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

Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 5.

35-year-old female complains of depressed mood, memory decrease, hair loss, edema of lower limbs.

PE: Dry skin with exfoliation. Dull amimic face. Slight edema of the shins. HR 50 bpm.

Lab: TSH 20 μIU/ml. High level of TPO and TG antibodies.

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 6.

60-year-old female complains of dyspnea at rest, general weakness, sleepiness.

History. A year ago underwent subtotal resection of thyroid gland, receives hormonal replacement therapy. Hormonal state is unknown. PhE: Seating in the bed, leaning forward. Amimic face with dull expression. Moderate edema of the shins. Tongue with teeth indentations. Harsh breath sound, decreased in lower parts of the lungs. RR 26 bpm. Percussion of the heart: right border is in the 4th intercostal space 2 cm right from sternum, left – 2 cm left from left midclavicular line, upper – 3rd intercostal space. Regular muffled heart sounds. HR 50 bpm. BP 100/60 mmHg.

ECG: Sinus rhythm. HR 52 bpm. Low QRS in all leads.

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Chest X-ray: moderate effusion in pleural recess. Cardiomegaly. Triangular heart shadow.

Explain the results of percussion and auscultation of the heart

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Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 7.

22-year-old male complains of thirst, polyuria, weakness.

History: Denies having any chronic disease. Drinks up to 5 liters per day. Lost 6 kg. PhE: clear consciousness. Dry skin with low elasticity. Dry tongue, acetone smell. BMI 17 кг/м2. HR 90 bpm. Lab: fasting plasma glucose 21 mmol/l, glucosuria +++, acetonuria ++.

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 8.

29-year-old male complains of dry mouth, polyuria, thirst, severe weakness, loss of 10 kg for 6 months.

PhE: dry skin and mucous, BP 112/80 mmHg. HR 98 bpm.

Lab: plasma glucose at admission 24,6 mmol/l, НbA1c 10,1%, C- peptide 170 pmol/l, titer of antibodies to beta-cells is 1:256 (N <1:4).

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 9.

75-year-old male complains of dry mouth, thirst, itching. History: arterial hypertension, had MI in 2012.

PhE: BMI 31 kg/m2, waist circumference 110 cm. Excoriations on the skin. Lab: Plasma glucose at admission 11,9 mmol/l, fasting plasma glucose 7,9 mmol/l, total cholesterol 5,9 mmol/l, LDL-C 3,6 mmol/l, triglycerides 3,8 mmol/l.

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 10.

26-year-old female complains of thirst, dry mouth, perineal itching, multiple furuncles on the body.

History: denies having any chronic disease. All symptoms appeared 2 years ago.

PhE: Dry skin. Multiple furuncles on the legs, abdomen and chest. Lab: fasting plasma glucose 24 mmol/l, HbA1c 12%, glucosuria.

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 11.

75-year-old male admitted in coma.

History: has diabetes mellitus type 2. Stopped taking glucose-lowering drugs several months ago. Didn`t control glucose level. Before hospitalization complained of abdominal pain, nausea, general weakness, became apatic.

PhE: coma. Dry skin, mucous and tongue. Soft eye bulb. Acetone smell. Deep loud breathing. RR 26 bpm. HR 120 bpm. BP 90/60 mmHg.

Lab: plasma glucose 31 mmol/l, ketonuria, glucosuria, рН is 7,29.

Leading Syndrome(s)

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Further investigations

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Presumptive diagnosis?

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Recommended treatment?

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Task 12.

35-year-old male complains of immediate severe weakness, shakiness, profuse sweating, palpitations, sensation of hunger, dizziness. History: Has type 1 DM. Symptoms occurred after insulin injection. PE: Patient is anxious. Tremor of the fingers. Moist pale skin. HR 120 bpm.

Lab: glycemia is 2,3 mmol/l.

Leading syndrome(s)

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Principles of treatment:

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Task 13.

70-year-old female was admitted in coma.

History: has type 2 DM. According to relatives words within last week enhanced glucose-lowering drug dose to 5 tablets of Glibenclamide per day because of hyperglycemia. Relatives could not raise her in the morning.

PhE: Coma. Pale moist skin. Periodical muscle clonus. Lab: glycemia 1,2 mmol/l.

Leading syndrome(s)

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Principles of treatment:

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STANDARDS OF LABORATORY PARAMETERS

CBC (Complete blood count)

Urinalysis

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Glycosylated hemoglobin

87

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Normal characteristics of ECHO-CG

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