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GASTROENTEROLOGY

 

1. The patient, 25 years, within last 4 months shows complaints to constipations (frequency of a stool 3 times a week), feeling incomplete devastation an intestine,  meteorism. At a defecation a feces firm. Objectively: Irritability, lability of mood. At carrying out VGDS, colonoscopy-an organic pathology it is not taped.

1. Your diagnosis?

2. On the basis of what criteria you have established the diagnosis?

3. A treatment planning?

 

2. The patient, 30 years, shows complaints to paroxysmal pains in right the hypochondrium, arising after reception of fat nutrition, a bitter taste in a mouth. Fractional duodenal intubation without features. Discolorations of integuments it was not observed. A cholecystography: the cholic bubble is well filled by contrast, after reception of sorbitum, reduced more than on 2\3. Radiopaque concrements it is not revealed.

1. Your diagnosis?

2. With what diseases it is necessary to spend differential diagnostics?

3. A treatment planning?

 

 

3. The patient, 23 years, complains of pains in the epigastric and paraumbilical area, arising through 1 hour after reception of nutrition, an eructation acidic, periodic constipations, depression of working capacity, the general delicacy. Objectively: tongue is imposed white for a short while, at a palpation morbidity in epigastric and paraumbilical area. VGDS - mucous an antral zonedepartment hyperaemia, individual erosions are marked. The  mucouse of duodenum with hyperaemia. Urease – test is positive.

1. Your diagnosis?

2. With what diseases it is necessary to lead differential diagnostics?

3. A treatment planning?

 

4. Patient Ш. 40 years, the raised delivery. Complains of a heartburn arising at an inclination of a trunk forward and in a prone position within year. For last month marks occurrence of dry tussis, difficulty of a swallowing. VGDS-a hyperemia of the bottom third of esophagus, opening rosellas of cardia.

1. Your diagnosis?

2. List additional methods of research for acknowledgement of the diagnosis.

3. A treatment planning.

 

5. Patient,  35 years complain of an eructation acidic, feeling of a burning sensation behind a breast bone, a tussiculation. At carrying out VGDS with a biopsy in an esophagus the gastric metaplasia is found out.

1. Your diagnosis?

2. List additional methods of research for acknowledgement of the diagnosis.

3. A treatment planning.

 

 

6. The patient, 35 years. Shows complaints to morbidity in epigastriums during the half a year, bound with reception of nutrition. At a palpation the moderate morbidity in pyloroduodenal zone. VGDS with a biopsy - an atrophy of a mucosa of a stomach, a hyperemia of a  duodenum. Urease test  is negative.

1. Your diagnosis?

2. List diseases with which it is necessary to spend differential diagnostics.

3. A treatment planning.

 

7. 42-years-patient complains on local epigastric pain, which appears after 2 h after meal, heartburn, acidic regurgitation, constipations. Pain relive after soda using. Think herself ill during several years. Exacerbations appear in spring and autumn. Smoking. Physical examination: decreased nutritional status, pulse- 80 b/min, rhythmic; AP-110/70 mm Hg; tongue-clean, moist; abdomen take active part in breathing, painful under palpation in piloroduodenal zone.     

Your primary diagnosis?

What additional diagnostic methods have been made?

Treatment?

 

8. 45-years-old patient admitted to the therapeutical department with complains on  epigastric pain, bloating, acidic regurgitation, single vomiting, which relive the condition. This complains appears suddenly after 2 h after a lot of meal. The day before patient had a psycho-emotional stress. The same condition was at the spring last year. Not ask medical help and was not treated. Under physical examination: decreased nutritional status, position in the bad – on the side with ….. Under the palpation local pain in duodenal projection was found, slight abdominal muscular defance.

1.  What is the most possible diagnosis?

       2. What diagnostic methods have been made?

 3. Treatment?

 

9. 46-years-old woman complains on attack pain in right subcostal zone after using of fat fried food, chills, seldom – ecteric sclera. Under physical examination  - positive Ker’s syndrome, pain in gallbladder proection. X-ray examination of abdomen – without pathology. Ultrasound examination – in gallbladder stones 0,7-0,9 sm in d was found.

Your  primary diagnosis?

What additional methods should be made?

Treatment? 

 

10. 32-years-old woman complains on diarrhea to 5-6 times daily. Stool with a blood and mucous dash, increased body temperature, cramping  pain in low abdomen before defecation, weakness, weigh loss. Symptoms presents more then 6 month. Physical exam.: skin and mucous are pale; bloating, abdomen is painful under palpation in colon region.

Your  primary diagnosis?

What additional methods have to be made to prove a diagnosis?

Treatment? 

 

11. 46-years-old mаn complains on decrease of appetite, heaviness in epigastric zone after meal, nausea, bloating, intestinal disturbances, weight loss. Under examination – ecteric skin, vascular stars, hynecomastia, ascities. Under palpation liver is painful, thick, edge is sharp. Enlargement of spleen.

Your  primary diagnosis?

What laboratory methods have to be made?

Treatment? 

 

12. 35-years-old woman complained on itching. She felt herself ill during 3 years. Under examination thick enlarged on 10 sm out of costal margin liver was found. Under laboratory examination:  general billirubin – 96 mkmol/l, direct  – 80 mkmol/l, alkaline phosphatase -3965, ALT - 2,35 

Your  primary diagnosis?

What laboratory methods have to be made?

Treatment? 

 

13.  A 36-year-old woman presented with recurrent episodes of upper abdominal pain, vomiting since last three years. She never had clinical jaundice in any of these episodes. The symptoms would recur every. Six-seven months or so and would be severe enough to necessitate hospitalization, administration of intravenous fluids, fermentative supplements and proton pomp inhibitors. The liver enzymes were found not raised, the serum amylase during the present hospitalization was minimally raised (449 IU/L; normal values 130-400 IU/L).but this biochemical abnormality was consistently noted. She had undergone repeated abdominal ultrasonography, barium meal with follow through and even barium enema elsewhere for the same; no clear justification of the latter studies was forthcoming.

1. What is the most probable diagnosis?

2. Which investigation method is the gold standard for the estimation of the exocrine functions of the pancreas?

3. List main principles of treatment in this cases?

 

14. A 32-year-old woman complains of the pain in the left epigastric area that has appeared in 2 hours after meal. She also complains of nausea, bloating of the abdomen, tendency to diarrhea. On physical exam: icteric scleras. The abdomen is painful by palpation in the Gubergrits and Skulsky point. The liver is at the ribs edge. Blood tests: amylase - 288 mmol/L, total bilirubin – 22 mmol/L.

1. What is the most probable diagnosis?

2. What laboratory and instrumental diagnostic methods can help directed by the diagnosis?

3. What is your medical tactics in this situation?

 

 15. A patient, aged 25, complains  of frequent  heart-burns,  air and acid eructation, burning, quickly feeling 'full' after eating, constringent pains behind  the breast-bone,   that  appear after meals. These symptoms have lasted for over 3 months, more often increasing after emotional stress or after physical overexertion. No changes in laboratory tests and normal results of endoscopy. The patient takes domperidon medication, after the intake of which feels better.

1. What is the most probable diagnosis?

2. What addition tests may be done?

3. What are the treatment options in this situation?

 

16. A 50-year-old man, on a background of abusing alcohol, has been feeling fatigued for the past 4 months. He remembers that he had experienced an acute virus hepatitis B and episode of jaundice about 10 years ago, but that resolved and he has been healthy since. His complains are:  itches, pain in the right uppercut,   sleepiness in the day and sleeplessness at night, nausea, sometimes a vomiting. Objectively answers the put questions in a slowed-up way, concentration of attention it is reduced, long fixes a view on one subject. On physical examination there are subicteritiousness of the sclera and visual  mucous no remarkable findings, liver dimensions by Kurlov 8 х 7 х 6 sm, hepatic smell from a mouth. Laboratory studies show his hemoglobin is 14.0 g/dL. A chemistry panel reveals normal serum electroytes, but he has a total protein of 5.4 g/dL, albumin of 2.9 g/dL, ALT 132 U/L and AST 113 U/L with total bilirubin 1.3 mg/dL and direct bilirubin 0.8 mg/dL.

1. What is the most probable diagnosis?

2. Which of the most common laboratory test used to diagnose hepatic encephalopathy?

3. What kind of diseases it is necessary to make the differential diagnosis in this case?

 

 

17. 25-year-old man has noted cramping abdominal pain for the past week associated with fever and low-volume diarrhea. On physical examination, there is right lower quadrant tenderness. Bowel sounds are present. His stool is positive for occult blood. A colonoscopy reveals mucosal edema and ulceration in the ascending colon, but the transverse and descending portions of the colon are not affected.

1. What is the most probable diagnosis?

2. What addition tests may be done?

3. What are the treatment options in this situation?

 

18. A 32-year-old woman complains of the pain in the right side of upper abdomen, which has not depended from meal, started more then 6 month ago. She also complains of nausea, bloating of the abdomen; develop fatigue, nausea, vomiting, diarrhea, abdominal discomfort, muscle and joint aches. On physical exam: icteric scleras. The abdomen is painful by palpation. The liver is enlarge,  liver dimensions by Kurlov 11 х 10 х 8 sm. Laboratory studies show normal serum electrolytes, total protein and albumin, but  ALT 128 U/L and AST 110 U/L with total bilirubin 1.6 mg/dL and direct bilirubin 1.1 mg/dL.

1. What is the most probable diagnosis?

2. What addition tests may be done?

 

INFECTIOUS - DESTRUCTIVE LUNGS DISEASES

 

19. The man of 40 years, after alcoholic intoxication, during 4 - 5 hours has overslept in the street.  The body temperature has increased up to 37,8 - 38,50C next day,  the cough with  a small amount of a sputum and herpetic rashes on the lips has appeared. He didn’t use any medication, except Paracetamolum and Mucolyticums. His condition progressively worsened last 4 days. The body temperature began to rise up to 39,50С in the evening. He has shills, sever pain in the right side of the thorax, increasing at the great height of inspiration, the palpitation, dyspnea and an unpleasant smell from a mouth. Suddenly early in the morning, at coughed has departed about 200 ml of pus with an unpleasant smell, after 10 days the beginning of disease. On arrival at the hospital, his general condition serious, his temperature is 38,70C. He has tachypnea (respiration rate - 26 per minute) and tachycardia (heart rate =pulse = 102 beets per minute). On physical examination: the right thorax side lags behind at the respiration. It is determined “thympanitis”, bronchial breathing, coarse and medium moist riles over the upper lobe of right lung. 

1.         What is your preliminary diagnosis?

2.          Which instrumental diagnostics methods are most important for confirmation of the diagnosis in this case?

3.          What kind of diseases it is necessary to make the differential diagnosis in this case?

4.          What is your medical tactics?

 

20. 33-years man suffers from chronic obstructive pulmonale disease more then 10 years. He has twice survived focal right-side pneumonia on the exacerbation of COPD in the spring and autumn this year, which has been cured by an adequate antibiotic therapy. His main complains are constant productive cough   with the purulent sputum departing in a plenty after wake up, dyspnea, low grade fever in the evening. On physical examination: On physical examination: his temperature is 37,20C. He has acrocyanosis, digital clubbing, tachypnea (respiration rate - 28 per minute) and tachycardia (heart rate =pulse = 102 beets per minute). There are respirations with prevalence of expiration, intensifying of a bronchophony, coarse and medium moist riles decreasing after an expectoration in the lower lobe of left lung.

1.         What is your preliminary diagnosis?

2.          Which instrumental diagnostics methods are most important for confirmation of the diagnosis in this case?

3.          What is your medical tactics?

 

21. 45-years patient has acute segmental right side pneumonia. The body temperature again began to arise to hectic number after two days from normalization. Fever, chill, dyspnea, abrupt dry cough, right side thoracalgia at deep respiration, weakness and palpitation has appeared. Objectively: the general condition is the serious, compelled position of the patient on the right side, tachypnea (respiration rate - 28 per minute) and tachycardia (heart rate =pulse = 120 beets per minute). There are the right thorax side lags behind at the respiration at survey of a thorax, absence of a voice tremor in the lower third of the right lung at palpation, a sharp weakening with the top border on Damoiseau's line at percussion. All breath sounds are absent over the lower third of the right lung at auscultation. In the blood: high neutrophilic leukocytosis with shift to the left, increasing of erythrocyte sedimentation rate, a hypochromic anemia.

 

1.         What is your preliminary diagnosis?

2.          Which instrumental diagnostics methods are most important for confirmation of the diagnosis in this case?

3.          What is your medical tactics?

 

 

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