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The patient complains of general weakness, dizziness, palpitations, mild pain in the left quadrant of the rib area. Vivid jaundice skin. Liver and spleen enlarged. Cardiac rate 82 Bpm, arterial pressure 110/60 mm Hg.
Blood test: HB - 72 gpl, RBC - 1,8 • 1012 L, WBC - 5,2 • 10 9 L, ESR - 7 mm / hr, microspherocytosis. Urinalysis: yellow, normal clarity, volume 1015 ml/24hr, glucose - 0, protein - 0, RBC - 0-1, WBC - 2-3, positive reaction of bile pigments. Biochemical analysis of blood: protein - 75 gpl, total bilirubin - 218.0 mircomol / l: direct - 38 micromol / l, indirect - 180 micromol / l, urea - 5.4 micromol / l creatinine - 59 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Minkowski-Shoffara disease (hereditary hemolytic anemia).
B. Cirrhosis of the liver.
C. Acute pancreatitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 3
The patient complains of general weakness, frequent nasal and uterine bleeding. The front surface of the body has petechial hemorrhage. Liver and spleen not enlarged.
Blood test: HB - 76 gpl, RBC - 1,9 • 1012 L, WBC - 6,2 • 10 9 L, ESR - 12 mm / hr, platelets - 91 • 10 9/ l. Urinalysis: yellow, transparent, volume 1015 ml/24hr, glucose - 0, protein - 0, RBC - 0-1, WBC - 2-3, negative reaction of bile pigments. Biochemical analysis of blood: protein - 77 gpl, total bilirubin - 18.0 micromol / l, urea - 5.2 micromol / l, creatinine - 57 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Septic endocarditis. B. Acute leukemia. C. Werlhof disease (thrombocytopenic purpura).
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 4
The patient complains of general weakness, palpitations, nosebleeds. Moderate jaundice skin. Normal liver size, spleen enlarged. Cardiac rate 82 Bpm, arterial pressure 110/60 mm Hg.
Blood test: HB - 82 gpl, RBC - 1,9 • 1012 L, WBC - 3,2 • 10 9 L, ESR - 12 mm / hr, platelets - 111 • 10 9 L. Urinalysis: yellow, transparent, volume1015 ml/24hr, glucose - 0, protein - 0, RBC - 0-1, WBC - 2-3, positive reaction of bile pigments. Biochemical analysis of blood: protein - 75 gpl, total bilirubin - 130.0 micromol / l: direct - 30 micromol / l, indirect - 100 micromol / l, urea - 5.7 micromol / l, creatinine - 65 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Cirrhosis of the liver.
B. Hypersplenism.
C. Hemolytic anemia.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 5
The patient is treated at the cardiology department, established diagnosis - coronary heart disease, atrial tachyarrythmia. Suddenly felt intense pain in the left quadrant of the rib area. Normal skin color. Arterial pressure 150/90 mm Hg. Body temperature - 37,8 º C. Moderately tense abdomen, painful in the left quadrant of the rib area, which determines the lower pole of the spleen. Negative reaction of Schotkin- Blumberg negative.
Blood test: HB - 146 gpl, RBC - 5,1 • 10 12 L, WBC - 17,2 • 10 9L, ESR - 5 mm / hr. Urinalysis: yellow, transparent, volume1023 ml/24hr, glucose - 0, protein - 0, RBC - 1-2, WBC - 2-3. Biochemical analysis of blood: protein - 63 gpl, total bilirubin - 19.2 micromol / l, urea - 6.4 micromol / l, creatinine - 69 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Splenic rupture.
B. Myocardial infarction.
C. Perforated gastric ulcer.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 6
The patient is being treated for a month in gastroenterology department for duodenal ulcer. No effects of treatment are observed: ulcer does not heal.
Blood tests: HB - 146 gpl, RBC - 4,9 • 10 12 L, WBC - 7,2 • 10 9L, ESR - 5 mm / hr. Urinalysis: yellow, transparent, volume1023 ml/24hr, glucose - 0, protein - 0, RBC - 1-2, WBC - 1-2. Biochemical analysis of blood: protein - 83 gpl, total bilirubin - 18.2 micromol / l, urea - 6.4 micromol / l, creatinine - 69 micromol / l.
Aspiration-titration method of gastric secretion analysis: basal secretion of hydrochloric acid - 47 micromol / hr., stimulated secretion of hydrochloric acid - 60 micromol / hr. Serum gastrin level - 1100 pg / ml.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Ulcer malignization.
B. Ulcer penetration.
C. Zollinger-Ellison syndrome.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 7
3 months ago the patient was operated on duodenal ulcer complicated by decompensated stenosis. Resection of the 2 / 3 of stomach (Chamberlain – Finsterer). Complains of: attacks of weakness, accompanied by dizziness, palpitations, nausea. Attacks occur immediately after eating and last 30 - 40 minutes.
Blood test: HB - 126 gpl, RBC - 4,0 • 10 12 L, WBC - 7,4 • 10 9L, ESR - 15 mm / hr. Urinalysis: yellow, transparent, volume1023 ml/24hr, glucose - 0, protein - 0, RBC - 1-2, WBC - 1-2. Biochemical analysis of blood: protein - 63 gpl, total bilirubin - 14.0 micromol / l, urea - 5.4 micromol / l, creatinine - 62 micromol / l. Blood glucose level (analysis taken during an attack). - 10.4 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Dumping – early syndrome.
B. Dumping - late syndrome.
C. Gastro - intestinal bleeding.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 8
2 months ago the patient was operated on duodenal ulcer complicated by decompensated stenosis. Resection of the 2 / 3 of stomach (Balfour). Complains of: attacks of weakness, accompanied by dizziness, palpitations, headache, feeling of hunger. Seizures occur in 2 - 3 hours after eating.
Blood test: HB - 136 gpl, RBC - 4,4 • 10 12 L, WBC - 6,4 • 10 9L, ESR - 10 mm / hr.
Urinalysis: yellow, transparent, volume 1023 ml/24hr, glucose - 0, protein - 0, RBC - 1-2, WBC - 1-2. Biochemical analysis of blood: protein - 65 gpl, total bilirubin - 15.0 micromol / l, urea - 5.4 micromol / l, creatinine - 62 micromol / l. Blood glucose level (analysis taken during an attack). - 3.3 micromol / l.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Dumping – early syndrome.
B. Dumping - late syndrome.
C. Cardiopsychoneurosis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 9
9 months ago the patient was operated on perforated duodenal ulcer. Done: ulcer cutting, selective proximal vagotomy. Complaints of: moderate pain in epigastrium, heartburn. During the endoscopic examination recurrence of duodenal ulcer revealed.
Aspiration-titration method of gastric secretion analysis: basal secretion of hydrochloric acid - 15 micromol / hr., stimulated secretion of hydrochloric acid - 22 micromol / hr. Serum gastrin level- 115 pg / ml. Gastric pH measurement: the body of the stomach 1.2 - 1.4; antral part 3.2 - 3.9; atropine test - positive.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Zollinger – Ellison syndrome.
B. Incomplete vagotomy.
C. Partial removal of ulcer substrate.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 10
12 years ago the patient (age 45) was operated on duodenal ulcer disease complicated by decompensated stenosis. Done: resection of the 2 / 3 of stomach (Chamberlain – Finsterer). Complains of: permanent general weakness, weight loss, legs swelling, diarrhea.
Blood test: HB - 76 gpl, RBC - 2,1 • 10 12 L, WBC - 4,4 • 10 9L, ESR -18 mm / hr., Color index - 0.6. Urinalysis: yellow, transparent, volume 1023 ml/24hr, glucose - 0, protein - 0, Er. - 1-2, Leuc. - 1-2. Biochemical analysis of blood: protein - 52 gpl, total bilirubin - 21.0 micromol / l, urea - 5.4 micromol / l, creatinine - 62 micromol / l, fibrinogen - 1.5 gpl. Stool sample: creatorrhoea, stearrhea.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Dumping – early syndrome.
B. Dumping - late syndrome.
C. Malabsorption syndrome.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 11
2 hours ago the patient (age 28), suffering from duodenal ulcer, after physical exertion at work felt a sharp pain in abdomen with irradiation in the right supraclavicular area. Gradually pain disappeared. Examined in the company’s medical center and sent to the hospital.
Blood test: HB - 146 gpl, RBC - 4,6 • 10 12 L, WBC - 6,4 • 10 9 L, ESR - 5 mm / hr. Urinalysis: yellow, transparent, volume 1023 ml/24hr, glucose - 0, protein - 0, Er. - 1-2. Leuc. - 1-2. 4 hours after a disease started, the surgeon revealed moderate muscle tension of anterior abdominal wall in right quadrant of the rib area.
Blood test: HB - 144 gpl, Er. - 4,5 • 10 12 L, Leuc. - 12,4 • 10 9 L, ESR - 6 mm / hr. Urinalysis: yellow, clear, volume 1024 ml/24hr, glucose - 0, protein - 0, Er. - 2-3, Leuc. - 1-2.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Perforated covered duodenal ulcer.
B. Acute appendicitis.
C. Acute pancreatitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
SECTION 4 “Clinical and Laboratory Research” Task number 12
Patient (age 35) is suffering from duodenal ulcer. 14 hours ago felt general weakness, lost consciousness, had coffee-ground vomit, liquid black stool.
Blood test: HB - 88 gpl, RBC - 2,2 • 10 12 L, WBC - 5,4 • 10 9 L, ESR - 7 mm / hr., Color index, 0.65. Urinalysis: yellow, transparent, volume 1023 ml/24hr, glucose - 0, protein - 0, RBC - 1-2, WBC - 1-2. Biochemical analysis of blood: protein - 62 gpl, total bilirubin - 23.0 micromol / l, urea - 8.4 micromol / l, creatinine - 67 micromol / l., Fibrinogen - 1.9 gpl.
Give your interpretation of the laboratory test data. Give preliminary diagnosis:
A. Acute enterocolitis.
B. Ulcerative Colitis.
C. Duodenal ulcer, complicated by bleeding.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 13
A patient during 14 years is ill on duodenum ulcer. Last 3 months he complains of feeling full in the stomach area, vomiting after eating, general weakness, slimming.
Blood test: НВ - 108 g/l, Еr. – 3,0 • 10 12 l, L. – 5,5 • 109 l, ESR - 4 mm/hour. Urinoscopy: yellow, transparent, specific gravity 1022, sugar– 0, protein – 0, 124 g/l, Еr. – 2-5 in sight, L. – 4-6 in sight, grainy cylinders - 1 – 3 in sight. Biochemical blood test: protein - 62 g/l, general bilirubin – 23,0 ymol/l, urea - 9,4 mmol/l, kreatinin – 69 ymol/l.,fibrinogen – 2,2 g/l. Ionogram: K – 3,0 mmol/l, Na – 135mmol/l, Cl – 68 mmol/l, Са – 2,2 mmol/l.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Chronic pancreatitis.
В. Ulcerous illness of duodenum, which is complicated by stenosis.
С. Ulcer penetration.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 14
A patient during 25 hours notes temporal stomach-ache, vomiting, delay of defecation and gases. 6 months ago he was operated concerning the splash appendicle genesis of peritonitis.
Blood test: НВ – 147 g/l, Еr. – 4,8 • 10 12 l, L. – 9,9 • 109 l, ESR- 12 mm/hour, Ht – 0,47. Urinoscopy: yellow, transparent, specific gravity 1025, sugar – 0, protein – 0, 124 g/l, Еr. – 3-5 in sight, L. – 5-6 in sight, grainy cylinders – 2 – 5 in sight. Biochemical blood test: protein - 65 g/l, general bilirubin – 19,0 ymol/l, urea - 7,4 mmol/l, kreatinin – 69 ymol/l., fibrinogen – 2,2g/l.
Ionogram: K – 3,1 mmol/l, Na – 134 mmol/l, Cl – 68 mmol/l, Са – 2,2 mmol/l.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Acute iliac passion.
В. Acute pancreatitis.
С. Acute cholecystitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 15
A patient during 3 days marks a stomach-ache, vomiting, swelling of stomach, sharp weakness, thirst. A front abdominal wall is moderately tense, peritoneal symptoms are positive.
Blood test: НВ - 127 g/l, Еr. – 2,8 • 1012 l, L. – 19,9 • 109 l, ESR - 30 mm/hour. Urinoscopy: yellow, transparent, specific gravity 1028, sugar – 0, protein – 0, 248 g/l, Еr. – 5-7 in sight, L. – 15-16 in sight, grainy cylinders – 3 – 5 in sight. Biochemical blood test: protein - 65 g/l, general bilirubin – 29,0 ymol/l, urea -17,4 mmol/l, kreatinin – 110 ymol/l., fibrinogen – 4,3g/l.
Ionogram: K – 3,0 mmol/l, Na – 124 mmol/l, Cl – 66 mmol/l, Са – 2,2 mmol/l.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Acute iliac passion.
В. Peritonitis.
С. Acute pyelonephritis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 16
The brigade of ambulance brought to the hospital a patient with the diagnosis “Acute stomach”.
During laboratory researches was set:
L. in blood – 14,8 х 109 l; ESR – 18 mm/hour. General bilirubin of blood – 28,8 ymol/l (direct – 14,4 ymol/l. indirect – 14,4 ymol/l.); alpha-amylase of blood – 76 mg/hour-l; Urine’s diastases – 2048 units.
Interpret data of laboratory examinations. What is the preliminary diagnosis? Point out constants and norms
А. Acute cholecystitis..
В. Perforational ulcer.
С. Acute pancreatitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 17
In a surgical department entered a patient with suspicion on acute pancreatitis.
What laboratory indexes confirm this diagnosis?
А. In clinical blood test is moderate anemia.
В. In biochemical blood test is increased index of fibrinogen.
С. Increased urine’s diastases.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 18
In hospital for 4 days treats patient with diagnosis “acute pancreatitis”. Significant effect from treatment is not marked. Over last 2 days the body temperature increased to 39-40 0С, stomach is swollen, peristaltic is sharply weakened. At palpation: in the epigastrium defines infiltrate; weakly-positive signs of Schotkin-Blyumberg and Razdolskiy.
During laboratory research: Blood test: Hb – 96 g/l; Еr. – 3,0 х109/l; L. – 23,6 х109/l; ESR – 34 mm/ hour; leycoformula: е – 1; p -18; с – 53; l 20; м – 8. Urinoscopy: protein – 0,49 g/l; L. - 2 - 4 in sight; Еr. 1 -2 in sight; hyaline cylinders – 1 -3 in sight. Blood glucose – 11,8 mmol/l. Urine’s diastases – 0 units. Biochemical blood test: protein – 50,3 g/l; general bilirubin – 36,0 ymol/l; direct – 16,8 ymol/l; indirect -19,2 ymol/l; urea – 9,3 mmol/l; iodine test – 4; alpha-amilase – 2,4 g/hour-l.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Perforational ulcer.
В. Acute destructive pancrestitis.
С. Acute cholecystitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 19
In surgical department was hospitalized a patient with complaints of pain in the right hypochondrium. In anamnesis: during the last year she was treated twice stationary with the similar attacks. On the Ultrasonography was identified multiple stones in gall bladder with diameter 3-5 mm.
During laboratory research: Urine on bilious pigments – sharply positive reaction.
Blood test – L. – 12,8 х109/l; ESR – 24 mm/ hour. Biochemical blood test: general bilirubin – 396,4 ymol/l; direct – 300 ymol/l;indirect – 96,4 ymol/l; ALT – 2,4; AST – 0,9; thymol test – 8,4units.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. GKH-II, choledocolithiasis, mechanical icterus.
В. Cirrhosis of the liver.
С. Hemolytic anemia.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 20
To a medical dispensaries applied patient with complaints of stomach-ache, backache, which was irradiated in a right thigh. From anamnesis – 7 hours ago he executed hard physical work.
During laboratory research was set: Blood test – L. - 16,8х109/l. Urinoscopy: protein – 0,99 г/л; L. - 4-6 in sight; Еr. fresh – 1/2 in sight; hyaline cylinders – 0-1 in sight; oxalates – significant number.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Acute appendicitis.
В. Acute cholecystitis.
С. Urolithiasis, renal colic on the right side.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 21
In a surgical hospital was hospitalized a patient with suspicion on acute appendicitis
At the admission: Hb – 137 g/l, Еr. – 3,7´10 12l, ESR – 7 mm/hour, L. – 8,7´10 9l. .
In 2 hours of supervision stomach-ache was localized in the right iliac area, where tension of muscles, positive Rovzing’s sign are marked.
Hb– 137 g/l, Еr. – 3,7´1012l, ESR – 8 mm/hour, L. – 13,5´ 10 9l.
Interpret data of clinical and laboratory examinations. What is your tactics?
А. The phenomena of acute appendicitis are progressed of patient, which is confirmed by increased level of leucocytes. Appendectomy is shown in an urgent order.
В. Patient has a renal colic on the right side, treatment in urologist.
С. Patient has acute cholecystitis, continue conservative therapy.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 22
A patient underwent an operation 6 months ago. It was a subtotal subfascial thyroid resection by Nikolayev. During the last 4 months patient marks weight gain, dryness of skin, slow reaction on irritants.
During laboratory research: Alkalaine phosphatase of serum – 3 units. (by King-Armstrong’s method). Cholesterol of serum – 13,6 mmol/l. Urine’s creatinine – 15 mg/kl. General thyroxin (T4) – 48 nmol/l.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Thymoma.
В. Acquired initial hypothyroidism.
С. Hypoparathyreosis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 23
A patient,48 years old, complains of a general weakness, sweating, pain in the lumbar area, frequent urination. He ills about 1 year, in the childhood treated from mesenteric adenitis. Liveliness is reduced, moderately pale. At palpation of stomach patient feels a pain in the right hypochondrium.
Blood test: Нb – 120 g/l, Еr. – 2,8 x 1012l, L. – 9,6 ´ 10 9l, ESR – 35 mm/hour,
sugar in blood – 4,5 mmol/l, urea - 8,6 mmol/l, kreatinin - 100 ymol/l Urinoscopy: protein – 0,66 g/l, L. for all in sight. In 1 of 3 portions is discovered Koch’s bacteria. Reaction of Parennyu and Mantu is positive.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Acute appendicitis.
В. Acute pyelonephritis.
С. Tuberculosis of the right kidney.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. “Clinic-laboratory researches” Task № 24
A patient, 36 years old, complains of attacks of pain in left lumbar area, nausea, vomiting. In the childhood treated from the pyelonephritis. Skin teguments are pale. At palpation stomach is painful in the left hypochondrium, where is determined the lower pole of kidney. Pasternatskiy’s sign is positive leftwards.
Blood test: Нb – 130 g/l, Еr. – 4,2 x 1012l, L. – 12,6 ´ 10 9l, ESR – 25 mm/hour, urea - 6,2 mmol/l, kreatinin 100 ymol/l. Urinoscopy: protein – 0,46 g/l, L. for all in sight.. There are signs of reduce function of the left kidney on intravenous pyelogram.
Interpret data of laboratory examinations. What is the preliminary diagnosis?
А. Tuberculosis of kidney.
В. Acute left-side pyelonephritis with reduce function of the left kidney.
С. Acute pancreatitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 25
A patient 58 years complains about pain in a hypogastrium, frequent urination with blood. He is ill about two months, treated during two weeks of ambulatory without an effect. Low delivery, mildly pale, stomach is soft, sickly above pubis.
Blood test: Нb - 120 g/l, Еr.- of 3,2 x 10 12 l, L. - 6,8 x 10 9 l, esr - a 37 mm/h, an urea is 6,0 mmol/l, kreatinine - 80 uM/l. Uranalysis: an albumen: 0,86 g/l, Er. all in sight, thickly, L. - 8-10 insight, specific gravity - 1020. On Ultrasound - the right wall of urinary bladder is thicken to 4 cm, on the right pyeloectasia is mildly express.
Interpret laboratory data. What is a previous diagnosis?
А. Tumour of urinary bladder with the compression of bee-entrance of right ureter.
В. Outsidebody tumour of pelvis.
С. Hernia of the obturatory opening.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 26
The patient of 52 years complains about pain in the left lumbar area, increase of temperature each evening to 39 0 С, chills. She is ill 10 days. Moderate pallor of skin, at palpation of stomach there is pain and tension of muscles in left hypochondrium, where the bottom pole of bud is determined.
Blood test: Нb - 110 g/l, Er. - 3,2 x 10 12l, L. - 16,0 x 10 9 l, serial nuclear - 14%, esr - 37 mm/h, an urea is 6,8 mmol/л, kreatinine – 100 uM/l. Uranalysis: an albumen is 0,246 g/l, L.in sight, thickly, Er. - 8-10 in sight. On Ultrasound - the left bud is enlarge, a capsule is sharply thickened, gipoehogenious parenchima, bottom pole is deformed, hydrophilic formation in it is of 20 х 30 mm.
Interpret laboratory data. What is a previous diagnosis?
А. Buds polycystic.
В. Apostematous pyelonephritis, abscess of bottom pole of the left bud.
С. Hypernephroma.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 27
Patient 28 years is ill on duodenal ulcer. Hospitalized concerning gastro-intestinal bleeding by a volume 700 ml. Conservative therapy is conducted. During 24 hours supervision of stool, it was not vomit. HR 88 - 92 beats / min. SC 120/80 mm. RT. Art
Clinical blood test: during hospitalization - НВ - 102 g/l, Еr.- 3,2 - 10 12 l, L. - 5,4 - 10 9 l, esr - 7 mm/ hours, color index - 0,65; in 24 hours - НВ - 89 g/l, Er. - 2,9 - 10 12 l, L. - 6,3 - 10 9 l, esr - 8 mm/ hours, color index - 0,64.
Why did indexes of НB and erythrocytes decrease?
А. Relapse of bleeding.
В. Hemodilution.
С. The ongoing bleeding.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 28
A patient 37 years hospitalized in concerning gastro-intestinal bleeding. The ulcer of bulb of duodenum is endoscopicaly educed on a front wall, covered by hematin. During realization of conservative therapy a patient began to complain about acute abdominal pain. At palpation stomach is tense, sickly.
Blood test: НВ - 78 g/l, Er. - 1,9 - 10 12 l, L. - 18,5 - 10 9 l, esr 6 mm/hours, color index - 0,60; Uranalysis: yellow, transparent, specific gravity 1023, sugar - 0, albumen - 0, Eras. - 1-2 in sight, L. - 1-2 in sight. The Biochemical blood test: albumen is 62 g/l, general bilirubin is 22,0 uM/l, urea is 8,6 mmol/l, kreatinine - 68 uM/l., Fibrinogenum is 1,9 g/l.
Interpret laboratory data. What is a previous diagnosis?
А. Intensifying of ulcerous illness.
В. Sharp cholecystopancreatitis
С. Combination of gastro-intestinal bleeding with the perforation of ulcer.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 29
A patient 68 years, during 4 days complains about crams stomach-ache, bloating, delay of stool and gases. During 6 months marks interchange constipations and diarrhea, lost weight 5 kg.
Blood test: НВ - 107 g/l, Er. - 3,0 - 10 12 l, L. - 10,1- 10 9 l, esr 42 mm/ hours.
Uranalysis: yellow, transparent, specific gravity 1025, sugar - 0, albumen - 0, 124 g/l, Eras. - 3-5 in sight, L. - 5-6 in sight, grainy cylinders - 2 - 5 in sight. The Biochemical blood test: albumen - 65 g/l, general bilirubin – 190 uM/l, urea of 7,4 mmol/l, kreatinine – 69 uM/l. Ionogram: K - 3,1 mmol/l, Na - 134 mmol/l, Cl - 68 mmol/l, Са - 2,2 mmol/l.
Interpret laboratory data. What is a previous diagnosis?
А. Acute obturatory colic obstruction of tumour genesis.
В. Crown’s Illness.
С. Girshprung’s Illness.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 30
A patient was operated 3 days ago in concerning with penetrating in the pancreas of duodenal, complicated by the decompensated stenosis ulcer. The resection of 2/3 stomach is executed by Balfur method.Complain about general weakness, sense of gravity and moderate pain in the area of stomach, nausea.
Blood test: НВ - 104 g/l, Er. 3,3 - 10 12 l, L. - 14,2- 10 9 l, esr - 22 mm/ hours. Uranalysis: yellow, transparent, specific gravity 1025, sugar - 0, albumen - 0, 124 g/l, Er. - 3-5 in sight, L. - 5-6 in sight, grainy cylinders - 2 - 5 in sight. The Biochemical blood test: an albumen - 64 g/l, a general bilirubin is 18,0 uM/l, an urea is 7,4 mmol/l, kreatinine – 67 uM/l. A diastase of urine is 1024 units.
Interpret laboratory data. What is a previous diagnosis?
А. Postoperative pancreatitis.
В. Acute drive loop syndrome.
С. Postoperative peritonitis.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 31
A patient, 55 years, complains about moderate pain in epigastriums, absence of appetite, general weakness. An ulcerous "niche" is radiography educed on small curvature of stomach 3,0 x 2,5 cm.
Analysis of secretion of stomach by a aspiration-titration method: basal secretion of hydrochloric acid - by 0,5 mmol/hours, stimulated secretion of a hydrochloric acid - by 7,2 mmol/hours. Blood test: НВ - 97 g/l, Er. - 2,8 - 10 12 l, L. - 8,1- 10 9 l, esr - 52 mm/ hours. Uranalysis: yellow, transparent, specific gravity 1025, sugar - 0, albumen – 0, Er. - 1-2 in sight, L. - 3-5 in sight. The Biochemical blood test: albumen - 61 g/l, general bilirubin - 15,0 uM/l, urea - 6,4 mmol/l, kreatinine – 66 uM/l.
А. Gastric Ulcer.
В.. Gastric besoar.
С. Gastric cancer.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 32
In a surgical department there is a patient with appendicular infiltration. In time of hospitalization: haemoglobin is 137 g/l, Er. - 3,7 x10 12 l, esr - 22 mm/hours, L. - 12,7x10 9 l. To the 4th day from the beginning of treatment a stomach-ache was localized in a right area, where tension of muscles is observed, positive Rovzing’s symptom, temperature of body is 38,5 0 С. Hb - 117 g/l, Er. - 2,7x 10 12 l, esr - 26 mm/hours, L. - 23,5x 10 9 l.
Interpret data of clinical and laboratory examination. What is your tactic?
А. A patient has a progressive phenomena of acute appendicitis which is confirmed by the increase of white blood cells and esr. Appendectomy is in the urgent order.
В. A patient has right nephrocolic, pyelonephrosis. An urologist should treat the patient.
С. A patient has abscessing of appendicular infiltration, shown for the peritoneal section of abscess.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 33
It was radiographicaly found the horizontal level of liquid in a right pleura cavity.
Blood test: НВ - 92 g/l, Er. - 2,2 - 10 12 l, L. - 5,4 - 10 9 l, esr - 7 mm/hours, cell-color - 0,60;
Set a diagnosis.
А. Right-side hydrothorax.
В. Right-sidehemothorax.
С. Right-side acute pleural empyema.
Examined and Approved at Interdepartmental Meeting
Protocol № 9 from 30.04.14
Head of Surgery Department with Pediatric
Surgery and Urology Course Prof. V.V. Leonov
MINISRTY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
Discipline “Confirmed”
“Surgery and Pediatric Surgery” Director of Medical Institute SSU
Practical skills «___» ______________ V.A. Smiyanov
BLOCK 4. "clinic-laboratory researches" Task № 34
It was radiographicaly found the horizontal level of liquid in a right pleura cavity.
Blood test: НВ - 132 g/l, Er. - 3,2 - 10 12 l, L. - 19,5 - 10 9 l, PO - 10%, esr - 27 mm/ hours, cell-color - 0,69;
Set a diagnosis.
А. Right-side hydrothorax.
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