Introduction into the Infectious Diseases. Infections with fecal-oral mechanism of transmission. Infections with droplet mechanism of transmission. Tests
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Diphtherial adenoiditis Infectious mononucleosis Abscess of epipharyngeal tonsill Herpetic quinsy At the patient B., 35 years, after the disease which was accompanied by the fever and pharyngalgias, there were an odynophagia, dysarthria, weakness and violation of motions in hands and feet, hyporeflexia, violation of sensitiveness in extremities to the polyneurotic type. What disease does it follow to think about above all things?
At the patient P, 20 years old, reconvalescent from heavy form of diphtheria in 10 days after excerption a general weakness pain and paresthesias appeared from permanent establishment (5th week from the beginning of disease), mainly in the distal departments of extremities. Independently can not be tricked into on feet. Objectively: considerable symmetric atrophy of muscles of extremities, especially – lower. To the tendon reflexes are mionectic. In a neurolymph is moderate pleocytosis is albumen-cellular dissociation. Your diagnosis?
Child 3 years from having many children social-unprosperity family is ill 3 days. The disease began sharply, from the increase of temperature to 38,0 °C, barking cough hoarseness voice. In a dynamics on a background of subfebrile temperature a cough became soundless. At a review: the state is heavy, inciter shortness of breath with the indrawing of jugular fossula, cyanosys of nasolabial triangle, HR –160 per minute, tonsills filling out, hyperaemia accented cyanochroic. In the plan of differential diagnostics the most reliable is:
Diagnostics of quinsy background on such criteria: epidemiologys information, sharp beginning, fever, tonsillitis, regional lymphadenitis, neutrophilic leycocytosys. What research must be conducted in an obligatory order by a patient with the diagnosis of quinsy?
During the examination of a patient with pharyngalgias subfebrile temperature, moderate hyperemia of mouth, increasing of left tonsil with grey-white cover which becomes bleading during separation. Megascopic submandibular leftside lymphatic nodus. What is previous diagnosis?
During the examination of a patient, 17 years old, observe tonsilitis, body temperature 38,2 °C, generalized lymphadenopathy (cervical ltmph nodes, located along the m. sternocleidomastoideus), mild jaundice, hepatospleenomegaly. What is preliminary diagnosis?
In 18 years old patient, diphtheria of mouth pellicle severe form was diagnosed. On the 6th day of disease pain in the heart region, palpitation were appeared. Pulse – 120 per 1 min, systolic noise on apex of heart. On ECG is incomplete blockade of left leg of Giss bunch. What complication has developed?
In a newborn, the septic state was accompanied with the increase of temperature to 40 oC which developed on 5th day, with pneumonia expressed intoxication: pallor, vomiting, shortness of breath, disturbance, cramps. Appeared rash (blisters with hemorrhages) on skin, mucous membrane of mouth cavity, throat and conjuctiva. The child suffers with congenital herpes. Lungs: difficult breathing and vesicular wheezing. Mild enlargement of liver. What is the most reliable diagnosis?
In a policlinic the patient C., 18 years old, appealed with complaints about a moderate pharyngalgia, head pain, general weakness fervescence, to 38,9 °C. It is ill already three days. Objectively: it is found out megascopic back neck, and inguinal lymphatic knots, hepatospleenomegaly, subicterus scleroticas and skin, changes in a throat, characteristic for tonsils. At the hemanalysis – lymphomonocytosis. Credible diagnosis?
In a policlinic the patient C., 18 years old, appealed with complaints about a moderate pharyngalgia, head pain, general weakness fervescence, to 38,9 °C. It is ill already three days. Objectively: it is found out megascopic back neck, and inguinal lymphatic knots, hepatospleenomegaly, subicterus scleroticas and skin, changes in a throat, characteristic for tonsils. At the hemanalysis – lymphomonocytosis. Principles of treatment?
In an epidemic cell rationally to organize verification of the state of immunity. The Use of RUHA allows to find out persons unimmune to diphtheria during a few hours. What minimum protective titre?
In children with catarrhal phenomena revealed an increase of inframaxillary lymph nodes, tonsil hyperplasia with whitish soft touch on them in the form of points and islands, the presence of rare maculo-papular bulging out, increased liver and spleen. Identify the likely diagnosis?
In patient R., 34 years old with general intoxication and increased body temperature up to 38 ?C, appear pain in region of right auditory canal and next day distortion of face to the left side. Review: softening of frontal and nasal-mouth skin folds, right eyelid cleft is wider than left, mouth cavity turned left, right eyebrow doesn’t move upwards and cheek is strenght. Right xerophthalmia, xerotomia and disordered taste sensation on the surface of right anterior 2/3 half of tongue. Herpetic vesicles in right exterior auditory canal and auricle. What is the most possible diagnosis?
Male patient, 22 years old, complains of sore throat, general weakness, headache. Objective status: fever 38 ?C, Ps 100 per min, pharyngeal mucosa is hyperemic, tonsils are swollen, porous, covered with layer, which is easily removed with spatula, without bleeding. What is the most possible diagnosis?
Patient 18 years, entered permanent establishment with complaints about head pain, general weakness increase of temperatures, to 37,5–38,2 °C during 6 days, pharyngalgia. Objectively: all groups of lymphonoduses, 1-3 cm in a diameter, elastic, are megascopic, little sickly, not soldered between itself. A liver is megascopic on 3 sm, spleen – on 1 sm. In a blood is leycocytosis, plasmatic mews – 15 %. What group of herpes does the exciter of this illness belong to?
Patient 60 years old complain of pains in right hand which last for 2 days. On the 3rd day appeared vesicular chain-like rash on the skin of arm, forearm and fist. Sensitivity in the rash area is decreased. Which disease can be diagnosed?
Patient A., 17 years old, became ill gradually. A general weakness, fatigue, pain in throat, stomach-ache, nausea, was marked. He was hospitalized on the 5th day of illness. Objectively: body temperature 38 °C, increased cervical, cubital and axillary lymph nodes. Subecteric skin and sclera. Observed elements of spot-papul rash on a trunk. Raids on tonsils are loose, yellow, tongue coated by white covering, a stomach is moderately swollen, hepatospleenomegaly. In general blood – leucocytosis, neutrophyle shift to left, atypical mononuclears – 10 %, plasmatic cells – 10 %. What is preliminary diagnosis?
Patient A., 18 years old, is complaining about headache, weakness, high temperature, soar throat. Objectively: general lymphadenopaty,wit lymph nodes 1-3 cm in diameter, dense, elastic not painful and not combined between themselves. Hepatospleenomegaly was noticed. In blood there is leucocytosis, monocytes – 15 %. What is the diagnosis?
Patient A., 35 years old, came to the clinic on the third day of disease with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver not enlarged. Blood analysis – leukocytosis, lymphomonocytosis. What is treatment for the patient?
Patient A., complains of redness of the skin and edema on the right cheek. During a review: body temperature 38,7 °C, enlarged and painful right submandibular lymphatic nodes, the border between red and normal skin is sharp, present vesicles with dark content, palpation is painful. Your primary diagnosis?
Patient B, 29 years, appealed to the clinic with complaints about the increase of temperature bodies, pain of head, dull ache in joints, chill, pharyngalgia, that increased at swallowing. Objectively: hyperemia of otopharynx, tonsills are hyperaemic, hypertrophied, on both are necrotizing areas of darkly-grey color, after removing a layer by the layer of which the deep defect of mucus shell appeared with an uneven bottom, sickly regional lymphatic knots are megascopic. What illnesses is it necessary to conduct differential diagnostics with?
Patient B, after disease, which was accompanied by fever and sore throat, has signs of dysphagia, dysarthria, weakness of limb muscles, hypoaesthesia of polyneurotic type. What is the most possible diagnosis?
Patient B., 18 years old, entered infectious department with complaints about headache, general weakness increasing of temperature to 37.5-38.2 °C during 6 days, pharyngalgia. Objectively: all groups of lymphonodes are megascopic 1-3 cm in a diameter, elastic, littlesickly, not soldered between itself. A liver is megascopic on 3 cm, spleen – on 1 cm. Common blood analysis: atypical mononuclears – 15 %. What is reliable diagnosis?
Patient B., 22 years, became ill sharply, when insignificant pharyngalgias appeared at swallowing, nasal voice. Objectively: on left tonsill and there is the pellicle raid on a handle. It is diagnosed: lacunar quinsy, appointed penicillinum and rinse 2 % by solution of soda. On the second day pellicles spread on a soft palate and tongue. On a neck the edema appeared to the collar-bone, voice nasal. Tones of heart are muffled, pulse 90 per min, BP is 95/65 mm HG. What most expedient medical tactic in this case?
Patient C., 16 years old, consulted to the infectious hospital on the 2nd day of diseases with complaints for a pain in throat at swallowing, increase of temperature. Objectively: body temperature 38,6 ?C, sharp hyperemia to the pharynx, edematous and loose tonsils, on both sides – purulent covering which can be taken off easily by spatula. By palpation painful enlarged submandibular lymph nodes. Pulse 114 times/minute. From epidemic anamnesis it is clear that the same symptoms had her boyfriend. Changes in other organs didn’t observe. What preliminary diagnosis can be suspected?
Patient D, 24 years old, grumbles about a general weakness, increase of t to 37,5°C, pharyngalgia, edema of neck. Objectively: the mucus shell of otopharynx was swollen, cyanochroic, tonsills is megascopic, covered by tapes, which spread for their scopes, is taken off heavily. What basic mechanism of development of this disease?
Patient D., 20 years old, fell ill and went to infectious polyclinic cabinet with complaints of moderate pain in the throat, headache, general weakness, increased body temperature of 38.9 °C. Fells bed during three days. At examination: increasing of inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats. In the blood – lymphogranulomatosis. The principles of treatment are?
Patient D., 32 years, appealed on the third day with complaints about a sharp general weakness, change of voice, pharyngalgia. Objectively: dense pellicles occupy all surface of tonsills, tongue, handles; a hypoderm was swollen from both sides to the middle of neck. Cardiac activity is satisfactory: pulse 90 per min, BP is 95/65mm Hg; temperature of body 38,3 °C. Your diagnosis?
Patient D., was hospitalized with complaints on fever, sore throat, trismus of masticator muscle, nausea, vomiting. Data of pharyngoscopy: moderate hyperemia, swelling, cyanosis of left tonsil and pharyngeal mucosa. Tonsil is covered with thick gray-white pellicle, which is spreading beyond the tonsil. On the left neck side big submandibular lymph node is palpable. Swelling of neck spreads to the clavicle. What form of disease has developed?
Patient K., 56 years old, during last 5 days has Herpes zoster with localization of the process on the right cheek and paraauricular region. Treating with herpevir. Today pain in the right eye appeared. During examination present of edema of eyelid and hyperemia of conjunctiva. What is the action of a physician?
Patient of 20 years old, on the 2nd day of illness painful swallowing, general weakness, headache complaints about. Objectively: temperature 39.0 °C, pulse – 110 per 1 min, mucous of mouth is hyperemic, tonsils is enlarged in sizes, loose, covered by the raid, that is easily taken off, surface after the removal is not bleeding. What disease is it necessary to think about?
Patient P, 17 years old, has got ill gradually. General weakness, fatigue, painful throat, and nausea were marked. He was hospitalized on the 5th day of illness. Objectively: temperature is 38 °С. Objectively: skin and sclera are yellowish, neck, anticubital and subclavian lymph nodes are enlarged. Not numerous mculo-papular elements of rash on a trunk are found. The tongue is covered with white coat. The tonsils covered with white yellowish patches.On palpation of stomach enlarged spleen and liver are found. In blood there is leucocytosis with neutophylic shift, atypical mononuclears-10 %, plasmatic cells- 10 %. What would be the diagnosis?
Patient P., 10 years old, hospitalized with combined form of diphtheria of tonsils, larynx and nose. On the 2nd day in the hospital patient’s condition worsened: general weakness, pain in the cardiac region, vomiting. Objective status: adynamia, paleness, acrocyanosis. Ps 54 per min, weak. Cardiac tones are muffled, extrasystole. AP – 80/40 mm Hg. Liver + 3 cm. What complication has developed?
Patient was consulted by doctor with complaints on sore throat. Objective status: subfebrile temperature, moderate hyperemia of pharynx with cyanotic tint, left tonsil is swollen with thick gray-white layer, which is hardly removed with bleeding. Regional submandibular lymph node is increased, light painful. What is preliminary diagnosis?
Patient Н., was hospitalized with a diagnosis diphtheria of pharynx, widespread form. At the review of oropharynx stratifications of gum-blush accented mother-of-pearl on tonsils pellicles, which are heavily taken off, a surface bleeds under them. What medical measures are primary?
Patient, 24 years old, with diagnosis dyphtheria was admitted to the infectious disease department. What remedy is most effective for treatment and should be used immediately?
Patient, 25 years old, came to the physician on the 3rd day of disease with complains of rash on the mouth, external nose and ears, which are itching and painful. Objectively: T-37,7 °C. On the not changed skin of mouth, nose and ear auricle there are vesicles with size of 1-2 mm grouped localization. About what disease you can think?
Patient, 35 years was hospitalized with diagnosis localized diphtheria of pharynx. What is the first dose of antitoxic antidyphtherial serum?
Sick 65 years old patient, complains about pain in a subscapular region. Objectively: on a skin surface of subscapular region the placed arcwise rose-red filling out hearths some infiltrative, with clear scopes was present. On-the-spot hearths grouped vesicles with transparent maintenance. What is the diagnosis?
Sick A., complaints about turning red rash and edema on a right cheek. During a review: temperature of body – 38.7 °C, submandibular lymph nodes enlarged and painful, border between turning red and healthy skin is clear, there are blisters with a dark liquid inwardly, palpation is painful. What is your previous diagnosis? Yüklə 1,25 Mb. Dostları ilə paylaş:
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