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*! Patient L., 32 years old complains of pain in the knee joints, in the lumbar region, frequent headaches, fatigue, hair loss, loss of weight to 5 kg in six months, loss of appetite, and periodical appearance of hematoma on the body. She considers herself sick for about 5 years. Repeatedly she was treated with a positive effect. In analyzes Hb 102g / L, ESR 42 mm / h, antibody to the denatured DNA is positive, antibodies to native DNA positive. Woman takes pathogenetic treatment for a long time.

Appointment of which basic drugs is most feasible:

*D-penicillamine

*+Prednisolone

*Sulfasalazine

*Methotrexate

*Leflunomide

32

*!A woman 26 years old, complains of pain and swelling in the small joints of the hands, reddening of cheeks, palpitations, weakness, weight loss, appearance of sores in the mouth. Ill 3 months after childbirth. On examination – pains in palpation of interphalangeal joints, erythematous rash on the face, especially the nose. Heart auscultation - muffled sounds, heart rate - 150 per minute. General blood test - erythrocytes - 3,8 × 10¹²/L, color index - 0.9, leukocytes - 2,1 × 10⁹/L, ESR - 48 mm/h.

Specify the cutaneous manifestations, most characteristic for the disease:

*Indurate swelling of the skin

*Periorbital swelling of the eyelids

*Erythema nodosum

*+Erythema face a "butterfly"

*Livedo reticularis

33

*!A woman K., 40 years old, complains of pain in the joints of the hands, feet, chilliness, numbness on the cold temperature. Objectively: facial vasculature of "stars" type. Wrists are in flexion contracture, ulcers on the fingers of feet, hands. Raynaud's syndrome. In the lungs vesicular breathing weakened in the lower parts. Heart sounds are muffled, systolic murmur at the apex, regular rhythm. Heart rate - 80 per minute. Blood pressure - 150/90 mm Hg. In the blood: E - 4,5 × 10¹²/L, Hb - 110 g/l, leukocytes - 5 × 10⁹/L. ESR - 18 mm/hour.

What is the basic drug for the treatment of this disease (the most appropriate)?

*Corticosteroids

*+D-penicillamine

*Cytotoxic agents

*Krizanol

*Allopurinol

34

*!Patient I., 27 years old complains of pain and moderate swelling of the small joints of the hands, knees, ankle joints, stiffness in the mornings, muscle aches, dry skin, paroxysmal headaches, tinnitus, impaired coordination of movement, pain in the lumbar region, periodic stabbing pain heart palpitations, disruption of the heart, dryness in the mouth and eyes, hands paleness and numbness, general weakness. Sick more than 10 years, debut was with the Raynaud's syndrome.

What research is most appropriate to carry out for verification of the diagnosis?

*Rheumatoid factor

*Antinuclear factor

*Antibodies to double-stranded DNA

*+Antibodies to tropoisomerase (SCL-70)

*Antibodies to cyclic citrullinated peptide (Anti-CCP)

35

*!The woman, a teacher, 32 years old, complains of pain and swelling of the small joints of the hands, wrist and right knee. She is ill for 3 years. Marked morning stiffness, ulnar deviation of the hands, chronic inflammatory nature of pain. No skin rashes. Cardiac sounds are clear, sonorous. ACCP - positive, the reaction of Wright and Huddlson - negative.

What basic drug is most advisable:

*Kuprenil

*Prednisolone

*Hondroksid

*+leflunomide

*Mycophenolate mofetil

36

*!The woman of 36 years shows complains of the acute pain in the left knee joint with redness of skin, a swelling, limitation of mobility, reddening of eyes, a peeling of palms. At inquiry it becomes clear that about a month ago she was treated at the familiar gynecologist. On the X-ray film of ileum-sacral joints there is a unilateral sacroileitis. An ESR 35mm/hour IFA on a chlamydia is the positive.

What diagnosis is most probable?

*+Reactive arthritis

*Acute rheumatic fever

*Systemic lupus erythematosus

*Systemic sclerosis

*Ankylosing spondylitis

37

*!The man of 44 years, at night after a meat dinner had acute pains in the 1st metatarsophalangeal joint of the left foot. Within 2 hours the joint considerably swelled up, skin over it became crimson cyanotic. On auricles solid pimples, whitish, painless at a palpation are defined.

What diagnosis is most probable?

*Reactive arthritis

*Acute rheumatic fever

*Systemic lupus erythematosus

*Systemic sclerosis

*+Gouty arthritis

38

*!A woman, a teacher, 32 years old, has pain and swelling of the small joints of the hands, wrist and right knee. She is ill for 3 years. Marked morning stiffness, ulnar deviation of the hands, chronic inflammatory nature of pain. No skin rashes. Cardiac sounds are clear, sonorous. PF – high positive, the reaction of Wright and Huddlson - negative.

What is the most likely diagnosis?

*+Rheumatoid arthritis

*Chronic rheumatic heart disease

*Psoriatic arthritis

*Osteoarthritis

*Reactive Arthritis

39

*!A man, 40 years old, complaining of shortness of breath during a little exertion, swelling in the legs, rosy cheeks. The boundaries of the relative dullness of the heart shifted to the left, up, the diastolic tremor on the apex. In heart auscultation - the enhanced 1^st sound and diastolic murmur at the apex, irregular rhythm. The liver is enlarged by 3 cm below the costal arch, swelling in the legs. For which defect listed above auscultation signs are most typical?

*Mitral regurgitation

*+Mitral stenosis

*Aortic valve stenosis

*Tricuspid valve stenosis

*Pulmonary truncus stenosis

40

*!A boy, 11 years old, is directed at patient treatment and examination. From history we know that 2.5 months ago he suffered from scarlet fever (typical form, medium severity). Later changes in handwriting were identified, the boy became restless, decreased school performance, and tearfulness appeared. Soon mother began to notice the boy's twitching of facial muscles, movements of inaccuracy during dressing and eating. Neurological disorders raised: increased manifestations of grimacing, the boy could not get dressed by himself, sometimes he needed help when eating, kept crying and irritability.

Choose a syndrome of the disease that present in a given patient:

*carditis

*+chorea

*joint

*uric

*cutaneous