Introduction into the Infectious Diseases. Infections with fecal-oral mechanism of transmission. Infections with droplet mechanism of transmission. Tests
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A 32 years old patient appealed to a doctor on a background of fever and increase of temperature to 38.0 °C, pain in the right ear area, left side “deviation” appear during the next day. On examination: right side smoothed out frontal and occipital skinning folds, right eyelids fissure is wider than left, a mouth is overtighten to the left, a right eyebrow does not rise upwards, and a cheek “hyperemia”, xerostomia and violation of taste receptors on front 2/3 right halves of tongue. Herpetic blisters in right external auditory canal and auricle. What is the most possible diagnosis?
A 37 years old patient, 2 days ago a spot on a hand appeared, which for days grew into pustule with a black bottom, painless at touch, with the crown of daughters vesicles on periphery. There are painless edema on a hand and shoulder. Temperature rise to 39.0 °C, dizziness appeared. Pulse – 100 beats per min, AP – 95/60 mm Hg. BR – 30 per a minute. What is the most possible diagnosis?
A 40 years old scientist, became ill sharply with chill, temperature of body – 39.8 °C, severe headache, vomiting, pain in muscles. Did not went to the doctor, the state had become worse, hyperemia of sclera, appeared, on lips herpes with hemorrhagic maintenance, the nose-bleeding, skin and sclera, became icteric, urine color is of strong tea, diuresis 200 ml, an anacholia was not present. What is the most reliable source of infection?
A 70 years old sick person, after supercooling severy pain in the left half of head in the area of forehead and left eye appeared. 3 days ago the temperature of body increased to 37,6 °C, the blister of pouring out at the head and left overhead eyelid appeared. What disease can be diagnosed?
A boy 11 years old, complaints about sickness at mastication, increasing of temperature to 37.1 °C, enlargment of parotid salivary glands . At the age of 8 years carried a paraflu infection. Objectively: in the region of right parotid salivary gland tubular sickly at palpation, a skin above it is not changed. A pharynx is moderate hyperemic, tonsils are not coated. What is your previous diagnosis?
A boy 6 years was in the close touch with a patient with diphtheria. What treatment-prophylactic measures need to be conducted, if vaccine anamnesis is unknown?
A child 2 years carries a diphtherial croup. There was the stop of breathing on 2nd days of whey therapy. What was the reason of asphyxia?
A female M., 24 years old came to the doctor with long-lasting fever, night sweat. Over the past three months, weight reduced by 7 kg. Low intention for sex. Objective examination found an increasing of all lymph nodes, hepatolienal syndrome. In the blood: Leucocyte – 2,2?109. What disease should be suspected?
A girl, 18 years old, became ill sharply: indisposition, pain of head, pharyngalgia, t – 38,2 °C. To the doctor appealed only on the 3th day of illness. Objectively: on one of tonsills the crateriform ulcer covered by the chlor raid. During the direct backterioscopy of area of defeat found out exciters morphologically similar to spirohets sticks. What previous diagnosis?
A girl, 6 years old, admitted to hospital with complaints on general weakness, increase of temperature, pain in a throat. Objectively: observed oropharyngeal mucous membrane is bright red, on tonsils – white covering, can take off easily and enlarged all groups of lymph nodes 1-3 cm in a diameter, dense and elastic in consistancy, not very painfull, are not soldered between themselves. Liver is enlarged till 3 cm, spleen - till 1 cm. In bloods - leykocytosis, plazmocytes – 20 %. What will be the credible diagnosis?
A patient 21 years old 4th day grumbles about a general weakness, moderate pharyngalgia fervescence, to 39°C. Did not treat oneself. Objectively: edema and cyanosys of mucus shell of otopharynx of left tonsill rough fibrinose raid which goes out on a palatal handle and tongue. Bloodstreaks appear at the attempt of removal by his spatula. Submandibular lymphatic knots are megascopic, more on the left side. What diagnosis is most credible?
A patient 60 years old for 2 days has disturbed severe pain in a right arm. On 3rd day appeared blisters, pouring out as a chain on the skin of shoulder, forearm and brush. Sensitiveness in the area of pouring out is mionectic. What disease can be diagnosed?
A patient A., 23 years old, hospitalized on the 2th day of disease with complaints about a weakness, pharyngalgias, that increase at swallowing, chill. State is moderate, temperature of body – 38.3 °C, a mouth opens freely, moderate hyperemia with small cyanosys of mucous in the throat, tonsils is megascopic, covered by the pellicles raids which spread on a wall pharynx and tongue. Increasing of neck lymphonodes. Pulse – 88 per 1 min, BP 120/60 mm of Hg. A liver and spleen are not megascopic. What is previous diagnosis:
A patient appealed to the doctor with complaints of difficulties in opening of the mouth. Two weeks ago fell down and head was hurt, did not have medication. At a review mouth opens on 1.5 cm, moderate expressed pain of muscles at the back of head. The paralysis of muscles of person, eyeballs, are more prominent. In a temporal area dry bloody crusts in the place of trauma. What are your diagnosis?
A patient came with complaints about erosions of his penis. From anamnesis frequent appearance of similar rashes during a year is found out. Objectively: on a balanus are the grouped blisters and erosions of polycyclic outlines, with clear margin, soft during palpation. What is your diagnosis?
A patient D., 20 years old came to the infectious polyclinic with complaints of moderate pain in the throat, headache, general weakness, increasing of body temperature to 38.9 °C. He fells sick during 3 days. Objective examination: increasing inguinal lymph nodes, hepatosplenomegaly, subicteric sclera and skin, changes in the throat are typical for sore throats were found. Blood analysis – lymphogranulomatosis. What is probable diagnosis?
A patient D., yesterday in the evening delivered in the hospital due to high temperature of body, increasing pharyngalgia, pain lockjaw of masseters, nausea, vomits. At nasopharhyngoscopy by an otolaryngologist the moderate expressed hyperemia, edema, cyanosys of mucous membrane of left palatal tonsil, oral cavity and nasopharynx were found out. The surface of tonsil is covered by the raid of dirty-grey color pellicle which goes beyond his borders (in nasopharynx). Increasing of left submandibular lymphatic node of dense consistency was also found. The edema of hypoderm of neck reaches to the collar-bone. What is the described disease?
A patient is hospitalized in infectious permanent establishment: sharp beginning of disease, temperature 39,9 °C, moderate pharyngalgia, takes place edema, insignificant hyperemia with cyanosys of mucuses shells of otopharynx, on tonsills dense, brilliant, greyish color the raids placed as continuous pellicle, is heavily taken off, bare a surface, that bleeds. Submandibular lymphonoduss are moderatory megascopic. A patient must immediately do:
A patient N., 45 years old, complaints about headache, general weakness increasing of temperature, to 37.4 °C. In 2 days pain appeared in the pectoral region of spine with an irradiation in a right between scapular regions. After some time skin in this region turned red as a strip from a spine to the subarmpit line, and in 2 days red knots which through the set time grew into blisters with transparent maintenance appeared in this place. What is your diagnosis?
A patient X., 25 years old, was examined by a otolaryngologist on the 4th day of illness. Temperature of body – 38.1 °C. Complaints about indisposition, moderate pains in the throat. Objectively: a mouth opens fully. Mucous soft palate, handles, tongue, was swollen, insignificant hyperemia with cyanosis. Increasing of tonsills, covered by the grey dense raid. The raid is taken off free. The edema of neck is not present. Increasing of submandibular lymph nodes. What is most credible diagnosis?
A patient, 13 years old, complaints on pain in a throat, body temperature rise till 38 °C. Objectively: hyperemia of skin, hyperpigmentation of oropharyngeal mucous , tonsils are enlarged in size, marked suppuration of follicles. During palpation enlarged posterior cervical and submandibular lymph nodes. Pulse 96 times/minute, spleen – under the edge of costal arc on 1 cm. About what disease it is necessary to think?
A patient, 22 years old, became ill sharply. History showed fever up to 38.2 °C with headache, repeated vomiting, olfactory and tastes hallucinations. Quickly got complex of meningeal symptoms, pyramidal paresis. The general epileptic attack and comatose state also developed. Neurolymph is with mixed lymphocytosis, cytochrome, single red corpuscles. What is previous diagnosis?
A sick person, 65 years old, complains of rash, pain in a subscapular region. Objectively: on a skin surface of the subscapular region present the arcwise rose-red filling out hearths some infiltrative, with clear scopes. On-the-spot hearths grouped vesicles with transparent maintenance. What preparation he should take?
A woman 65 years old the disease had beginning sharply from increase of temperature to 39.0 °C, weakness, and pain in the left part of thorax that increased with breathing motions. On 3rd day of disease vesicular breathing appeared after motion of rib on the left on a hyperemic background. Together with sick a grandchild lives 4 years. What measures of prophylaxis of disease need to be adopted?
A woman C., during 3 days complaints about a general weakness, headache increasing of temperature to 39-40 °C, insignificant pharyngalgia. Her husband is sick with tonsillitis. Objectively: a skin is pale, cyanosis of lips. Hyperemia of mucous of oropharynx, increasing of tonsils. On the spot of tonsils there are continuous dense accented mother-of-pearl raids, which are taken off with great effort with bleading. Increasing of submandibular lymphatic nodes. Edema of the neck. AP 105/65 mm Hg. What is most credible diagnosis?
An 18 years old patient, entered the hospital with complaints of headache, general weakness, raising the temperature to 37,5-38,0 °C for 6 days, a sore throat. Objective examination: increasing of all lymph nodes, 1-3 cm in diameter, flexible, megaloblastic not soliter together. Increasing of the liver size till 3 cm, spleen – 1 cm. Common blood analysis: leukocytosis, plasma cells – 15 %. What is preliminary diagnosis?
At a 36 years old sick person, 4 days ago a rash appeared on a skin that is accompanied by itching. Swelling of stomach. Disturbed dull pain in right subcostal area had constipation. Day prior to it he ate the smoked meat. Atypical reactions appeared after the use of tomatoes, strawberry, chocolate. Objectively: on the skin of person, trunk, extremities are rashes. Level of general IgE in normal. What is most possible diagnosis?
At a child 4 years on the third day of disease the widespread form of diphtheria of nasopharynx is diagnosed. Preparation of specific therapy:
At a child 6 years with a diphtherial widespread croup the first dose of antidiphterial whey makes:
At a child with the catarrhal phenomena it is found out the increase of submandibular and back neck lymphatic knots, hyperplasia of tonsils with the magnificent raid of gum-blush on them as points and aits, presence of the single roseol-papular pouring out, increase of liver. Name a credible diagnosis.
At a girl, 22 years old, heavy form of diphtheria of otopharynx. Specific treatment is begun only on a 5th day from the beginning of disease, in the day of appeal of parents for medical help. The sick is instiled only in a maternity hospital. What complication of diphtheria is potentially dangerous?
At a patient by the method of specific laboratory diagnostics the confirmed noncommunicative form of diphtheria of otopharynx. Specific etiotropic treatment is appointed on the second day from the beginning of disease. Your attitude toward setting of antibiotics:
At a patient the dense darkly-grey raid covers tonsils is considerably megascopic and spreads for their scopes. Mucus shell bloodshot accented cyanochroic, was considerably swollen. Immediate medical measure:
At a patient which appealed to the district doctor with pharyngalgias, it is discovered at a review: temperature is subfebrile, moderate hyperemia of otopharynx, megascopic left tonsill, on him dense grey-white color raid which becomes separated from heavily, mucus bleeds under him. Megascopic littlesickly regional submandibular lymphonodus. Specify a previous diagnosis?
At a patient which treats oneself stationary on an occasion the widespread form of diphtheria of otopharynx, on a background the positive dynamics of displays of illness appeared periodic hit of spoon-meat in a nose, voice acquired a nasal tint. During a review: hang-on of soft palate and absence of his motions at fonation. On-the-spot palatal tonsills tailings of grey raid for a gum-blush, perifocal edema. What complication of diphtheria at a patient?
At a patient, 17 years: tonsils, temperature 38,2 °C, generilized lymphadenopathy (the first multiplied neck lymphatic knots which are located along m. sternocleidomastoideus), small icterus hepatospleenomegaly. What exciter causes this disease?
At a student 25 years on a background sharp development of illness is fervescence to 40 ?C, rapid growth of intoxication – a pharyngalgia appeared at swallowing. Objectively: oedematousness and hyperemia of mucuses shells of otopharynx and tonsills. On the tonsils there is raid of grey-white color, which is taken off by a spatula in the type of pellicle, that does not dissolve in water and is not ground by a spatula. In place of the taken tape off sanguifluousness. Suspected diphtheria of fauces. What most expedient medical tactic?
At maintenance of call on a house a district paediatrician put to the sick child 5 years old, diagnosis “Acute lacunar tonsillitis”. Specify, who must carry out the laboratory inspection of patient and in what terms.
At sick L, 35 years old, a diagnosis is set is diphtheria of pharynx, noncommunicative form. What first dose of antitoxic antidiphtheria whey is it necessary to appoint?
At sick person with the combined form of diphtheria of tonsills, larynx and front departments of nose on the 2nd day of stay in permanent establishment the state became worse: a weakness grew, pain appeared after a breastbone, vomiting. Objectively: patient is adinamic, pale, acrocyanosys. Pulse 54 per 1 min, weak filling. Cardiac tones are muffled, chaotic extrasystoles. BP is 80/40 mm Hg. Liver +3 cm. What complication arose up at a patient?
At sick, that grumbled about the massive salivation, during the objective inspection it is found out gingivitis, separate rather yellow ulcers on tongue, mucus shell of cheeks, ash, moderate increase, and painful back neck lymphonoduses. What previous diagnosis?
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