Клинические задачи по дисциплине «Внутренние болезни» (на английском языке) = Clinical Cases in Internal Diseases Specialty (in English). Учебно-метод

PEOPLES’ FRIENDSHIP UNIVERSITY OF RUSSIA

MEDICAL INSTITUTE

Department of internal medicine with course of cardiology and functional diagnostics

CLINICAL CASES

IN INTERNAL DISEASES

SPECIALTY

(IN ENGLISH)

Study guide for internal medicine

For students of III, IV courses of medical faculty on a specialty «General medicine» and «Dentistry»

Edited professor Zh. D. Kobalava

Moscow

Peoples’ Friendship University of Russia

2018

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FOREWORD

The compendium "Clinical cases in internal diseases specialty (in English)" is intended for work on practical lessons, self-preparation of english-speaking students and control of knowledge. The main purpose of the compendium is to form the students' skills of interviewing the patients and distinguishing the syndromes, i.e. clusters of pathophysiologically related symptoms and signs.

All the cases assume distinguish between the syndromes, if it's possible - formulation and substantiation of the clinical diagnosis and are aimed at improving the ability of students to interpret the results of physical and laboratory or instrumental examination.

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CLINICAL CASES ON LUNGS

SECTION 1

Task 1. A 34-year-old male patient complains of a cough with rusty sputum, chest pain under the right shoulder blade associated with deep breathing and cough, and a fever of 39 ° C.

PhE: the right half of the chest lags during breathing. Upon palpation, below the 6th rib on the right side, there is increased vocal fremitus; over the same area, dull sound is heard upon percussion. On auscultation bronchial breath sounds are heard, with fine crackles.

The X-ray of the chest: infiltration is observed.

Leading syndrome (s)?

______________________________________________

Рresumptive diagnosis?

______________________________________________

Task 2.

A 66-year-old woman, a heavy smoker, complains of shortness of breath at minor physical exertion. The respiratory rate is 24 breaths per minute. The chest is barrel-shaped, and a bulging of lung apexes in front. The lower border of lungs is shifted downward by 1 rib along all the lines. Percussion: box sound. Auscultation is defined by weakened vesicular breathing, no wheezing. Leading syndrome (s)?

Presumptive diagnosis?

______________________________________________

Further investigations

______________________________________________

Task 3.

A 56-year-old patient, who abuses alcohol, is concerned about fever of up to 40°C, with evening chills and severe sweating. By himself, he took antipyretics without effect.

PhE: the left side of the chest lags during breathing. A dull sound is heard on percussion at the inferior angle of the left scapula. In the same place, breathing is sharply weakened and coarse crackles are heard on auscultation.

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Chest X-ray: homogenous round-shaped shadowing with indistinct contours with lucid center in the projection of the 10 segment of the left lung.

Leading syndrome (s)?

______________________________________________

Presumptive diagnosis?

______________________________________________

Task 4

A 64-year-old male patient complains of a cough with large expectoration of sputum (about 500 ml per day), purulent, malodorous and streaked with blood, fever up to 38.5°C, general weakness and sweating.

PE: the right half of the chest lags the left during breathing. Vocal fremitus is increased in the axillary region. On percussion, a tympanic sound is heard below the 6th rib from the front to the back of the axillary line, bronchial breath sounds are also heard there on auscultation.

Leading syndrome (s)?

______________________________________________

Anticipated diagnosis?

______________________________________________

Further investigations

______________________________________________

Task 5

A 24-year-old male patient with a polyvalent allergy presents with difficulty in breathing often after exposure to the allergen and at night. Before attack appears perspiration in the throat, dry hacking cough. The patient`s history is remarkable for allergic rhinitis, and nasal polyps. On examination during attack: respiratory rate - 28 breaths per minute; involvement of axillary respiratory muscles. On auscultation, weakened vesicular breathing, and a large number of wheezing over the entire surface of the lungs are heard.

Leading syndrome (s)?

______________________________________________

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Presumptive diagnosis?

______________________________________________

Further investigations

______________________________________________

Task 6

A 72-year-old man, a smoker for 55 years, one pack of cigarettes per day, complains of a cough with mucous sputum streaked with blood, and weight loss of 9 kg over six months. On examination: the patient is exhausted, BMI - 17kg/m2, vocal fremitus is increased in the projection of the middle lobe. There’s been revealed dullness on percussion, and weakened vesicular breathing. On the X-ray, in the projection of the middle bronchus of the right lung, was found a round shadow with irregular contours of a diameter of 3cm. In bronchoscopy of the middle bronchus to the right was revealed a hilly formation, and bleeding on contact with the bronchoscope.

Leading syndrome (s)?

______________________________________________

Presumptive diagnosis?

______________________________________________

Further investigation

______________________________________________

Task 7

A 66-year-old male patient complains of fever, non-productive cough, heaviness in the left side of the chest, increasing breathlessness. It is his second week of being sick. Temperature is 37.8°C and a respiratory rate is 22 breaths per minute. Examination of the chest: bulging and lagging of the left half of chest when breathing; there is also a sharp weakening of vocal fremitus, dull sound on percussion below the 4th intercostals space. Breathing in this area is sharply reduced.

Leading syndrome (s)?

______________________________________________

Presumptive diagnosis? Further investigations

______________________________________________

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Task 8

2 days ago, a male patient of 65 years, had sudden dyspnea during minimal physical exertion, pain in the right half of the chest, and coughing up of blood. He’d been suffering from varicose veins disease for about 10 years. On examination: pasty lower extremities, edema, soreness, hyperemia of right lower limb up to the knee. On palpation, there is increased vocal fremitus; dull sound on percussion is heard below the angle of the right scapula, and on auscultation, increased bronchophony and bronchial breathing are heard.

Leading syndrome (s)?

______________________________________________

Presumptive diagnosis?

______________________________________________

Further investigations

______________________________________________

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