 umol / lThe total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 16 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?4. Defeat any of the gastrointestinal tract occurs in this patient?5. What actions are necessary to clarify the diagnosis?

Task 3.The patient complaints of vomiting 2 times.Vomit-colored coffee grounds. Pulse 100 beats per minute,blood pressure 105/70 mm Hg. Article., the frequency of 28 breaths per minute. Results of laboratory tests:

CBCErythrocytes 3.8 million / mlHemoglobin 110 g / lColor index 1Hematocrit 33%Reticulocytes 3%Leukocytes 4000/mklStab 4%58% segmentedEosinophils 3%Basophils 1%Lymphocytes 30%

Monocytes 4%Platelets 250 th / mmESR 10 mm / h

Biochemical analysis of bloodTotal protein 70 g / lAlbumin 63%Globulins 37%Urea 5.9 mmol / lCreatinine 80 umol / lThe total bilirubin 15 mmol / l

Direct 2 mmol / lIndirect 13 mmol / lIron 17 umol / lPotassium 4.5 mmol / l


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Sodium 150 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?4. Defeat any of the gastrointestinal tract occurs in this patient?

5. What actions are necessary to clarify the diagnosis?

Task 4.The patient complaints of weakness, dizziness, loose stools black, with an unpleasant smell, repeatedvomiting, vomit dark color. The patient is conscious, pale, the pulse was 110 beats per minute, bloodpressure 90/60 mm Hg. Article., the frequency of 28 breaths per minute. Results of laboratory tests:

CBCErythrocytes 2.6 million / mlHemoglobin 85 g / lColor index 1

Hematocrit 26%Reticulocytes 4%Leukocytes 4000/mklStab 2%60% segmentedEosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 190 th / mmESR 10 mm / h

Biochemical analysis of bloodTotal protein 60 g / lAlbumin 63%Globulins 37%Urea 3.5 mmol / lCreatinine 100 mol / lThe total bilirubin 3 mmol / lDirect 0 mmol / lIndirect 3 mmol / lIron 13 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?4. Defeat any of the gastrointestinal tract occurs in this patient?5. What actions are necessary to clarify the diagnosis?

Task 5.The patient on the front surface of the forearm, in the lower third of his wound a linear form from which thepulsating jet enters red blood. Complaints of weakness, dizziness, mild pain in the wound. The patient isconscious, pale, the pulse was 115 beats per minute, blood pressure 85/55 mm Hg.Article., the frequencyof 30 breaths per minute. Results of laboratory tests:

CBCErythrocytes 2.8 million / ml


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Hemoglobin 88 g / lColor index 1Hematocrit 25%Reticulocytes 2%Leukocytes 4000/mklStab 2%60% segmented

Eosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 190 th / mmESR 10 mm / h

Biochemical analysis of bloodTotal protein 60 g / lAlbumin 65%Globulins 35%

Urea 4.5 mmol / lCreatinine 80 umol / lThe total bilirubin 5 mmol / lDirect 0 mmol / lIndirect 5 mmol / lIron 14 umol / lPotassium 4.5 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?

4. What a way to stop the bleeding was to be applied to the pre-hospital?

Task 6.The patient is unconscious. In the words of the accompanying 8 hours ago struck by a car, receiving a blowto the abdomen. There is a massive bruise in the anterior and lateral abdominal wall to the left. The patienthas sudden pallor, the pulse was 120 beats per minute, blood pressure 75/50 mm Hg.Article., the frequencyof 32 breaths per minute. Results of laboratory tests:

CBCRed blood cells 2,000,000 / mmHemoglobin 55 g / l

Color index 1Hematocrit 20%Reticulocytes 2%Leukocytes 3500/mklStab 2%60% segmentedEosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 180 th / mmESR 15 mm / h

Biochemical analysis of bloodTotal protein 55 g / l


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Albumin 63%Globulins 37%Urea 3 mmol / lCreatinine 60 umol / lThe total bilirubin 3 mmol / lDirect 0 mmol / lIndirect 3 mmol / l

Iron 10 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases most often encountered this syndrome?4. What kind of damage is most likely in this patient?5. What actions are necessary to clarify the diagnosis?

Task 7.The patient is unconscious. In the words of the accompanying 2 hours before admission the patient had anepisode of vomiting multiple large amount of blood. Patient over 10 years suffer from cirrhosis of theliver. On examination, marked a sharp pale skin, cold clammy sweat, the pulse was 126 beats per minute,blood pressure 70/40 mm Hg.Article., the frequency of 30 breaths per minute. Results of laboratory tests:

CBCRed blood cells 2,000,000 / mmHemoglobin 50 g / lThe color index of 0.9Hematocrit 20%

Reticulocytes 3%Leukocytes 3500/mklStab 5%59% segmentedEosinophils 2%Basophils 1%Lymphocytes 30%Monocytes 3%Platelets 180 th / mmESR 15 mm / h

Biochemical analysis of blood

Total protein 55 g / lAlbumin 60%Globulins 40%Urea 3 mmol / lCreatinine 85 umol / lThe total bilirubin 45 mmol / lStraight 10 mmol / lIndirect 35 mmol / lIron 14 umol / lPotassium 4.3 mmol / lSodium 147 mmol / l



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4. What disease is most likely in this patient?5. What actions are necessary to clarify the diagnosis?

Task 8.The patient complaints about the presence of hemorrhoids and the periodic appearance of a small amountof blood the color unchanged immediately after defecation. The patient is pale, the pulse was 90 beats per

minute, blood pressure 120/70 mm Hg. Article., the frequency of 20 breaths per minute. Results oflaboratory tests:

CBCErythrocytes 3.5 million / ml, microcytosis, poikilocytosisHemoglobin 80 g / lHematocrit 35%The color index of 0.6Reticulocytes 1%Leukocytes 6000/mklStab 1%65% segmented



Urea, 5 mmol / lCreatinine 100 mol / lThe total bilirubin 15 mmol / lDirect 2 mmol / lIndirect 13 mmol / lIron 8 mmol / lPotassium 4.5 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?

4. What actions are necessary to clarify the diagnosis?

Task 9.Patient for 15 years is suffering from duodenal ulcer. Complained of feeling unwell, dizziness. The patient ispale, the pulse was 90 beats per minute, blood pressure 120/70 mm Hg. Article., the frequency of 20breaths per minute. Results of laboratory tests:

CBCErythrocytes 3.3 million / ml, microcytosis, poikilocytosisHemoglobin 80 g / lHematocrit 36%

The color index of 0.6Reticulocytes 1%Leukocytes 7000/mklStab 3%


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63% segmentedEosinophils 2%Basophils 1%Lymphocytes 21%Monocytes 10%Platelets 300 th / mmESR 10 mm / h

Biochemical analysis of bloodTotal protein 75 g / lAlbumin 65%Globulins 35%Urea 7 mmol / lCreatinine 110 mol / lThe total bilirubin 8 mmol / lDirect 1 mmol / lIndirect 7 mmol / lIron 7 mmol / l

Potassium 4.3 mmol / lSodium 140 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What actions are necessary to clarify the diagnosis?

Task 10.The patient has an extensive purulent wound of the right thigh with the level of contamination mikr.kl. 109 /g tissue. Twenty-four hours ago, the development of abscess diagnosed pneumonia. Hectic fever up to 400

C, the pulse was 120 beats per minute, respiratory rate 30 per minute, blood pressure 110/70 mm Hg. ofArt. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 42%Color index 1Leukocytes 20000/mklMetamyelocytes 217% of stab64% segmented



Urea 10 mmol / lCreatinine 200 mol / lThe total bilirubin 20 mmol / lLine 4 mmol / l


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Indirect 16 mmol / lIron 20 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

Urinalysis

Straw-yellow colorpH 6The relative density of 1.025Protein 0.099 g / lGlucose is notBilirubin is notEpithelial cells are absentWhite blood cells are 1-2 in the field of viewRed blood cells in the field of view 7.8Cylinders single hyalineMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. The more complicated for the underlying disease?3. What are the pathological syndromes in a patient?

Task 11.In a patient with acute necrotizing pancreatitis developed complications - retroperitoneal abscess. Onexamination, the patient revealed severe clinical signs of purulent intoxication. Made coagulogram, thefollowing results:

Fibrinogen 8 g / lThe clotting time of 3 minutesProthrombin index of 105%APTT 30 secondsPDF 10 ug / lPlatelets 200 th / mmPlatelet aggregation 15 seconds

1. List the available patient coagulation disorders.2. What is a pathological syndrome developed in a patient?3. The more dangerous the development of this syndrome?

Task 12.In a patient with extensive burns, burn disease during the inspection revealed clinical signs of severeintoxication, respiratory failure, oliguria. Made coagulogram, the following results:

Fibrinogen 8 g / lThe clotting time of 2.5 minutesProthrombin index of 110%APTT 28 secondsPDF 10 ug / lPlatelets 170 th / mmPlatelet aggregation 12 seconds

1. List the available patient coagulation disorders.2. What is a pathological syndrome developed in a patient?


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3. Which stage of the syndrome occurs?

Task 13.In a patient with acute severe hemorrhage on the basis of a gunshot wound to the lower extremity third dayfrom the date of injury appeared hemorrhagic rash. The examination revealed signs of hepato-renal

failure. Made coagulogram, the following results:

Fibrinogen 0.3 g / lClotting time 20 minutesProthrombin index 60%APTT 2 minutesPDF 90 ug / l50 thousand platelets / ml

1. List the available patient coagulation disorders.2. What is a pathological syndrome developed in a patient?

3. Which stage of the syndrome occurs?

Task 14.In a patient with pancreatic cancer resection performed pancreatoduodenal. On the 2nd day after surgerythe patient's condition suddenly deteriorated and there were hemorrhages in the skin, severe dyspnea,oliguria. Made coagulogram, the following results:

Fibrinogen 0.5 g / lClotting time 22 minutesProthrombin index 58%APTT 2 minutes

FDP 100 mg / l40 thousand platelets / ml

1. List the available patient coagulation disorders.2. What is a pathological syndrome developed in a patient?3. Which stage of the syndrome occurs?

Task 15.In a patient after a course of intramuscular injections of complaints appeared for the presence of sharplypainful tumor formation in the right quadrant verhnenaruzhnom gluteal region, chills, headache,weakness. On palpation of tumor formation is determined by the fluctuation. On examination, the patient's

fever of up to 390 C, the pulse was 100 beats per minute, respiratory rate 26 per minute, blood pressure120/80 mm Hg. of Art.Results of laboratory tests:

CBCErythrocytes 4.5 million / mlHemoglobin 140 g / lHematocrit 45%Color index 1Leukocytes 13000/mkl10% of stab66% segmentedEosinophils 1%

Basophils 0%Lymphocytes 20%Monocytes 3%Platelets 300 th / mm


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ESR 35 mm / h

Biochemical analysis of bloodTotal protein 70 g / lAlbumin 50%

Globulins 50%Urea 7 mmol / lCreatinine 100 mol / lFibrinogen 4 g / lThe total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 18 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

1. List available at the patient pathological symptoms.

2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What disease is present in this patient?What is an emergency medical event is shown in this case?5. Describe the tentative status localis in this patient

Task 16.The patient in the early postoperative period, there were the following symptoms: abdominal pain without aclear localization, bloating, vomiting, weakness. Palpation revealed a protective muscle tension throughoutthe abdominal wall. Temperature 38.50 C, pulse 100 beats per minute, respiratory rate 28 per minute, bloodpressure 120/80 mm Hg. of Art. Results of laboratory tests:

CBC

Red blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 50%Color index 1.03Leukocytes 15000/mkl10% of stab70% segmentedEosinophils 1%Basophils 0%Lymphocytes 16%Monocytes 3%Platelets 300 th / mm

ESR 35 mm / h

Biochemical analysis of bloodTotal protein 65 g / lAlbumin 50%Globulins 50%Urea 9 mmol / lCreatinine 150 mol / lFibrinogen 4 g / lThe total bilirubin 10 mmol / lDirect 1 mmol / l

Indirect 9 mmol / lIron 18 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l


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UrinalysisStraw-yellow colorpH 6The relative density of 1.02

Protein 0.099 g / lGlucose is notBilirubin is notEpithelial cells are absentWhite blood cells are 1-2 in the field of viewRed blood cells are 5-6 in the field of viewCylinders single hyalineMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?

3. Which diseases can occur in this syndrome surgery?4. What disease is present in this patient?What is an emergency medical event is shown in this case?

Task 17.The patient weighing 90 kg in the first 3 days after surgery was not indicated enteral administration of fluidsand food. In the postoperative infusion therapy was carried out with the introduction of fluid in a volume of500 ml. At 2 days after surgery, complaints of thirst, dryness of mucous membranes.Reduced skin turgor,pulse 100 beats per minute, blood pressure 100/60 mm Hg. of Art. Results of laboratory tests:

CBCErythrocytes 5.6 million / ml

Hemoglobin 165 g / lHematocrit 60%Color index 1Leukocytes 8000/mklStab 2%60% segmentedEosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 310 th / mmESR 5 mm / h

Biochemical analysis of bloodTotal protein 85 g / lAlbumin 63%Globulins 37%Urea 8 mmol / lCreatinine 130 mol / lThe total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 20 umol / lPotassium 5 mmol / l

Sodium 165 mmol / l

Urinalysis


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Color rich yellowpH 5The relative density of 1.04The protein is absentGlucose is notBilirubin is not

Epithelial cells are absentWhite blood cells are 1-2 in the field of viewRed blood cells are isolated in the preparationThe cylinders are absentMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What remedial measures are shown in the first place?

Task 18.The patient has a long history of duodenal ulcer. In the past 3 months complaint of a feeling of heaviness inthe abdomen, vomiting after eating, dry mouth, weakness, dizziness. Pulse 100 beats per minute, bloodpressure 100/60 mm Hg. of Art. Results of laboratory tests:

CBCErythrocytes 5.3 million / mlHemoglobin 165 g / lHematocrit 60%Color index 0.95Leukocytes 9000/mkl

Stab 2%60% segmentedEosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 310 th / mmESR 5 mm / h


Albumin 63%Globulins 37%Urea 8 mmol / lCreatinine 130 mol / lThe total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 20 umol / lPotassium 4.8 mmol / lSodium 145 mmol / l

Urinalysis

Color rich yellowpH 5The relative density of 1.03


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The protein is absentGlucose is notBilirubin is notEpithelial cells are absentWhite blood cells are 1-2 in the field of viewRed blood cells are isolated in the preparationThe cylinders are absent

Mucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What are the priority activities in this case?

Task 19.The patient in the postoperative period was not carried out infusion therapy. Complaints of dry mouth. Thedecrease skin turgor, dry mucous membranes, heart rate 100 beats per minute, blood pressure 100/60 mm

Hg.of Art. Results of laboratory tests:

CBCErythrocytes 5.3 million / mlHemoglobin 165 g / lHematocrit 60%Color index 1Leukocytes 9000/mklStab 2%60% segmentedEosinophils 3%Basophils 1%

Lymphocytes 25%Monocytes 9%Platelets 310 th / mmESR 5 mm / h

Biochemical analysis of bloodTotal protein 85 g / lAlbumin 63%Globulins 37%Urea 8 mmol / lCreatinine 130 mol / l

The total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 20 umol / lPotassium 3.2 mmol / lSodium 125 mmol / l

UrinalysisColor rich yellowpH 5The relative density of 1.039

The protein is absentGlucose is notBilirubin is notEpithelial cells are absent


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White blood cells are 1-2 in the field of viewRed blood cells are isolated in the preparationThe cylinders are absentMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What are the priority measures needed?

Task 20.The patient in the postoperative period, parenteral introduced a large number of hypertonic solutions. At the4th postoperative day the patient complained of severe headache, ringing in the ears, swelling of thelegs. Pulse 70 beats per minute, blood pressure 150/95 mm Hg. of Art. Results of laboratory tests:

CBC

Erythrocytes 3.6 million / mlHemoglobin 110 g / lHematocrit 30%Color index 1Leukocytes 4000/mklStab 2%60% segmentedEosinophils 3%Basophils 1%Lymphocytes 25%Monocytes 9%Platelets 190 th / mmESR 5 mm / h

Biochemical analysis of bloodTotal protein 60 g / lAlbumin 63%Globulins 37%Urea 3.5 mmol / lCreatinine 50 umol / lThe total bilirubin 10 mmol / lDirect 1 mmol / lIndirect 9 mmol / lIron 15 umol / l


1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. In any surgical diseases may occur this syndrome?4. What are the necessary emergency medical event?

Task 21.The patient, during the 10-year-old suffering from gallstone disease: chronic calculous cholecystitis,complained of persistent pains in the right upper abdomen, nausea. Ill during the day, when the fullbackground of the emergence of well-being noted above complaints. On examination, the skin and visible

mucous icteric painted, pulse 55 beats per minute, blood pressure 120/70 mm Hg. of Art. Results oflaboratory tests:

CBC


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Red blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 42%Color index 1Leukocytes 8000/mklStab 2%


Biochemical analysis of bloodTotal protein 70 g / lAlbumin 63%

Globulins 37%Urea, 5 mmol / lCreatinine 100 mol / lProthrombin index 80%Fibrinogen 1 g / lThe total bilirubin 250 mmol / lDirect 230 mmol / lIndirect 20 mmol / lIron 20 umol / lPotassium 4.8 mmol / lSodium 145 mmol / lAlkaline phosphatase 300 U / LALT 210

AST 160

UrinalysisColor BrownpH 6The relative density of 1.02The protein is absentGlucose is notBilirubin isEpithelial cells are absentWhite blood cells are 1-2 in the field of view

Red blood cells are isolated in the preparationThe cylinders are absentMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. Which diseases can occur this syndrome?4. What actions are necessary to clarify the diagnosis?

Task 22.

The patient, who was on long-term mechanical ventilation in the postoperative period developed acutebilateral pneumonia.In determining the parameters of acid-base status, the following results:

Blood pH 7.0


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The partial pressure of carbon dioxide in arterial blood pCO2 80 mmHgThe partial pressure of oxygen in arterial blood pO2 75 mm HgBase excess BE 3 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. Which diseases in surgical patients with this syndrome can occur?

4. What actions are necessary to correct this condition?

Task 23.The patient on the third day from the onset of the disease was hospitalized in serious condition in thesurgical hospital. In the course of the survey revealed a clinical picture of widespread peritonitis. Indetermining the parameters of acid-base status, the following results:

Blood pH 7.1The partial pressure of carbon dioxide in arterial blood pCO2 30 mm HgThe partial pressure of oxygen in arterial blood pO2 95 mm HgBase deficit BE -22 mmol / lThe level of standard bicarbonate SB 6 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. Which diseases in surgical patients with this syndrome can occur?4. What actions are necessary to correct this condition?

Task 24.The patient, during the 10-year-old suffering from peptic ulcer, 12 duodenal ulcer, stenosis of the outputconditions of the stomach, accompanied by daily repeated vomiting. In determining the parameters of acid-base status, the following results:

Blood pH 7.6

The partial pressure of carbon dioxide in arterial blood pCO2 50 mmHgThe partial pressure of oxygen in arterial blood pO2 90 mm HgBE base excess 14 mmol / lThe level of standard bicarbonate SB 38 mmol / l

1. List available at the patient pathological symptoms.2. What is a pathological syndrome in a patient?3. Which diseases in surgical patients with this syndrome can occur?4. What actions are necessary to correct this condition?

Task 25.The patient twice after gastrectomy performed relaparotomy at the joint failure of the anastomosis and the

ongoing peritonitis.The patient on mechanical ventilation, skin pale with icteric tinge, oliguria, pulse 120beats per minute, blood pressure 85/55 mm Hg. of Art. Results of laboratory tests:

CBCErythrocytes 3.5 million / mlHemoglobin 110 g / lColor index 1Hematocrit 35%Reticulocytes 1%Leukocytes 9000/mkl10% of stab60% segmented

Eosinophils 3%Basophils 1%Lymphocytes 17%Monocytes 9%


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Platelets 170 th / mmESR 30 mm / h


Albumin 45%Globulins 55%Urea 4.5 mmol / lCreatinine 270 mol / lThe total bilirubin 80 mmol / lStraight 10 mmol / lIndirect 70 mmol / lIron 14 umol / lPotassium 4.5 mmol / lSodium 145 mmol / lALT 300AST 320Fibrinogen 1 g / l


Task 26.The patient was admitted for 3 days of onset of clinical peritonitis. At surgery, gangrenous diagnosed withruptured appendicitis, peritonitis. Postoperatively, a serious condition, the patient is pale, complaining ofshortness of breath. An examination of respiratory rate 32 per minute in the lower lungs on both sides areheard moist rales, pulse 120 beats per minute, blood pressure 120/70 mm Hg. of Art., urine output 600 mlper day. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 120 g / lThe color index of 0.9Hematocrit 40%Reticulocytes 1%Leukocytes 12000/mkl12% of stab61% segmentedEosinophils 0%Basophils 1%


Biochemical analysis of bloodTotal protein 55 g / lAlbumin 45%Globulins 55%Urea 15 mmol / lCreatinine 270 mol / l

The total bilirubin 20 mmol / lLine 4 mmol / lIndirect 16 mmol / lIron 15 umol / l


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Task 27.In a patient with diabetes mellitus for the presence of complaints of painful education on the back of theneck, weakness, malaise, fever up to 380 C. When viewed from the back of the neck inflammatory infiltrateup to 1 cm in diameter with a necrotic core in the center. Results of laboratory tests:

CBCErythrocytes 4.5 million / mlHemoglobin 130 g / lHematocrit 43%Leukocytes 12000/mkl

10% of stab61% segmentedEosinophils 0%Basophils 1%Lymphocytes 19%Monocytes 9%Platelets 250 th / mmESR 30 mm / h

1. List available at the patient pathological symptoms.2. What disease is the patient?3. Describe the alleged status localis.

4. What treatment is required?

Task 28.The patient complaints about the presence of sharply painful acinar tumor formation in the left armpit for afew days, the temperature increase up to 37.80 C, the restriction of abduction of his left hand. When viewedfrom the left axillary area inflammatory infiltrate of the merging of several sites up to 6 cm in diameter in thecenter is determined by the fluctuation. Results of laboratory tests:


Hematocrit 45%Leukocytes 11000/mklStab 9%62% segmentedEosinophils 2%Basophils 1%Lymphocytes 19%Monocytes 7%Platelets 300 th / mmESR 25 mm / h


2. What disease is the patient?3. Describe the alleged status localis.4. What treatment is required?


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Task 29.The patient complaints about the presence of sharply painful redness on the right leg and the feeling of heatin this area, raising the temperature to 400 C, chills, headache. The patient heart rate 105 beats per minute,respiratory rate 30 per minute. When viewed in the bright center of the right leg hyperemia and edema withclear margins, there is no symptom fluctuations. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 120 g / lHematocrit 40%Leukocytes 17000/mkl11% of stab62% segmentedEosinophils 0%Basophils 1%Lymphocytes 19%Monocytes 7%Platelets 300 th / mm

ESR 25 mm / h

UrinalysisStraw-yellow colorpH 6The relative density of 1.02Protein 0.099 g / lGlucose is notBilirubin is notEpithelial cells are absentWhite blood cells are 1-2 in the field of view

Red blood cells are 5-6 in the field of viewCylinders single hyalineMucus is notSingle crystals of salt

1. List available at the patient pathological symptoms.2. What disease is the patient?3. Describe the alleged status localis.4. What treatment is required?

Task 30.

In a patient after a course of intramuscular injections in the presence of complaints of painful education inthe right gluteal region, the temperature increase up to 37.70 C. When viewed in the right quadrantverhnenaruzhnom buttocks painful infiltration 8 x 6 cm in the center of the infiltrate revealed a symptomfluctuations. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 120 g / lHematocrit 40%Leukocytes 13000/mklStab 8%62% segmented

Eosinophils 2%Basophils 1%Lymphocytes 20%Monocytes 7%


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Task 31.The patient with grade 3 obesity operated on for acute cholecystitis in verhnesredinnogo laparotomicaccess, complaints of pain in the wound, increasing with movement, headaches, weakness, fever up to38.70 C. On examination, a painful wound around the seal without clear boundaries, occupying the area upto 20 x 30 cm in the center of the seal is determined by fluctuations of the symptom. Results of laboratorytests:

CBCRed blood cells 4,000,000 / mm

Hemoglobin 130 g / lHematocrit 40%Leukocytes 18000/mkl12% of stab62% segmentedEosinophils 1%Basophils 1%Lymphocytes 20%Monocytes 4%Platelets 300 th / mmESR 35 mm / h


Task 32.The patient with a stab wound in the left thigh suddenly appeared in great pain in the left thigh, chills,temperature of 400 C, headache, meningeal symptoms. On examination, the wound on the anterolateralsurface of the left thigh painful seal without clear borders measuring 20 x 15 cm, the skin over them istense, not hyperemic, a symptom of crepitations positive. When X-rays revealed the presence of hip air insoft tissues. Results of laboratory tests:

CBCErythrocytes 3.5 million / mlHemoglobin 110 g / lHematocrit 35%Leukocytes 22000/mkl12% of stab62% segmentedEosinophils 1%Basophils 1%Lymphocytes 20%Monocytes 4%Platelets 200 th / mm

ESR 30 mm / h

Biochemical analysis of blood


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Total protein 55 g / lAlbumin 50%Globulins 50%Urea 10 mmol / lCreatinine 140 mol / lThe total bilirubin 20 mmol / l

Line 4 mmol / lIndirect 16 mmol / lIron 20 umol / lPotassium 4 mmol / lSodium 135 mmol / l

1. List available at the patient pathological symptoms.2. What disease is the patient?3. What is needed surgical treatment?4. Describe the expected picture of the tissue during surgical intervention.

Task 33.The patient complaints about the presence of painful compression of the index finger pads of the right arm,severe pain in the finger wearing a pulsating character, raising the temperature to 380 C. When viewed onthe palmar surface of the distal phalanx of the index finger of his right hand is sharply painful stresseducation, the skin over it hyperemia, skin smoothed image. Results of laboratory tests:

CBCRed blood cells 5,000,000 / mmHemoglobin 140 g / lHematocrit 45%Leukocytes 11000/mklStab 8%


1. List available at the patient pathological symptoms.2. What disease is the patient?3. Describe the alleged status localis.4. What treatment is required? What type of anesthesia is preferred in this situation?

Task 34.Patient 5 days ago injured a finger of the right wrist with a violation of the integrity of the skin. At present,complained of acute pain and swelling of 1 and 5 fingers of the right hand, the impossibility of motion in theright hand, raising the temperature to 380 C, headache, weakness. When viewed from the brush swollen,purple, maximum palpable tenderness in the projection of the flexor tendons of fingers 1 and 5.Results of laboratory tests:

CBCErythrocytes 4.5 million / mlHemoglobin 139 g / l

Hematocrit 45%Leukocytes 13000/mklStab 8%62% segmented


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Task 35.Breast-feeding woman 14 days after birth complained of pain and a feeling of heaviness in the right breast,the presence of seals in its upper part, raising the temperature to 390 C, chills, headache.When viewedfrom the right mammary gland is enlarged, the quadrant is determined verhnenaruzhnom infiltrate withoutclear contours, negative symptom fluctuations.Results of laboratory tests:

CBCErythrocytes 4.1 million / mlHemoglobin 130 g / lHematocrit 42%Leukocytes 12000/mklStab 8%64% segmentedEosinophils 2%Basophils 1%Lymphocytes 20%Monocytes 5%Platelets 300 th / mm

ESR 26 mm / h

1. List the available patient pathological symptoms.2. What disease is the patient?3. Describe the alleged status localis.4. What treatment is required?

Task 36.Breast-feeding woman 10 days after birth complained of severe pain in the right breast, headache, fever upto 400C, chills. When viewed from the right mammary gland is greatly increased, on the skin andverhnenaruzhnom nizhnenaruzhnom quadrants bubbles with hemorrhagic content.In patient number 30 inthe respiratory movements per minute, pulse 130 beats per minute. Results of laboratory tests:

CBCErythrocytes 4.2 million / mlHemoglobin 135 g / lHematocrit 44%Leukocytes 20000/mkl15% of stab60% segmentedEosinophils 2%Basophils 1%Lymphocytes 18%Monocytes 4%



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UrinalysisColor rich yellowpH 5The relative density of 1.02Protein 1 g / lGlucose is not

Bilirubin is notEpithelial cells are absentWhite blood cells are 1-2 in the field of viewRed blood cells are isolated in the preparationThe cylinders are absentMucus is notSingle crystals of salt


Task 37.The patient complaints of sharp pain in the anus during defecation increasing, raising the temperature to380 C. When viewed in the anus for 6 hours is determined by the formation of painful on palpation, apositive symptom fluctuations. Results of laboratory tests:

CBCRed blood cells 5,000,000 / mmHemoglobin 145 g / lHematocrit 46%Leukocytes 16000/mkl

7% stab65% segmentedEosinophils 2%Basophils 1%Lymphocytes 21%Monocytes 4%Platelets 300 th / mmESR 20 mm / h



Task 38.In a patient with severe post-operative period there were complaints about the difficulty in chewing andswallowing, nausea, chills.Temperature 39.40 C. On examination of the parotid gland swelling, painful,there is no fluctuation.Results of laboratory tests:


Hematocrit 40%Leukocytes 18000/mkl7% stab65% segmented


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Task 39.The patient was on penetrating wounds of the chest on the right, hemothorax, wound debridement done,drain the pleural cavity.On the third day drainage of the pleural cavity is removed. On the 6th day of diseaseonset in a patient came to the painful complaints of dry cough, pain in his right side, shortness ofbreath. The patient lies on his right side.Temperature 39.80 C, pulse was 120 beats per minute, thebreathing is shallow, the frequency of 30 breaths per minute. Chest radiography revealed fluid right up to

level 5 edges (due to the rear). Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 40%Leukocytes 20000/mklMetamyelocytes 2%17% of stab58% segmentedEosinophils 2%Basophils 1%


1. List available at the patient pathological symptoms.2. What disease is the patient?3. What data percussion and auscultation should be expected in this patient?4. What is needed an additional method of diagnosis?5. What treatment is required?

Task 40.Patient by the end of the first day of the onset of the disease, on admission to hospital complaints of intensepain around the abdomen. The patient was pale, restless.Low 390S, BP 150/90 mm, the pulse was 120beats per minute, respiratory rate 28 per minute. On palpation determined the protective muscle tensionthroughout the anterior abdominal wall, and symptom-SHCHetkina Blumberg, bowel sounds on auscultationdid not listen. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 40%Leukocytes 20000/mkl

7% stab63% segmentedEosinophils 2%Basophils 1%


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2. What disease is the patient?3. What are the release phase of the disease, and which phase of the disease is possible in this case?4. What is the most accurate method of diagnosing the disease is known to you?5. What treatment is required?

Task 41.A patient with an open fracture of the middle third of the tibia on the left on the 18th day from the date ofinjury noted the resumption of pain in the limbs, the growth of weakness, malaise, headache, fever up to380 C. On examination, marked redness and swelling of the left tibia. On radiographs of the fracture zone isnot fused uzuratsiya bone fragments, a small cavity with the presence of small plate sequesters aroundosteoporosis. Results of laboratory tests:

CBCErythrocytes 4.5 million / mlHemoglobin 140 g / lHematocrit 45%Color index 1Leukocytes 13000/mkl10% of stab66% segmentedEosinophils 1%Basophils 0%Lymphocytes 20%Monocytes 3%



Task 42.

The patient has a history of left upper limb injury in violation of the integrity of the skin in the area of theolecranon. Currently, complaints of pain and swelling in the area of the olecranon on the left, a littlesoreness in the elbow in extension. Temperature 37.50 C. On examination of the olecranon on the left isdefined by a painful swelling, positive symptom fluctuation. On the X-ray band Elbow are nochanges. Results of laboratory tests:

CBCErythrocytes 4.5 million / mlHemoglobin 140 g / lHematocrit 45%Color index 1Leukocytes 10000/mkl

Stab 6%64% segmentedEosinophils 4%Basophils 1%


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2. What disease is the patient?3. Describe the alleged status localis.4. What is the diagnostic event will confirm the diagnosis?5. What treatment is required?

Task 43.The patient has a history of trauma of the left knee 10 days ago. Currently, complaints of severe pain andswelling of the left knee joint, limitation of motion in the joint, the temperature of 38.50 C, chills,sweating. On examination, his left leg bent in the knee joint is a painful swelling, a symptom is determinedby fluctuations in the balloting and the patella. On radiographs of the left knee joint space expansion.Results of laboratory tests:

CBC

Red blood cells 4,000,000 / mmHemoglobin 130 g / lHematocrit 41%Color index 1Leukocytes 18000/mkl10% of stab64% segmentedEosinophils 1%Basophils 1%Lymphocytes 20%Monocytes 4%


1. List available at the patient pathological symptoms.2. What disease is the patient?3. Describe the alleged status localis.4. What is the diagnostic event will confirm the diagnosis?5. What treatment is required?

Task 44.In a patient with varicose veins of the left lower extremity complaints in the presence of ulcers in the innerankle on the left. On examination, - a deep maloboleznennaya ulcer in the left medial malleolus with a

moderate amount of purulent discharge.Results of laboratory examination revealed no pathology.


Task 45.In the words of the patient 2 days ago was wounded by shrapnel glass. When viewed from the front of theright thigh there is a linear wound a length of 5 cm wound edges are smooth, not smashed, gape. From thewound enters the dark blood of non-pulsed jet. Skin around not changed.

1. Determine the type of wound.

2. Determine the type of bleeding.3. Determine the phase of wound healing.4. What treatment is necessary in this situation?5. What type of wound healing can be expected?


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Task 46.In the words of a patient is injured four days ago. When viewed from the outer surface of the upper third ofthe forearm has a wound measuring 5 x 3 cm wound is irregular in shape, with irregular contours, edgessmashed, with areas of necrosis and hemorrhage. From the entry wound indicated purulent. The skinaround the wound hyperemic, tense. The wound is painful on palpation.

1. Determine the type of wound.2. What kind of complication occurs?3. Determine the phase of wound healing.4. What treatment is necessary in this situation?5. What type of wound healing can be expected?

Task 47.The patient was operated on for acute gangrenous appendicitis, perforated. On the 4th day of thepostoperative period there were severe pain in the wound area, pyrexia up to 390 C at night with a fever. Inthe projection of the wound is marked hyperemia and edema of the skin, extending to the lateral surface ofthe anterior abdominal wall.On palpation the seal is determined without clear boundaries sizes up to 20 x 10

cm in the center of the seal is determined by the positive symptom fluctuations. On palpation of the woundis marked soreness and receipt of a moderate amount of purulent discharge between the stitches.

1. What is a postoperative complication in a patient?2. Determine the phase of wound healing.3. What primary therapeutic measures should be taken in this situation?4. What type of wound healing can be expected?

Task 48.The patient operated on for acute gangrenous appendicitis, perforated, local peritonitis, on the third daythere was festering wound. On the 10th day post-operative period following the complex of therapeuticmeasures in the right iliac region has a wound the size of 10 x 3 cm, a depth of 3 cm Skin around the

wound is not changed.Wound edges are smooth, the sides and bottom are made of bright pink granulationtissue, secretions from the wound there.Palpation of the edges of the wound painless.

1. Determine the type of wound on the circumstances of its receipt.2. Determine the phase of wound healing.3. What treatment is necessary in this situation?4. What type of wound healing can be expected?

Task 49.The patient, operated on the tangential gunshot wound to the middle third of the right shoulder, madePECVD without suturing the wound. At the 8th postoperative day, the outer surface of the middle third of theright shoulder there is a wound measuring 5 x 1.5 cm, a depth of 2 cm around the wound Skin does not

change. Wound edges are smooth, the sides and bottom are made of bright pink granulation tissue,secretions from the wound there. Palpation of the edges of the wound painless.

1. Determine the type of wound.2. Determine the phase of wound healing.3. What treatment is necessary in this situation?4. What type of wound healing can be expected?

Task 50.60 days ago on gastric ulcer perforation, diffuse peritonitis underwent laparotomy.Currently, the midline ofthe xiphoid process to the navel there is a wide shiny pink scar with irregular contours, rising above thesurface of the skin. On palpation of the scar solid consistency, is soldered to the surrounding tissues.

1. Determine the phase of wound healing.2. The more complicated during the wound healing process?3. What treatment is necessary in this situation?


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Task 51The patient received 33 years in the surgical department with complaints of weakness, dizziness,palpitations, vomiting, bloody, loose stools black. On examination, pallor and cyanosis of the lips,hemodynamic changes (Ps-100 ud.v 1 min, blood pressure -95/60 mm Hg). In the clinical analysis of blood

Hb 67 g / l, Ht 28. At endoscopy revealed an ulcer of 12 duodenal ulcer with signs of bleeding took place. Atthe time of the inspection is not bleeding.1. Does the patient in the transfusion of red blood cells?2. Specify the sequence of your actions if necessary transfusion.

Task 52The patient aged 58 suffering from long time developed liver cirrhosis complication - bleeding fromesophageal varices. Clinical and laboratory studies indicate a severe degree of blood loss with thedevelopment of hemorrhagic shock and disseminated intravascular coagulation1. What are blood components requires the patient?

Task 53The patient is 42 years old in connection bleeding started infusion of red blood cells.During the bloodtransfusion marked pain in the chest and back, feeling the heat, short-term stimulation, shortness of breath,difficulty breathing, facial flushing, heart rate, 110 beats. In 1 minute., Blood pressure 75/40 mm Hg1. With what may be due to the deterioration of the patient?2. Your actions.

Task 54You brought the patient to 30 years, after 1 hour after the accident. His condition was grave, confusedmind. Heart rate - 130/min, blood pressure -80/60 mm. mercury. of Art., CH.D.D - 28 min. Skin and visiblemucous membranes pale. No skin lesions. Over the entire right half of chest auscultation is defined sharplyweakened breathing, and on percussion - deadened sound, even in the supine position.

1.Sformuliruyte preliminary diagnosis.2.How additional methods you designate to clarify the diagnosis?

Task 55Male 40 years old construction worker fell from a height of 2 meters and hit the left side of the concreteblock. Wounded in the mind.Restless. Complaints about the lack of air.Respiration is rapid,shallow. Cyanosis person. Heart rate - 96/min, blood pressure -100/60 mm. mercury. of Art., CH.D.D - 26min. There is a deep wound of the left half of the chest. Severe subcutaneous emphysema of the torso,head and upper extremities.1. What complications have developed in a patient with a wound to the chest?2. Specify arrangements for first aid.

Task 56

Patient P., 18 years old dropped curbs left side when jogging on physical education.Appealed to the clinic ofthe Institute and was released with a diagnosis of "contusion left costal arch." Ultrasound and x-rays werenot met. During the troubled days of dull pain in the left upper quadrant. You appealed to the emergence ofsharp pain in the left half of the abdomen, weakness, dizziness, difficulty breathing in horizontalposition. The general condition of a heavy, pale skin. A / D 90/50 mm Hg HR 100 in 1 min. Hb 78g / l. Ht26%.Abdomen painful divisions in the left, a symptom-SHCHetkina Blumberg doubtful.1. The diagnosis?2. What are the mistakes made in the prehospital period?3. Your medical event?

Task 57At the crash site found the victim with a wound to the abdomen. Moans. At the anterior abdominal wallwound with extensive bowel loops dropped out. The pulse is weak.The general condition of heavy

1.Opredelite nature of injury?2. What is the procedure of first aid?


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Task 58For you to hospital by ambulance transported the patient is 68 years with complaints of pain in the middlethird of the right thigh.Anamnesis revealed that about 2 hours ago ill, slipped on the street, in the fall hit thecurbs. When conducting a clinical examination is noteworthy limb deformity in the middle third of the rightthigh, a sharp pain on palpation, the inability to axial load.1. What disease you suspect a patient?2. What tool do you plan to conduct a survey?

3. What kind of conservative therapy and surgical treatment can be used in the treatment of this patient?4. What are the complications of this disease can occur in a patient?

Task 59When you contact a doctor the patient notes the presence of edema in the left ankle, severe pain whenwalking. Anamnesis revealed that some days ago, a patient on a ladder sprained right foot. Whenconducting a clinical examination of the patient's attention is drawn to a pronounced swelling in the ankle,pain on palpation, abnormal mobility of the foot in abduction to the outside.1. What disease you suspect a patient?2. What tool do you plan to conduct a survey?3. What treatment can be applied in this patient?4. What are the complications of the disease may occur in this patient?

Task 60To you the patient is taken to hospital with complaints of the presence of nausea, vomiting, headache, briefloss of consciousness. Anamnesis revealed that about 3 hours ago, the patient was in an accident. Wheninterviewing the patient the circumstances of injury does not remember.1. What disease you suspect a patient?2. What tool do you plan to conduct a survey?3. Consultations of experts which shows this patient?4. Which group of drugs must be applied in the treatment of this patient?5. If there are any complications the patient showed an emergency surgery?

Task 61In the hospital in critical condition brought a patient who fell from a window four floors. The patient isunconscious, the contact with it is not possible. On examination, drew the instability of central

hemodynamics, presence of peripheral paresis of the lower extremities.1. What disease you suspect a patient?2. What tool do you plan to conduct a survey?3. Which treatment strategy can be selected for this patient?4. Determine prognosis of this disease?

Task 62In the hospital the patient is transported from the accident scene. Anamnesis revealed that the patientduring a crash while driving, the collision knocked the chest on the steering wheel. On examination, thepatient noted the presence of severe shortness of breath, rapid breathing, the presence of tachycardia,decreased blood pressure to 100 mm Hg.column. Palpation of the right and left half of chest sharply painful,when determined by the tympanic percussion sound over right lung field, the breath does not listen.

1. What disease you suspect a patient?2. What tool do you plan to conduct a survey?3. What kind of treatment in this patient is shown?

Task 63You are planning the implementation of the planned surgery on the right-sided inguinal hernia.1. How will you spend preparing the operative field for surgical intervention?2. Coke kind of kantominatsii most likely during this surgery?3. Which set of measures to prevent possible injury suppuration you can offer?

Task 64

You went to the patient with the clinical picture of peritonitis of appendiceal origin, confirmed by the data oflaboratory and instrumental examination. You are planning the implementation of emergency surgery:laparotomy, appendectomy and drainage of the abdominal cavity.1. How will you spend preparing the operative field for surgical intervention?


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2. Koka type of injury is most likely kantominatsii during this surgery?3. Which set of measures to prevent possible injury suppuration you can offer?

Task 65In a patient with purulent wound has clinical symptoms of cellulitis of the right thigh?1. What would be a complex surgical treatment of wounds, and what the main purpose of her?

2. What types of additional treatment of the wound can be used during the surgical treatment?3. What types of wound drainage are most preferred in the treatment of this patient?4. Identify the indications for antibiotic therapy in this patient, what kinds of antibiotics can be used?

Task 66To you the patient is admitted with a gunshot wound to his left shoulder. Anamnesis revealed that thepatient has received this injury for about 2 hours ago.1. What would be a complex surgical treatment of wounds, and what the main purpose of her?2. What types of additional treatment of the wound can be used during the surgical treatment?3. What types of wound drainage are most preferred in the treatment of this patient?4. What you'll end up surgery?

Task 67In analyzing the results of treatment of patients undergoing surgery for abdominal organs in the intensivecare unit registered a high incidence of pneumonia.1. What are the most likely reasons for the high incidence of postoperative pneumonia in patients operatedon?2. Define a set of measures aimed at reducing the incidence of postoperative pneumonia.

Task 68A patient aged 52 to 15 years suffering from duodenal ulcer disease. Repeatedly passed courses antiulcertreatment as an outpatient and inpatient. In the past 3 months along with pain in the epigastric andheartburn was celebrating vomiting eaten food, lost weight by 5 kg. On examination, malnutrition,decreased skin turgor. The examination revealed narrowing of the outlet of the stomach in violation of the

evacuation of gastric soderzhimogo.Hb-160 g / l., L-thousand eight-ESR 30 mm / h, total protein albumin-51-22. The patient will have surgery.1. How to prepare the patient for the upcoming surgery?

Task 69The patient with cancer 58 years lower third of the esophagus, liver metastases and impaired passage offood into the stomach.During the last three months has lost 10 kg.These laboratory investigations: Hb-160 g/ l., L-thousand eight-ESR 30 mm / h, total protein albumin-51-22.1. What is the nutritional need of the patient?2. Select the optimal route of administration of nutrient mixtures.3. What nutrient mix will you use?

Task 70The patient after gastrectomy performed twice relaparotomy. Regarding the failure of seams anastamozaand develop as a result of peritonitis. There are signs of the functions of digestion and absorption in theintestine. In this regard, the patient showed an parenteral nutrition.1. List the major drugs that should be included in the total parenteral nutrition patients2. What are the complications of parenteral nutrition should be expected during parenteral nutrition

Task 71To you the ambulance brought the patient is 59 years old. In the mind, adinamichen complains ofabdominal pain, pyrexia up to 390S. The state is closer to heavy. Skin normal color, dry. Breath ofspontaneous frequency of 24 breaths per minute, auscultatory breath is held in all departments, wheezingdoes not listen. Heart sounds are muffled, rhythmic pulse of 115 beats per minute. BP = 120/80 mmHg Inspection of the abdomen, see photos. Palpation: pain in the postoperative scar, a symptom-

SHCHetkina Blumberg negative. Auscultatory peristaltic active noise and the noise of friction of theperitoneum does not listen. Urine output was adequate, independent chair, designed, normal color on theday of admission.


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1. List available at the patient pathologicalsymptoms.2. What is a pathological syndrome in a patient?3. Your diagnosis?4. Your diagnostic and treatment activities and their timing?

task 72You asked the patient to 61 years. Closer toa satisfactory condition. Complaints of pain in the postoperativescar and redness of the skin in this area. Operated on for perforatedgastric ulcer 6 months ago. The bodytemperature of 37.40 C. Skin normal color, dry. Breath of spontaneous frequency of 18breaths per minuteand auscultation the breath is held in all departments, wheezingdoes not listen. Heart sounds aremuffled,rhythmic pulse of 89 beats per minute. BP =200/110 mm Hg Inspection of the abdomen,

see photos. Palpation: pain in the flushing of the skin, deep palpation painless,symptom-SHCHetkina Blumberg negative.Auscultatory peristaltic active noise and the noise of friction of theperitoneum does not listen. Urine output was adequate,independent chair, designed, normal color on theday of admission.

1. List the available patient pathological symptoms.2. Describe Status localis.3. Your diagnosis?4. Your diagnostic and treatment activities and their timing?


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Task 73To you the patient turned 78 years old.Complaints of pain in the back of the neck. In history: a long timesuffered from diabetes, 2-3 weeks ago, said the appearance of solid education on the back of the neck,which gradually increased in size, with increasing pain in the area. Medical care are not treated, nottreated. On the day of admission noted fever, chills, severe weakness, purulent discharge from theformation of the back of the neck. When you receive a state of moderate severity. The body temperature of39.40 C. Skin normal color, dry. Breath of spontaneous frequency of 21 breaths per minute, auscultatory

breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmic pulse of 100beats per minute. BP = 160/80 mm HgTongue dry, coated with white bloom. The abdomen is not swollen,soft and painless on palpation, peristaltic noises are heard. A chair-shaped, normal color. Adequate urineoutput.

1. List the available patient symptoms and syndrome.2. Describe Status localis.3. Your diagnosis?4. Your diagnostic and treatment activities and their timing?

Task 74You asked the patient to 71 years. With complaints of pain in the right gluteal region, chills, headache,weakness, fever up to 390S. In the history of the patient held a course of anti-inflammatory therapy byintramuscular injection on spinal osteochondrosis with radicular syndrome. On examination, the state iscloser to a heavy, normal skin color, dry. Breath of spontaneous frequency of 26 breaths per minute,auscultatory breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmicpulse of 110 beats per minute. BP = 160/90 mm Hg The abdomen is not swollen, soft, painless, no

peritoneal symptoms, active peristaltic noises. Urine output was adequate, independent chair, designed,normal color on the day of admission. Locally: see photos, palpation of congestion in the center section ofthe softening of tissues.On admission the patient made a clinical analysis of blood and blood chemistry.Results:Erythrocytes 4.2 million / ml, total protein 70 g / l;hemoglobin of 135 g / l, urea 8 mmol / l;hematocrit 43%, creatinine 100 micromol / l;a color indicator, total bilirubin 10 umol / l;13000/mkl leukocytes, fibrinogen of 4 g / l;stab 10%, potassium 4.8 mmol / l;segmented 66%, sodium 145 mmol / l.1% eosinophils;0% basophils;lymphocytes, 20%;3% monocytes;


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300 thousand platelets / ml;ESR 42 mm / h

1. List the available patient pathological symptoms. 2. Describe Status localis. 3. Your diagnosis? 4. What is an

emergency medical event is shown in this case? task 75 You brought the patient to 36 years, with complaints of mild

pain in the left ankle, a common weakness. From history we know that about a month ago there was a long time

outdoors in temperatures below-50C while intoxicated without shoes on his left leg. When you receive locally, see

photos.

1. Presumptive diagnosis?2. What are the possible formation of a line of demarcation in this pathology?3. Your treatment policy

task 76You asked the patient to 66 years. A few days before admission, felt unwell, weakness, loss of appetite,diffuse muscle pain. On the eve of receipt of the eveningsaid the rise in temperature to 40.10 C andchills. Inthe morning there were sharp pains, and the bright redness of the right tibia.Appealed to the clinic in thecommunity, local doctor sent the patient for treatment inhospital. When you receive a state ofmoderateseverity. Skin normal color, dry.Breath of spontaneous frequency of 18breaths per minuteand auscultation the breath is held in all departments, wheezingdoes not listen. Heart sounds aremuffled,rhythmic pulse of 95 beats per minute. BP =150/80 mm Hg Tongue dry, coated with whitebloom. The abdomen is not swollen, soft andpainless on palpation, peristaltic noises are heard. A chair-shaped, normal color.Adequate urine output. Locally, see photo.


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1. Describe Status localis.2. Presumptive diagnosis?3. Your medical tactics.

task 77You brought the patient to 68 years. Withcomplaints of back pain, fever. In history: 2 weeks beforeadmission to the skin of the back reddish swelling appeared, whichgradually increased in size, then itsprojectionappeared multiple bubbles with the accumulation of pus, the generaldeterioration, fever upto 390S, forcing the patient to call a team "Ambulance , "whichbrought to the hospital. When you receiveastate closer to the heavy. Skin normal color, dry. Breath of spontaneous frequency of 25breaths perminute, auscultatory breath is held in all departments, wheezing does not listen. Heart sounds aremuffled, rhythmicpulse of 110 beats per minute. BP = 160/80mm Hg Tongue dry, coated with whitebloom.The abdomen is not swollen, soft andpainless on palpation, peristaltic noises are heard. A chair-shaped, normal color.Adequate urine output. Locally, see photo.


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1. List the available patient symptoms andsyndrome.2. Describe Status localis.3. Your diagnosis?4. Your diagnostic and treatment activities and their timing?

task 78

To you the patient turned 16 years old.Complaints of swelling of the face, left eye, a painful education in theleft temporal region.In history: 5 days ago in the left templeappeared "pimple" that thepatientthemselves squeezed out, and thenappeared the above complaints. When you receivea state close to satisfactory. The body temperature of 37.40 C. Skin normal color, dry. Breathof spontaneous frequency of 16 breaths per minute, auscultatory breathis held inall departments, wheezing does not listen. Heart sounds are muffled, rhythmicpulse of 89 beats perminute. BP = 110/70mm Hg The language of "pure" wet. The abdomen is not swollen, soft and painless onpalpation, peristaltic noises are heard. A chair-shaped, normal color. Adequate urine output. Locally, seephoto.

1.Describe Status localis.2. Your diagnosis?3. Your diagnostic and treatment activities and their timing?

Task 79You asked the patient to 52 years for the surgical treatment - cholecystectomy on the performance ofgallstone disease. The patient's condition is satisfactory. BP 120/80 mm Hg Pulse 78 beats. per minute. 2months ago, suffered a heart attack.In what time frame you will recommend the implementation of a surgical operation?What additional diagnostic methods should be used to determine the degree of risk the surgery?

Task 80To you the patient turned 58 years old. He was concerned about pain in the left lower limb, resulting inwalking and going in alone.Without the pain can go 1000 meters.For what disease is characterized by such symptoms?What to pay attention when examining a patient?What additional methods you prescribe?

Task 81The patient in the first day after surgery for tumors of the abdominal cavity of the total welfare of a suddenthere was shortness of breath, chest pain. On examination, cyanosis of the face is determined, swelling ofthe neck veins.To honor the possible complications?

What studies should be carried out to clarify the diagnosis?

Task 82


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Your patient is 62 years old will have surgery for cancer of the colon.What methods of prevention of deep vein thrombosis will you use?

Task 83Your patient will have surgery.What are the issues you must discuss with him to get the consent for surgery?

Task 84Your patient to be transfused.What are the issues you must discuss with him to get consent for its implementation?

Task 85Your patient will gastroscopy.What are the issues you must discuss with him to get consent for research?

Task 86Your patient will have a laparoscopy.What are the issues you must discuss with him to get the consent for surgery?

Task 87Your patient will have elective surgery for abdominal organs. Previously, the patient underwent mitral valvereplacement and receives indirect anticoagulants. INR is 3.0.The risk of any complication is most likely?What kind of correction you make in therapy?

Task 88On examination, the patient with cancer of the stomach you find enlarged lymph nodes in the leftsupraclavicular region.What additional methods you prescribe?What are the most likely treatment option.

Task 89An examination of a patient with gastric cancer you have found an increase in the size of the stomach. Forpercussion dullness identified in sloping areas abdomen.What are the possible reasons for these deviations.Determine the patient's treatment options.

Task 90Your patient will have elective surgery - resection of the colon.What is the preoperative preparation you assign?

The task of 91 patients with colon cancer you mentioned yellowness of the skin and sclera.What are the most likely cause discoloration of the skin and sclera.What additional methods you prescribe?Indicate the most likely treatment option for patients.

Task 92Your patient needs surgery. However, the patient does not consent to its executionYour next steps?

Task 93Are you a doctor patient N.

What kind of information on health status and in what form you should give to his family?

Task 94


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Your patient will have surgery for peritonitis.The patient's condition serious. BP = 100/50 mm Hg Pulse was120 beats. per minute.What is the preoperative preparation should be undertaken to reduce the risk of surgery?

Task 95In a patient with multiple injuries noted increased bleeding and mucosal sites of injections.With what may be associated with these symptoms?

What additional methods you prescribe?

Task 96Your patient will have elective surgery for abdominal organs. With regard to coronary heart disease patientsreceive aspirin.What complication is most likely?What kind of correction you make in therapy?

Task 97You came to the patient with profuse uterine bleeding continued. BP = 110/70 mm HgPulse 110 beats. perminute. In the study showed: hemoglobin 90 g / l. Fibrinogen - 1.0 g / l. Platelets were 100 x 103 / ml. APTT

- 40 sec.At what point abnormal hemostatic coagulation parameters?What kind of drugs, and in what order you will use in the treatment of this patient?

Task 98Your patient needs operative treatment for narrowing of the output of the stomach. Within 2 weeks thepatient noted vomiting and has lost 8 kg. The patient noted decreased urine output, 4 days there was nochair.What are disorders of homeostasis in this patient and what are they related?What is the preoperative preparation necessary to conduct a patient to reduce the risk of surgicaltreatment?Based on what criteria you judge the effectiveness of training?

Task 99To you the ambulance arrived from outside the patient is unconscious, it is known that around 6:00 he wasin the cold. When you receive a very severe condition. Skin pale, cold to the touch, dry. Breathing shallow,carried out in all departments, BH = 21 min.Heart sounds are muffled, arrhythmia, bradycardia to 58 beatsper minute. BP = 60/20 mm Hg The abdomen is not swollen, weakened peristaltic noises.1. What caused the patient's condition, your diagnosis?2. What research is needed to produce?3. What are the therapeutic measures and their sequence?4. List the potential complications and methods for their prevention.

Task 100.

To you the ambulance brought a patient from a burning apartment. In conscious, listless, adinamichen,drowsy, complained of intense pain in his hands, stomach, thirst, dry mouth.The skin of both arms, the fronthalf of the body hyperemic, with areas of blistering from 2.0 to 15.0 cm in diameter, filled with serous fluid,the rest of the body, pale skin.Spontaneous breath, tachycardia to 110 beats per minute, pulse weakfilling. BP 100/70 mm Hg The abdomen is not swollen, peristaltic noises active. Rectal temperature of 400C.1. Your diagnosis?2. Where should the patient be hospitalized?3. What are the therapeutic measures and their sequence?4. List the potential complications and methods for their prevention.

Task 101To you turned 30 years old patient complaining of pain in both feet, fever to 38.5 . From history we know

that 2 days ago was a long time outside in wet shoes with air temperature, 4 C. 3. Arriving home, said paleskin of both feet, tingling in the fingers of both feet, numbness, until the complete lack of sensitivity; warmedcold feet in hot water.In the morning pointed to the increase in body temperature 38oS, chills, sharp painand swelling of both feet, the appearance of blisters with serous-hemorrhagic content on the fingers and


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back of both feet, forcing the patient to contact the hospital.1. Presumptive diagnosis?2. Describe the local status.3. Your medical tactics.4. What are the errors in the actions of the patient do you find?

Task 102You brought the patient to 50 years old in serious condition, complaining of pain in the right ankle, generalweakness, thirst, fever to 39.5 . From history we know that about a month ago there was a long timeoutdoors in temperatures below-50C while intoxicated without shoes on the right foot. On admission thepatient can not rely on the right foot, a foot of black to the level of the ankle, where there is a clear line ofdemarcation formed. The right lower leg swelling, skin in the lower third of the hyperemic.1. Presumptive diagnosis?2. Your medical tactics.3. What are the possible formation of a line of demarcation described in the pathology?

Task 103

To you turned 20 years old patient complaining of pain in the first finger of his left foot. Concerned about thepain in one and a half to 2 weeks. On examination, the nail phalanx of a finger of the left foot swelling,hyperemic skin on the medial surface. In the area of the nail shaft in the medial corner of the nail plate aregipergranulyatsii, partially concealing it. In this zone there is detachment of the nail shaft with theaccumulation of pus underneath.Area sharply painful on palpation.1. Your diagnosis?2. Surgical approach, type of anesthesia?3. After the operative management of patients, prevention of this disease?

Task 104At 4:00 in the morning to your neighbor, turned 57 years old with complaints expressed, arching pain in fivefinger right hand, chills, a sharp rise in temperature to 39oS. From the words about a week ago while

working in the garden injures thumb piece of glass. Medical care did not address, home processed "wound"with a solution of iodine. On examination, five finger right hand sharply increased in size, skin hyperemic,with the spread of congestion on the palmar surface of the wrist to wrist. Finger in the "forced" position,bent, movements are limited in scope because of the sharp pain, palpation of the thumb and wrist to theulnar surface of the almost impossible, sharply painful.1. Presumptive diagnosis, and your actions?2. The required volume of the patient survey?3. What is the treatment policy for this pathology?

Task 105

To you the patient turned 52 years old, suffering from pain in his right leg calf muscles when walking,increased sensitivity to cold feet. Without pain it can take up to 150 mOn examination, the skin pale legs, cool to the touch. Pulsation is defined only in the right groin. In thepopliteal artery and arteries of the rear foot is not defined. The left leg is determined by the ripplethroughout.1. What disease you expect?2. What are the methods you recommend?3. What treatment options are possible in this situation?4. Enter some basic medicines.

Task 106You asked the patient to 38 years. 3 days ago she had a pain and redness on the medial surface of thetibia. Self-applied hot compress. Redness and pain spread to the medial surface of the thigh.

When viewed on the tibia are visible varicose veins and flushing of the skin, apply to the medial surface ofthe thigh. Palpable in these zones is determined by the pain, tight bands.1. What disease you expect?2. What are the diagnostic methods will you use?


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3. What is the treatment policy?

Task 107In patient 62 years of age undergoing surgery resection of the sigmoid colon for cancer on the 5th day afteroperation there was tenderness in the calf muscles of the left leg, swelling of legs and thighs.On examination, marked cyanosis of the feet.The pulsation of the arteries is defined on all over the limb.1. What complications have developed in a patient?

2. What is the threat it represents?3. What are the methods of diagnosis you take?4. What treatment you prescribe?5. What preventive measures should be conducted before, during and after surgery?

Task 1083 days ago, the patient pricked palmar surface of the ungual phalanx II finger of the left wrist. After 2 days,became concerned about severe, throbbing pain in the finger. On the eve before admission to hospitalbecause of severe pain in the strong arching finger did not sleep all night.When you receive a t - 37.6, nail phalanx of the left hand fingers II swelling on the palmar surface of themarked flushing of the skin.1. What is the nature of the disease?

2. What additional research can be done?3. The proposed type of treatment.

Task 109The patient 30 years over 10 years has diabetes type I. About 3 months ago he appeared at the foot of thephenomenon of intermittent claudication, and 2 weeks ago, I have pain in the finger of his right foot and nailphalanx of his ulcer appeared.When viewed from the right lower leg has a marble color, the distal part of foot bluish-purple color withlymphangites phenomena.Pulse on the arteries greatly weakened.Tactile, pain, temperature sensitivityabsent in both feet and right leg.1. What is the complication of the disease in a patient?2. What is the need to conduct further examination?

3. How should the patient be treated?

Task 110To you turned 60 years old patient with complaints about the presence of a wound on the left foot and thephenomenon of intermittent claudication.On examination revealed an ulcer on the plantar surface of the left foot measuring 2 x 3 cm on the pulse ofthe arteries of both feet dramatically weakened. Showed a reduction in tactile sensitivity and pain sensitivityof both feet to the level of the ankles. According to the Doppler was a sharp weakening of the blood flow inthe arteries of both Glen and feet. According to laboratory studies revealed the presence of sugar in theurine and 9.6 mM hyperglycemia \ l.1. What disease is the patient?2. What is the treatment policy for this pathology?

Task 111When repairing the victim was hit electrical household electric. The consciousness of the patient isabsent. There acrocyanosis. There is no pulse at the carotid arteries. On both hands there were traces ofburning.1. What is the nature of defeat?2. What is the sequence of first aid?

Task 112As a result of an automobile accident the driver's lower limbs were crushed by a car engine car. Within 2hours of free limb was not possible. Skin pale patient. Complaints of weakness and nausea. Pulse 100

beats per minute. Blood pressure is 100 \ 60 mm Hg. of Art. The front thighs are visible indentations of thelongitudinal compressive parts of the engine.1. What kind of damage is the patient?2. What are the sequence and nature of first aid?


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Task 113The patient with diabetes regarding its existing polyps of the colon is supposed to endoscopic removal. Inthis connection it is recommended for 5-6 days, compliance with sparing diet. One day before the procedurethe patient refused to complete the meal.Suddenly, the patient's condition deteriorated. Marked by loss ofconsciousness, which was preceded by excessive sweating, palpitations, psychomotor agitation,pallor. Systolic blood pressure 80 mm Hg. of Art. Pulse 98 beats per minute, blood glucose - 2.8 mmol \ l.

1. What is the cause of the condition of the patient?2. What caused it?3. What are the therapeutic measures are indicated for relief of this disease?

Task 114Patient 48 years operated on for acute destructive cholecystitis complicated by peritonitis. Performedcholecystectomy and drainage of the abdominal cavity. The early postoperative period with symptoms ofmoderate paresis of the intestine, which effectively stoped the use of drug stimulation.But by the end of 4days after surgery the patient's condition deteriorated there was growing bloating, cramping pain around thestomach, stopped to withdraw gases, joined nausea and vomiting, and marked with signs of endogenousintoxication.1. What is the complication of early postoperative period occurred in this patient?

2. What are the possible causes of this complication in the early postoperative period?3. What methods will allow further investigation to determine the diagnosis?4. What is the nature and extent of necessary medical action?

Task 115A man 45 years was performed appendectomy and abdominal drainage in the right iliac region over thegangrenous appendicitis. On the 9th day after the operation of the drainage canal noted receipt of enteralcontents. The patient's condition of medium gravity, t-37,2-37,5. abdomen is soft, slightly painful in thesurgical wound. No peritoneal signs. Independent chair. In finding the silicone drainage channel depth of10-12cm, which stands for liquid intestinal contents. The skin around the channel with the signs ofmaceration.1. What is the nature of postoperative complications?2. What are the etiology and pathogenesis of complications?

3. Required additional research methods.4. Principles of medical and operational benefits.

Task 116The patient at the end of the first days after appendectomy performed there was severe weakness,dizziness.On examination, marked pallor, tachycardia, drop in blood pressure. For percussion, and according to theultrasound study in sloping areas of the abdominal cavity is defined by the presence of free fluid.1. What explains this state of the patient?2. What additional diagnostic methods should be applied?3. What is the treatment policy?

Task 117To you turned 25 years old patient complaining of acute abdominal pain. You are diagnosed with "Acutephlegmonous appendicitis, peritonitis, local," and offered the patient an emergency operation. From thepatient refused the proposed surgery.1. Your next steps?

Task 118Are you a doctor patient 60, who on examination reveals cancer of the colon.1. What information about the health of you give to the patient, his relatives, friends, co-workers?

Task 119Are you a doctor patient 62 years old, who has to surgery for gastric cancer.

1. What issues you should discuss with the patient to obtain informed consent for surgery?

Task 120You went to a patient 42 years with a clinical picture of gastrointestinal bleeding. The general condition of


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the patient of moderate severity. AD 110 \ 70 mm Hg. of Art. Hb - 60 g \ l. Ps - 110 beats per minute. Atgastroduodenoscopy revealed a duodenal ulcer, which marked the edge of the red blood flow. Bleedingstopped clipping of the vessel.1. Make a plan for infusion - transfusion therapy aimed at compensation for blood loss.

Task 121The patient is 58 years old, suffered a gastro - intestinal bleeding, requires transfusion of packed red blood

cells.1. What information do you need to provide to the patient prior to transfusion?2. Specify how your actions during the transfusion?

Task 122.Breast-feeding woman 14 days after birth complained of pain and a feeling of heaviness in the right breast,the presence of seals in its upper part, raising the temperature to 39 C, chills, headache.When viewedfrom the right mammary gland is enlarged, the quadrant is determined verhnenaruzhnom infiltrate withoutclear contours, negative symptom fluctuations.Results of laboratory tests:

CBCErythrocytes 4.1 million / ml stab 8% Lymphocytes 20%

Hemoglobin 130 g / l Segmented 64% Monocytes 5%Eosinophils Hematocrit 42% 2% Platelets 300 th / mmLeukocytes 12000/mkl Basophils 1% of the erythrocyte sedimentation rate 26 mm / h

1. List the available patient symptoms.2. Describe the alleged status localis.3. What disease is the patient?4. What additional diagnostic methods are needed?5. What treatment is required?

Task 123Breast-feeding woman 10 days after birth complained of severe pain in the right breast, headache, fever to40 C, chills. When viewed from the right mammary gland is greatly increased, on the skin and

verhnenaruzhnom nizhnenaruzhnom quadrants bubbles with hemorrhagic content.In patient number 30 inthe respiratory movements per minute, pulse 130 beats per minute. Results of laboratory tests:

CBCErythrocytes 4.2 million / ml stab 15% Lymphocytes 18%Hemoglobin 135 g / l Segmented 60% Monocytes 4%Eosinophils Hematocrit 44% 2% Platelets 300 th / mmLeukocytes 20000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / hUrinalysisColor rich yellow-Glucose is not Leukocytes 1-2 in the fieldpH 5 Bilirubin no viewThe relative density of epithelial cells Red blood cells are isolated in1.02 missing drug

Protein 1 g / liter cylinders missingMucus is no single crystals of salt


Task 124The patient complaints of sharp pain in the anus during defecation increasing, raising the temperature to 38 C. On examination, the anal area for 6 hours is determined by the formation of painful on palpation, apositive symptom fluctuations. Results of laboratory tests:

CBCRed blood cells 5,000,000 / mm stab 7% Lymphocytes 21%Hemoglobin 145 g / l Segmented 65% Monocytes 4%Eosinophils Hematocrit 46% 2% Platelets 300 th / mm


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Leukocytes 16000/mkl Basophils 1% of the erythrocyte sedimentation rate 20 mm / h

1. List available at the patient pathological symptoms.2. Describe the alleged status localis.3. Describe What disease is the patient?4. What additional methods are needed?5. What treatment is required?

Task 125The patient, during the seven days of receiving parenteral nutrition, there were complaints about thedifficulty in chewing and swallowing, nausea, chills. Temperature 39.4 C. Examination of parotid glandswelling, painful, there is no fluctuation. Results of laboratory tests:

CBCRed blood cells 4,000,000 / mm stab 7% Lymphocytes 21%Hemoglobin 130 g / l Segmented 65% Monocytes 4%Eosinophils Hematocrit 40% 2% Platelets 270 th / mmLeukocytes 18000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / h

1. List available at the patient pathological symptoms.2. Describe the alleged status localis.3. What disease is the patient?4. What treatment is required?

Task 126.In the emergency department the patient taken 28 years. complaining of intense pain in the right iliacregion. Ill during the day, in relation to employment on the job to a doctor not previouslyaddressed. Ambulance put the preliminary diagnosis of acute surgical pathology.On examination, the patient of average weight, lies on the right side. The temperature of 37.8. Pulse 90beats per minute, blood pressure 135 \ 90 mmHg st.Dyhanie surface, the frequency of respiratorymovements to 18 per minute.Tongue coated with white bloom. Abdomen tense in the right sections, which

specifies the positive symptoms of irritation of the peritoneum.

CBCRed blood cells 4,000,000 / mm stab 7% Lymphocytes 21%Hemoglobin 135 g / l Segmented 65% Monocytes 4%Eosinophils Hematocrit 40% 2% Platelets 250 th / mmLeukocytes 16000/mkl Basophils 1% of the erythrocyte sedimentation rate 60 mm / h

1.How pathology can be assumed?2. Does the patient in surgery?3. Specify what other methods of biochemical or special surveys are needed in this case.4.Kakie special methods can be used to refine liagnoza?5. What is the minimum standard of preparation of the patient in the case of the operation.

Task 127In the surgical ward patient received 83 years on the lower extremity atherosclerosis, occlusion of the rightfemoral artery, chronic arterial insufficiency of the 4 th., Ga

surgery examination_3-4 (question cases) [eng]

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