Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №27

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient Z., 39 years, complains of intensive headache in temporal and occipital regions, pulsation feelings in temples, noise in ears, nausea, dizziness, general weakness. The previous day he tested an engine in a garage without ventilation.

General condition is comparatively satisfactory. Skin is of ordinary colour, clean. Peripheral lymphatic nodes are not enlarged. Breathing rate – 20/min. Breathing is vesicular. AP-110/60, PR-60/min, rhythmical. Heart tones are rhythmical, muffled. Abdomen is soft, not painful.

Positive test to carboxihemoglobin.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №28

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Worker aged 29 has been working at pressure in caisson at 2,8 atm. After quick exit from caisson acute headache, vertigo, hearing impairment and visual acuity occurred. On objective examination – clinical signs of acute Ménière's syndrome: unsteadiness on walking, horizontal nystagmus, unsteadiness in Romberg position. Expressed general hyperhidrosis.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №29

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient M., 48 years, is admitted to a hospital by ambulance car. He is occupied in a factory where aniline paints are produced.

Objectively: general condition is moderately grave. Skin and visible mucous layers are grey-blue. Speech is dysathric. Patient is disorientated in space. Painfulness in projection of n. trigeminus and n. facialis is observed. PR-94/min, weak, arrhythmic, AP-110/60. Heart tones are muffled. Abdomen is sensible at palpation in right subcostal area. Liver is found 1,5-2 cm lower than right rib arc, its rim is painful. Spleen is not enlarged.

CBC: Er-3,5x10¹²/l, Hb-110g/l, reticulocytes-12%, L-15,4x10⁹/l, bodies of Geihns-Erlich-14%, methemoglobin-39%. ESR-3mm/h.

Urine: reaction to paraaminophenolum (+++).

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk