1. Put the preliminary diagnosis.

2. Do you agree with the diagnosis of medical clinics?

3. What should be the further tactics?

Answer

1. HIV infection, stage IB (acute infection: mononucleosis: syndrome).

2. The doctor clinic was mistaken in determining the stage of AIDS HIV infection - this late stage of HIV infection (1UV-U), which pack portant symptoms of opportunistic defeats. The patient have place mononucleosis syndrome develops during acute HIV infection (IIB stage). These recent history bear witness of infection - not more than 3 months ago.

3. Implementation of counseling, referral to the center of preventive AIDS for further laboratory testing to confirm the HIV infection, the study of the immune status of the statement on the account for further dispensary observation.

Task 2

The young man, 18 years old, during the passage of the medical commission in the military during the inspection revealed scaly flaky skin on the face and body, skin pigmentation along the intercostal gaps left (about a year ago suffered a herpes zoster), on the elbow skin and forearms - multiple injection marks (the patient admitted that for 6-7 years, uses intravenous drugs), in the mucosa of the mouth - lots of white cheesy overdubs, perleche’s in the corners of the mouth. Changes in the internal organs were found.

1. Put the preliminary diagnosis.

2. How should I interpret the changes in the skin and mucous membranes?

3. Assign the survey.

4. What should be the tactics of the patient?

Answer

1. Clinical data and history - about changes in the mucous shells of the skin and traces of suffering a herpes zoster, multiple injections nalichzh traces testifying to the long-term intravenous substance use, - suggest the diagnosis of HIV infection.

2. Changes in the mucous membranes of the mouth (thrush and angular cheilitis), the skin (seborrheic dermatitis) show the surface manifestations of Candida infection.

3. Plan of inspection: blood for HIV antibodies in the ELISA and the immune blot Thing.

4. The patient should be referred to the city center for prevention and fight against AIDS. If the diagnosis is confirmed, you need to study the immune status (number C04-lymphocytes), preferably viral load. C04 If the number of lymphocytes is below 0,35h109 / L, the patient will require the appointment of antiretroviral therapy.

Task 3

An examination of the donor to the blood bank revealed the anti-bodies to HIV ELISA. Donor - woman, 24 years old Muscovite. She is married and her husband is often on business trips, living in hotels. The patient no complaints, no changes in the internal organs were found during the inspection.

1. Put the preliminary diagnosis.

2. Determine the tactics of the patient.

3. What is the strategy to identify the source of infection?

Answer

1. It is likely that patients with HIV infection, the PA stage or III, were given a positive serological reaction and the absence of any signs of illness.

2. The patient should be removed from the donation, send for further examination at the center of prevention and control of AIDS, where they will spend repeated blood tests for HIV antibodies in ELISA and in the case of a positive reaction - determination of antibodies in the immune blot. Upon receiving a positive response - statement on the account of the dispensary for further observation. The question of the diagnosis of the message is decided after a complete examination with pre-test and post-test counseling.

3. It is necessary to conduct an epidemiological investigation, which carries an epidemiologist center for prevention and control of AIDS, to identify the source of infection among close individuals.

task4

During the opening of an abscess in a patient with HIV infection at the stage of the MBG surgeon pierced rubber glove and hurt his finger (Highlight drop of blood).

1. What should be the doctor's tactics in this situation?

2. Does it matter at the stage of the disease has the operated patient to the risk of infection of the surgeon?

3. Assess the degree of risk of infection and the need for chemo-prophylaxis in this case.

4. Determine the amount of chemoprophylaxis.

5. What measures have been taken to the surgeon is necessary before surgery?

Answer

1. It is necessary to immediately treat the gloves with a disinfectant solution and remove them. Squeeze out the blood from the wound under running water to wash your hands with soap and water, treat them with 70% alcohol, lubricate the wound with 5% iodine solution. Inform the administration of the medical institution, which shall immediately draw up a statement about the accident and make a record of it in the individual health professional card. Watching victims doctor, study his blood for HIV antibodies should be at the center of prevention and control of AIDS every 3 months during the year. It is recommended to start preventive reception of three antiretroviral drugs, not later than 6 hours after the injury.

2. HIV-infected patient is contagious at any stage of the disease. The risk of infection increases with the development of the disease, which is associated with an increase in viral load.

3. Highlight 3 degrees of risk of infection:

- High (Type 1) - with a deep wound, accompanied by bleeding;

- Moderate (type 2) - with a shallow wound with blood droplet isolation;

- Minimal (type 3) - if the skin surface trauma or contact with the patient's bodily fluids on the mucous membranes.

Combination therapy with antiviral drugs for 4 weeks is required for the I degree of risk it should be offered with the II degree of risk and desirable for the III degree of risk.

4. Scope of chemoprophylaxis depends on parenteral risk of infection (see. Below). In this case, in spite of the superficial skin lesions (droplets of blood), the risk is high, because the patient 1UV stage. Combination chemoprophylaxis should be started immediately, it is held for 4 weeks. Prevention, started within 72 hours after possible infection, it is considered inexpedient.

5. Before the operation it is necessary to make sure you have an emergency kit. Perform the operation must be in the presence of a second specialist, capable of replacing the injured doctor and continue the operation immediately. Manipulations should be performed in a double-rubber medical gloves.

Task 5

The patient, 30 years, appealed to the local doctor during the flu epidemic with complaints of cough, weakness, pain in the chest when breathing, increased body temperature to 37.5 ° C. On the issue of physician-old disease patient said: "4 months". This forced the doctor to collect a detailed history. It turned out that the first manifestation of the disease was the appearance of dark spots on the glans penis. To the doctor to address hesitate, treated by a psychic. Condition did not improve, increasing weakness, there were dark spots on the skin. Recently chilling notes, increase in body temperature at night, coughing, chest pain.

Objectively: pale, low-power, on the face, neck, torso, legs, dark red spots with a bluish tint, some appear as convex, dense nodules ranging in size from small (0,3x0,5 cm) to larger (up to 2 cm) , painless, in the area of ​​the penis, these lesions are painful and bleed. On the mucous membrane of the cheeks and the gums similar education. Lymph nodes of all groups increased, painless, elastic. In the lower parts of the lungs are heard crackles. Pulse 92 per minute, blood pressure of 140/90 mm Hg Heart sounds are muffled. Appetite is reduced.

Stool pappy, 2-3 times a day. Irritating. The doctor sent the patient to a dermatologist.

1. Signs of the disease is a rash on the mucous membranes and skin?

2. Put the preliminary diagnosis and justify it.

3. What should be the further tactics of the patient?

Answer

1. Speckled-papular rash on the skin and mucous membranes, which have a characteristic cherry-red color, round in shape, protruding above the skin, cause suspicion on Kaposi's sarcoma. The progression of lesions, their appearance in the mucous membranes, signs of a lesion of the lungs and intestines may indicate dissemination.

2. SC may occur in the elderly, they it is not associated with HIV infection. Only in patients with immunodeficiency SC occurs at a young age. Weight loss, low-grade fever, signs of disseminated With K, a young man appeared, suggest HIV infection at the stage of secondary manifestations (1UV).

3. Testing for antibodies to HIV, the collection of additional epidemiological and logical history (parenteral intervention, intravenous drug use, sexual contact). Upon confirmation of the diagnosis of HIV infection - the direction of the patient at the center of prevention and control of AIDS. Required elements histologically for study to confirm the diagnosis of IC.

Task 6

In the intensive care unit ambulance brought 23-year-old patient. According to his relatives, for 3 weeks were growing body temperature (last 7 days in the morning and 38 ° C at night to 40.5 ° C with a strong fever) and fatigue, disturbed headaches, worsened appetite, nausea and vomiting appeared from time to time has been liquid chair. In recent days, marked memory impairment, delirium. From history we know that the patient is registered in the center of the prevention and control of AIDS within 2 years. Three years consume heroin intravenously. At follow-up examination a month ago, the amount of C04-lymphocytes 0,52h 109 / l.

On examination: the state of heavy, pale, respiratory rate 22 per minute, pulse 110 per minute, blood pressure 90/60 mm Hg There was a petechial rash conjunctival folds of transition. Cardiac moderately muted, systolic murmur at the apex. Identified Banti's syndrome. Focal and meningeal symptoms are not present. Disoriented in time and place. Oliguria. Hemogram: leukocytes - 15,6h109 / l stab - 12% segmented - 78% lymphocytes - 9% monocytes - 1%, ESR - 40 mm / h. isolated from the blood culture St. aureus.