Introduction into the Infectious Diseases. Infections with fecal-oral mechanism of transmission. Infections with droplet mechanism of transmission. Tests
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Patient 22 years old, has increase temperature of body till 37,8 °C. Treated under the supervision of district doctor with a diagnosis of influenza. On the 5th day of illness temperature remained the same; it began difficultly in opening eyes. On examination – edema on face, expressed conjunctivitis with film stratifications. Mucous pharynx is heperemia, on the back wall of gullet considerable graininess. Lymph nodes are enlarged in neck. The general state of patient is satisfactory. This disease is related to cold. What disease you suspect?
Patient A., 28 years old, hospitalized with a previous diagnosis of flu. On the 5th day of illness, rash appeared on the trunk and internal surfaces of extremities. Temperature 41.5 °C, hyperemia of sclera, tremor of tongue, tachycardia, spleenomegaly, excitation. What is the most possible diagnosis?
Patient B., 20 years old, complains about severe headache in temples and orbits, dull ache in the trunk, dry cough. Temperature of the body 39.6 °C. Inflammatory changes of mucous membrane of oropharynx. Normal breathing in the lungs. What is the most credible diagnosis?
Patient B., 20 years, became ill acutely. The unexpected severe diarrhea appeared with frequent vomiting, with plenty of vomits. The patient arrived from a South-east Asia countries. He has temperature 36,1 ?C during 3 weeks. Abdomen is pulled, not painful. Stool is a rice-water. What most reliable changes in blood will be present?
Patient C, 17 years old, became ill suddenly. Profuse diarrhea with frequent vomits without nosier. A patient arrived from south-east Asia. Temperature – 36,1 °C. An abdomen is pulled in, painless. The stool has the appearance of rice-water. What diagnosis is most reliable?
Patient C, 17 years old, worker of vegetable garden. Became sick 2 days ago. The disease is related to use of meal of dirty root crop. Disease begun with chill, fever of 38.1 ?C, had pain in abdomen and in the muscles of all groups and joints, weakness, nausea. Emptying is liquid, viscid, with a strong smell, ordinary color. At objective examination: sclera, conjunctivitis, hyperemia of soft palate, “raspberry” tongue. At palpation of abdomen – moderate pain in epigastrium and in right iliac area. What will be the diagnosis?
Patient E, 47 years, became ill in 4 days after returning from Egypt. A disease begun with the liquid emptying which look like a watery kind afterwards, joined with frequent vomiting, expressed weakness and fatigue. The state progressively got worse and within 18 hrs was admitted in an infectious department in a very grave condition. The lines of person are strained, skin is cold, cyanosis, temperature of body 35.5 ?C. Aphonia, cramps of hands and feet. The skin fold falls out through the abdomen. A stomach is pulled; no pain at palpation. Blood pressure is 70 and 30 mm of Hg. The pulse on radial artery is not determined, urination and emptying normal. Weight of patient at admission to the hospital was 60 kg. What is the degree of dehydration of the patient?
Patient L., 18 years old is sick with fever till 38 °C which proceeds 5 days. he has moderate dry cough, common cold, badly opens eyes. On examination –edema on face, expressed conjunctivitis with film raids. Mucous of pharynx is hyperemic, posterior wall of pharynx is grainy. Internal organs are without pathology. What form of disease does the described picture correspond to?
Patient M., 11 years old, complains on general weakness, cough, at night suddenly temperature rose till 39,5 ?C, appeared restlessness, barking cough, noisy whistling breathing with drowing in supra- and subclavicular cavities, intercostal spaces. He was in contact with the patient acute respiratory viral infection. What should recommend him the first line?
Patient N, 13 years old, hospitalized in the infectious department with a diagnosis of cholera, severe dehydration of Ш-ІV stage. What measures are primary?
Patient P, 35 years old, became ill within 2 days after returning from India. A disease begun with appearance of liquid diarrhea which resembled a watery appearance, afterwards joined with multiple vomit, expressed weakness and fatigue. State progressively got worse and within 12 hrs delivered in an infectious department in a grave condition. The skin is cold, cyanosis, temperature of body 35.5 ?C. Aphonia, cramps of hands and feet. A skin fold falls out from abdomen. The stomach is pulled in, no pain at palpation. Blood pressure is 70 and 30 mm of Hg. A pulse on a radial artery is not determined, urination and emptying are normal. Weight of patient at admission to the hospital was 80 kg. What volume of infusion solutions is needed for primary rehydration?
Patient P., 14 years old, is hospitalized in the infectious department in the severe condition. Complains on expressed headache, mainly in frontal and temporal regions, supercilliary arcs, origin of vomiting appear in condition of severe pain, pains by moving the eyeballs, in muscles and joints. Objectively: patient is excited, body temperature-39 ?C. BP-100/60 mmHg. Bradycardia was replaced by tachycardia. Appeared tonic cramps. Doubtful meningeal signs. From anamnesis it is clear that his brother has flu at home. What will be your diagnosis?
Patient R., 16 years old, hospitalized for 5-day illness with complaints of moderate headache in fronto-temporal region, laid nose, sore throat, pain in the left eye, rise in temperature to 38.1-38.5 °C. General condition is satisfactory. Shortness of nasal breath, mucous discharging from the nose, hyperemia of face, enlargment of the neck and submaxillary lymph glands, left foamy conjunctivitis. What is preliminary diagnosis?
Patient R., 26 years old, became ill sharply: temperature 39,5 °C, severe headache, mainly in frontal and temporal an area, pains in muscles and joints. Examined on the 2th days of illness: state of middle weight, skin clean, dry. Moderate hyperemia with cyanosis, pulse 120/min., rhythmic. Cardiac activity rhythmic, tones are muffled, in lights of the vesicular breathing. Stomach is without peristalsis. What is the preparation of choice for treatment of this patient?
Patient T., 22 years old, appealed to the hospital with complaints of the frequent stool without the abdominal pain, vomits without nausea, pain in calves. Objectively: Т-36,2 °C. A skin is pale, cold, tongue dry, voice getting hoarse. An abdomen is pulled in, painless. Emptying remind a “rice-water”. What terms of extract of patients from a hospital at this illness?
Patient with complaints about a general weakness, diarrhoea appeared to the doctor. Objectively: temperature of body 36,4 ?C, skin covers clean, acrocyanosis, tongue is dry, stomach| is soft, not painful, emptying is abundant, watery, with the supernatant flakes of white color, odourless and admixtures. For clarification of diagnosis culture of stool was made on Resselya. What is the color of culture chang?
Sick C., 20 years old, was admitted to the hospital with complaints about the frequent emptying without stomach-ache, vomiting without nausea, pain in calf muscle. Objectively: Temperature of body is 36,2 ?C. Skin is pale, cold, tongue is dry, voice is hoarsed. The stomach is pulled is not painful at palpation. Emptying resemble with “rice-water”. Are there what terms of discharge of patients from the hospital at such illness?
Sick C., 23 years, ill from 3 days after returning from India. The disease has begun with the liquid emptying which looks like a watery, after wards joined with multiple vomiting, expressed weakness and cramps. The state progressively got worse and was admitted within 12 hour in an infectious hospital in a grave condition. The eyes of person is sharped, skin is cold, acrocynosis temperature of body 35,5 ?C. Aphonia, cramps of hands and feet. The fold of skin falls out through abdomen. stomach is pulled in, no pain at palpation. Blood pressure is 70 and 30 mm of Hg. Pulse on radial artery is not determined, urination and emptying are not good. What is the most appropriate diagnosis?
Sick I., 25 years, returned from rest in Egypt. Early in the morning diarrhea began. Emptying each 1-1,5 hrs, abundant watery, without mucus and blood. Abundant vomiting also appeared. The temperature of body at first rise to 37,3 ?C, afterwards became 35,5 ?C, stomach-aches negative. Delivered in an infectious department. What is first aid?
Sick M., 22 years old, complaints about increasing of body temperature to 39 оC, headache in frontal area, pain in eyeballs, photophobia, pain in a muscles, dry cough. Became ill suddenly. The state is heavy. Objectively face is hyperemic, injection of scleras. Pulse 96 per min, rhythmic. Tones of heart are hypotonic. In the lungs – dissipated dry wheezes. Mucous membrane of oropharynx is hyperemic, grainy, vessels are extended. menengial symptoms are not present. Analysis of blood: leukocytes 3?109/L, е 1 %, band neut. 6 %, seg. neut 51 %, lymphocytes 35 %, мonocytes 7 %. What is most probable diagnosis?
Sick P., 25 years old, presents with frequent vomitting. Objectively: dryness of skin and mucous membranes, brief cramps in gastrocnemius muscles, the temperature of body is normal, voice is hoarsed, moderate tachycardia and hypotension. The compensated metabolic acidosis is marked. About what degree of dehydration is it possible to think?
Sick X., which returned from vacations from Turkey within 5 hrs in the morning, diarrhea began. Emptying each 1-1.5 hrs, with abundant watery without mucus and blood. In future bloodless watery, abundant vomitting appeared through 12 hrs. The temperature of body at first rise to 37.5 ?C afterwards became 35.7 ?C is delivered in an infectious department. What disease did you suspect?
Sick, 20 year old, apeared to the hospital with complaints about the frequent emptying without a stomach-ache, vomit without nausea, pain in calve. Objectively: temperature of body – 36,2 ?C. A skin is pale and cold, a tongue is dry, voice getting hoarse. A stomach is pulled in, painless, emptying like a “rice-water”. What are the criterias for discharging of the patient from the hospital?
Sick, 52 years old, with complaints about pain in lumbar region, headache edema of chin. It is known from anamnesis that the sick suffers from obesity of ІІ degree. Recently carried heavy neurological stress and had flu. He has chronic bronchitis for 5 years, chronic gastritis for 8 years. Objectively: Temperature of the body 38.2 °C, AP – 140/90 mm Hg. It is proposed the diagnosis of acute glomerulonephritis. What transferred factors could be the reason of disease?
The disease began sharply from diarrhea, that was accompanied by an abdominal pain. The act of defecation brought facilitation. Emptying of green color, abundant, foamy, with a strong unpleasant smell. Temperature of body is subfebrile. It is found out hyperemia and graininess of soft palate. In blood: leucopenia, eozinophilia. Violations of water-electrolyte balance are moderate.Your diagnosis:
The disease began sharply, 6 hours ago at a normal temperature appeared frequent liquid emptying, then vomit joined. At the inspection: voice is soundless, eyes reddish, pulse frequent, arterial pressure low, urine is not present, cramps appeared in lower extremities. The heart and lungs without changes. A liver and spleen are not enlarged. Choose preparations of ethiotropic therapy which can be used:
The ill patient in severe state was delivered to infectious department with no consciousness. Pale dark circles around eyes. Skin is cold, covered with sticky sweat. Temperature of body 35.6 ?C. Pulse 140/min and weak.Blood pressure is 40 and 0 m of Hg. Tongue is dry. Emptying is involuntary and watery. Three times vomited like “fountain”.What is the state of the patient?
The main principle of therapy for re-hydration in cholera is.
The patient P., 14 years old, is suffering from flu. He is hospitalized in infectious dept. due to worsening of his condition. He is conscious. A patient is suffocated. Pallor of skin covers with cyanosis, breathing rate 50 times/minute. BP-80/55 mmHg, pulse 110 times /minute. Body temperature-39,5 °C. Excretion of rose foamy sputum. On percussion of lungs there is tympanic sound with dullness in lower part of lung .On auscultation there is moist rales in lower posterior part of lungs. What complication of flu appeared in patient?
The seventh pandemic of cholera is caused by V cholera El Tor. It begans in 1961 on the Sulawesi island. However, to the epidemic of cholera arose up only in the countries of the third world. It is known that cholera is classic bacterial infection with the fecal-oral mechanism of transmission with the certain infectious dose of exciter. After the L.V. Hromashevsky factors of transmission of exciter of illness can be contaminated by them drinking-water, meal, hands. What is the basic factor of risk, that is instrumental in the such uneven division of morbidity on countries?
To the district doctor a patient, complaints on abundant excretions from a nose, moderate headache, hearing loss, perversion of taste. On examination – dry of skin, nose excoriation, in a pharynx – mild hyperemia. Temperature of body is subfebrile. Pathological changes of internal organs are absent. Which acute respiratory viral infection carries the patient?
To the internist appealed patient with complaints of weakness, diarrhea. Rested on a south, where the cases of diarrhea were present. Objectively: t-36,4 °C, skin covers are clean, acrocyanosis, tongue is dry, abdomen is soft, painless, emptying abundant, watery, with the flakes of white color floating on a surface, without odor and admixtures. For clarification of diagnosis sowing on the Ressels medium was made. How will the color of medium change?
18 year old student was hospitalized to the infectious disease department on the 2nd day of disease with complaints on sore throat during swallowing. Objective status: t – 37,5 °C, light hyperemia and swelling of right tonsil, which is covered by gray-white color pellicle, slightly erected above the tonsil’s surface. The pellicle is easily removed by spatula, disclosing hemorrhagic ulcer with smooth bottom. What is the most possible diagnosis?
35 years old patient A., came to the clinic on the third day of illness with complaints of drowsiness, sweat, headache, fever up to 38.5 °C. Reviewing physician found sore throat, splenomegaly, enlarged lymph nodes. Liver is not enlarged. Blood analysis – leukocytosis, lymphocytosis. What additional test should hold the patient for infectious mononucleosis?
A 19-years-old patient became ill 5 days ago: subfebrile temperature, acquired voice, dry cough weakness. After hospitalization: t – 37,1 °C, but the state is heavy, pallor, expressed weakness, aphonia, noisy stenotic breathing, inciters indrawings of intercostal intervals, pulse-110 shots per min., frequency of breathings 36 per min., cyanosys of lips and nailes. Tonsills is covered by the greyish dense raid. Define strategy of intensive therapy:
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