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

Polysomnography: index of apnea/hypopnoea - 32 per hour, the average drop recorded of blood oxygen saturation per night is up to 89%.

What is (are) the leading syndrome(s)?

______________________________________________

What is the assumed diagnosis?

______________________________________________

Task 16

A 48-year-old male patient complains of sudden-onset dyspnea, nonproductive cough, severe chest pain radiating to the right arm. History: Today the patient presented with pleural effusion and pleural puncture was performed, 1.2 litres of blood were evacuated. Objectively: RR 34 /min. Revealed asymmetry of the chest when breathing, lack of vocal fremitus in the right, there has been revealed tympanic percussion sound and the absence of respiratory noise. Chest X-ray: the absence of a pulmonary pattern on the right.

What is (are) the leading syndrome(s)?

______________________________________________

What is the assumed diagnosis?

______________________________________________

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CLINICAL CASES ON CARDIOVASCULAR SYSTEM

SECTION 1

Task 1

51 year old male, a smoker, with a long history of arterial hypertension, denies taking any antihypertensive drugs.

Life history: his father had a stroke at the age of 49 years.

PhE: waist circumference of 105 cm, BP 174/96 mmHg, HR 62 beats/min.

Lab: GFR 57 mL/min /1,73m2, urine albumin/creatinine ratio 45 mg/g.

Interpret BP level

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Specify risk factors

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Specify target organ damage

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_________________________________________________

Specify the associated clinical conditions

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Formulate and justify the diagnosis

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Task 2

40 year old male complains of BP elevation up to 170/100 mmHg throughout the year. Denies taking any antihypertensive therapy.

PE: Waist circumference of 110 cm. BP 162/112 mmHg, HR 76 beats/min.

Lab: total cholesterol 6,8 mmol/l, LDL cholesterol 5,2 mmol/l, triglycerides 2,2 mmol/l, HDL cholesterol 0,6 mmol/l.

Echocardiography: LVMI 140 g/m2.

Interpret BP level

___________________________________________________

Specify risk factors

___________________________________________________

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Specify target organ damage

___________________________________________________

_________________________________________________

Specify the associated clinical conditions

___________________________________________________

Formulate and justify the diagnosis

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Task 3

67 year old female with a long history of arterial hypertension on constant antihypertensive therapy.

History: 2 years ago had a stroke.

PhE: Waist circumference of 110 cm. BP 152/77 mmHg, HR 74 beats/min.

Lab: total cholesterol 8,0 mmol/l.

Carotid ultrasound: carotid intima-media thickness on the right is 1,5 mm.

Interpret BP level

___________________________________________________

Specify risk factors

___________________________________________________

Specify target organ damage

___________________________________________________

Specify the associated clinical conditions

___________________________________________________

Formulate and justify the diagnosis

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Task 4

77 year old male, a smoker (60 pack/years) complains of exertional pain in the calves. The pain appears after walking on 100 m, disappears at rest. Also describes numbness, coldness of the toes, feeling of pins and needles in the feet.

PhE: skin of the feet is pale, dry and cold. There is attenuation of the pulsation of the left popliteal artery and dorsalis pedis artery.

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Name the syndrome(s)

___________________________________________________

_

Specify further investigations?

___________________________________________________

Task 5

57 year old male, a smoker, with dyslipidemia complains of squeezing and pressing retrosternal pain occurring during fast walking or climbing upstairs to 3 stairwells. The pain radiates to the left shoulder, lasts up to 5 minutes and stops in 2-3 minutes after nitroglycerin intake. The symptoms appeared 6 months ago.

Name the syndrome(s)

___________________________________________________

Specify risk factors

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Specify further investigations

___________________________________________________

_____

Formulate the diagnosis

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Task 6

49 year old male complains of the intense burning pain behind the sternum radiating to the neck, jaw, lasting for 2 hours. The pain is accompanied by a sense of impending doom, cold sweat, shortness of breath. Denies having such symptoms before.

Name the syndrome(s)

___________________________________________________

Specify further investigations

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Approach to management

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Task 7

72 year old male complains of intense burning pain behind the sternum for more than an hour, accompanied by a cold sweat.

PhE: BP 100/60 mmHg, HR 120 beats/min.

ECG: ST-segment elevation in I, aVL, V1-V6 leads. Lab: Troponin I 6,7 ng/ml.

Formulate and justify a diagnosis

___________________________________________________

Approach to management

___________________________________________________

Task 8

56 year old female complains of dyspnea to the extent of suffocation, cough with pink albuminoid sputum. The symptoms appeared after the stress.

PhE: orthopnea, rales of different caliber below the angles of scapulaes on both sides. RR 30 min. BP 212/128 mmHg, HR 110 beats/min.

Name the syndrome(s)

___________________________________________________

Approach to management

___________________________________________________

Task 9

27 year old male without a history of chronic disease complains of nagging dull pain in the precordial region. The pain gets worse in the supine position, on deep breathing, coughing. Also has fever up to 37,6°C.

History: 2 weeks ago had acute respiratory viral infection

PhE: Muffled heart sounds, non-persistent grating, rasping noise in the heart region.

Interpret the results of auscultation

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Specify further investigations

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Task 10

42 year old female with a history of frequent sore throat and three joint attacks in childhood.

PhE: arrhythmic heart sounds. At the apex: loud S1, opening click of mitral valve, diastolic murmur. Arrhythmic pulse. Pulse deficit of 12 beats/min.

Interpret the results of auscultation

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Interpret the results of pulse examination

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What kind of ECG-changes is expected

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Name the most likely diagnosis

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Task 11

70-year old male complains of squeezing and pressing retrosternal pain occurring at climbing 1 stairwell up, stopping at rest; dizziness.

PhE: pale skin. Heart auscultation: diminished S2 and rough systolic murmur in the 2nd intercostal space to the right of the sternum. The murmur radiates to the carotid arteries. Pulse: parvus et tardus.

Interpret the results of auscultation

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Name the syndrome(s)

___________________________________________________

Specify further investigations

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Task 12

43 year old male.

PhE: carotid dance, De Musset's sign, Quincke`s sign, BP 152/44 mmHg. Heart auscultation: diminished S2 and diastolic murmur in the 2nd intercostal space to the right of the sternum. Pulse: altus et celer.

Interpret the results of auscultation

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Explain the abnormalities in BP level

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Specify further investigations

___________________________________________________

__________

Task 13

22 year old male with known connective tissue dysplasia and mitral valve prolapse complains of palpitations, shortness of breath during daily physical exercise.

PhE: Auscultation of the heart: diminished S1 and systolic murmur on the apex. The murmur radiates to the left axillar region.

Interpret the results of auscultation

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Name the syndrome(s)

___________________________________________________

Specify further investigations

___________________________________________________

Task 14

76 year old male complains of shortness of breath with minimal exertion (self service), gradually increasing edema of the ankles and legs, enlargement of the abdomen, heaviness in the right hypochondriac region

History: 3 years ago experienced myocardial infarction,

Name the syndrome(s)

___________________________________________________

Name the most likely diagnosis?

___________________________________________________

__

Specify further investigations

___________________________________________________

Task 15

64 year old female, a nurse`s aide, complains of severe general and muscular weakness after high physical exercise, dry mouth, thirst, poliuria, increased nocturnal diuresis.

PhE: muscles of the calves are tender on palpation. BP 162/93 mmHg Lab: serum K+ 2,6 mmol/l.

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Name the syndrome(s)

___________________________________________________

_

Which of the causes of BP elevation do you suspect?

___________________________________________________

Specify further investigations

___________________________________________________

Task 16

47 year old female, a teacher, complains of occasional sudden BP elevation up to 220/100 mmHg, provoking by straining effort, headaches, dizziness. BP elevation is accompanied by sweating, shivering, anxiety, palpitations, excessive urination.

PhE: Sitting BP 157/92 mmHg, HR 72 beats/min; standing BP 133/78 mmHg, HR 90 beats/min/

Interpret the results of BP measurement

___________________________________________________

________________________________________________

Which of the causes of BP elevation do you suspect?

___________________________________________________

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SECTION 2

Task 1.

50 year old female complains of headaches in the occipital region, occasionally accompanied by nausea and dizziness.

History: BP elevation up to 200/100 mm Hg is present during a year. Denies taking any antihypertensive therapy.

PhE: BMI is 32 kg/m2, waist circumference of 97 cm. Apex beat is palpated 1 cm outwards from the left midclavicular line in the V intercostal space, reinforced, resistant, with an area of 2 cm2. The boundaries of the relative dullness of the heart are the following: right - IV intercostal space along the right parasternal line, left - 1 cm outwards from the left midclavicular line in the V intercostal space, upper - in the III intercostal space along the left parasternal line. Heart sounds are regular. Predominance of S2 on aorta. BP is 172/97 mmHg, HR – 72 beats/min.

Lab: total cholesterol 7.2 mmol/l, LDL cholesterol 4.2 mmol/l

ECG: sinus rhythm. Left axis deviation. Sokolov-Lyon index is 43 mm.

Echocardiography: LVMI 140 g/m2, the relative thickness of the left ventricular wall is 0.47

Interpret the results of a general examination

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Interpret the results of palpation and percussion of the heart

___________________________________________________

Interpret the results of auscultation of heart

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Interpret the level of blood pressure

___________________________________________________

Specify the risk factors ________________________________

___________________________________________________

Specify target organ damage

___________________________________________________

_

Specify the associated clinical conditions

___________________________________________________

Formulate and justify a diagnosis

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Task 2

67 year old male complains of decreased vision within six months. History: Has a BP elevation up to 220/110 mmHg for 6 months. 2 months ago started antihypertensive therapy, BP is 180-190/110 mmHg. Heavy smoker (60 pack-years).

PhE: BMI is 25 kg/m2. Waist circumference of 90 cm. Apex beat is palpated 2 cm outwards from the left midclavicular line in the V intercostal space, reinforced, resistant, with an area of 2 cm2. The boundaries of the relative dullness of the heart are shifted to the left. Predominance of S2 in the 2nd point of auscultation. BP is 192/111 mmHg. Systolic murmur is heard over the renal arteries, more pronounced on the left side.

Lab: total cholesterol 9.0 mmol/l, LDL cholesterol 4.5 mmol/l, creatinine 150 μmol/L, eGFR 41 mL/min/1,73 m2.

ECG: sinus rhythm. Left axis deviation. Sokolov-Lyon index is 45 mm.

Interpret the results of a general examination

___________________________________________________

Interpret the results of palpation and percussion of the heart

___________________________________________________

Interpret the results of auscultation of the heart and vessels

___________________________________________________

Interpret the level of blood pressure

___________________________________________________

Which of the causes of BP elevation do you suspect?

___________________________________________________

Name the diagnostic method for detection of the reason of BP elevation

___________________________________________________

Specify the risk factors

___________________________________________________

Specify target organ damage

___________________________________________________

Specify the associated clinical conditions

___________________________________________________

Formulate and justify a diagnosis

___________________________________________________

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