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Task 3; HAEMORRHAGIC FEVER

Task 1; VIRAL HEPATITIS

Patient, 44 years notes yellow sclera, skin, dark urine, weakness, repulsion of food, light sickness, the past 5 days. In the last 3 days, temperature of body is within 37.2 – 37.5* C. Pain in large joints and head, disappeared the appetite, at the last 2 days, dark urine, yellow sclera and skins. Took analgin, antigrippin, vitamins.

Three months back treated in neurological branch due to functional frustration of nervous system, got the medicine in the manner of subdermal tablets and intravenous injection.

The general condition to average gravity. The temperature 36.8*C. Sclera and skin sparingly yellow. Peripheral lymph nodes are not changed. Pulse is 52 / min. BP is 110 / 60 mmHg. Vesicular breathing. The abdomen is soft and painful. The liver emerges from beneath right edge of the rib, lower pole of spleen is palpable. Urine is dark brown, excrement is sulphur color.

1. Preliminary diagnosis
2. Differential diagnosis; Pseudo TB, Leptospirosis
3. Plan of examination and treatment; Interferon + Lanivudin

Task 2; MENINGOCOCCAEMIA + MENINGITIS

Patient V, 22 years, student has entered the infectious hospital on the 2^nd day of diagnosis, “influenza – hypertoxic form”. The disease began sharply, suddenly appeared the shivering, weakness, strong headache, the temperature of the body increased before 39.5* C. No contact with infectious patient

During examination the condition was severe. The temperature of the body 39.7*C. Adynamic, dull, pale, cyanosis of lips. Clouded consciousness. On the skin of the trunk, upper and lower limbs and ample haemorrhagic rash. Tones of heart are mute, BP is 60 / 20 mmHg. In lungs vesicular breathing is heard. Moderate hyperemia of soft palate and back wall of mouth. The tongue is dry and gray coated. The abdomen is soft and painless. The liver and spleen are not increased. Meningeal symptoms are weakly positive. Did not urinate in the past 12 hours.

1. Preliminary diagnosis and his motivations
2. Plan of examination
3. Plan of urgent medical action

Task 3; HAEMORRHAGIC FEVER

Patient N, 30 years, hunter, several weeks has been in the woods. After 2 weeks from his return he fell ill. The disease began sharply, with increasing temperature 40 *C, shivering, headache, pain in muscles. The temperature became subfebrile on the 4^th day, but malaise, loss of appetite remained. On the 5^th day of disease on the chest, and internal surface of limbs appeared ample petechial rash, from the same day pain in loins, oligouria, urine with red colour, severe nose bleeding.

During examination; condition was grave, weak, subicteric sclera, the temperature is 37*C. In lungs and heart without changes, the liver and spleen are increased. Positive symptom of Pasterensky sign is positive on both sides. In urine analysis erythrocytes 20 – 30 in microscopic field, and hyaline cylinders are present.

1. Diagnosis and his motivations
2. Diseases for differential diagnosis
3. Plan of examination
4. Plan of treatment