Patient N; 32 years entered in infectious branch on the 6th day of disease. 3 days back he came form a short term business trip. At arrival his condition was grave. He is unconscious. There was repeated vomiting, notes nystagmus, reaction of pupil of the eye on light is faded. The skin is pale, humid. There is vesicular breathing in the lungs without wheezing. The tones of heart are mute, pulse is weak, 120 / min. BP is 90 / 60 mmHg. Liver is thick and palpated 1 cm below the rib arc. The spleen emerges on 2 cm from beneath the rib arc. There is tremor of tongue. Moderate rigidity of occipital muscles, symptom of Kernig. Pathological reflexes are not defined, tendon reflexes are increased. Urine and stool are normal.
On background conducted therapy in 2 hours his condition was better, was partly restored consciousness. BP is 110 / 60 mmHg. Blood test; Hb – 75 g / L, erythrocytes – 2.2 x 1012/L, poikilocytes – 0.8, leucocytes – 11.8 x 10 9/ L, ESR – 39 mm / Hour
P: 17 – PARAGRIP
Patient, 17 years. Applied to polyclinic for the 3rd disease. Zabolel gradually, when appeared the malaise, weakness, blocked nose, having a tickle in the throat. Treated by itself, on the 3rd day disease general grew worse. Temperature of the body increased to more than 37.6C, barking cough, feeling of heaviness in breastbone, harsh voice. At checkup condition was satisfactory. Skin of the usual coloration, nose breathing is labored, moderate rhinorrhea. In pouring, hyperemia, back gulp. The palatal tonsil’s hyperemic without rash. The lymphatic tissues are not increase. Pulse is 80/min, satisfactory quality. No rales were auscultated.
Sero diagnosis: IHA, CFT, Neutralization.
It has less acute onset than influenza, intoxication – less pronounced.
Laryngitis and rhinitis is typical.
P: 18 – HIV INFECTION.
Patient of 37 years. Has entered on examination in infectious branch complaint often ‘catarrhal’ diseases. Reduction of the mass of the body, appearance violet- red rash on lower limb and trunk in the manner of erythemia.
Beside 3rd years ago, appeared and are saved to date cervical, enlargement of lymph nodes. Seasonally notes the fluid char 4 – 5 times a day by length from 1 week to more than 1,5 months.
From anamnesis known that often can be business trop in African countries. Didn’t mark any contact with sick. At checkup- condition is satisfactory. On skin of lower limbs and trunk there are erythemic spots –violet-red color, reminding angioma. Palpation of axillary’s and subclavicular lymph nodes, amount is 1 x 1.5cm. Consistency is that of rubber band, painless. Mucous cheeks, soft palate and tonsils there are whitish rash, easy leaving palette knife. The heart tones are low. Pulse -88. Breathing is vasicular. The belly is soft, painless. Liver and spleen are not increased. The chair 3 times/ day; fluid without admixtures.
P:19 – FLU – PNEUMONIA.
Patient -20years. Has entered in receiving quietness of the infectious hospital for 8 day disease. Acute onset of disease with shivering and increasing of the temperature more than 39.1C. He was disturbed by the pain in eyeballs, mortgaged nose, and dull ache in all tele. Treated using Antigrippin and Paracetamol – on the background of treatment, his condition became normal. However on 5th day disease again appeared with headache, the temperature of body increased to 39C, cough with mucous phlegm, and pain in thorax under blade on the left.
Objective: condition to average gravity, temperature of the body 38C. Frequent cough. Thick soft palate and back wall gulp, hyperemia, and pulse 110/min, rhythmic. The tones of heart were muted. In light on the right breathing Vesicular, on the left in side of the area and below corner of the blade fading pulomary sound, at auscultation in the place abundance humid wheezing.
P- 20 – ANTHRAX.
Patient has entered hospital complaint on weakness, headache, increasing of the temperature body to 39C. Furuncle formation on rear of the left cyst. Sick 2 days ago, when soon after removing with Fallen cow appeared said symptom. At checkup condition is heavy, temperature was at 39,4C.
The skin of person is hyperemic, cyanosis of lips. There are dark scabs on skin of the rear surdace of the left cyst by amount 3.5 – 2.0 refer to with rim on edge. The surrounding area of the skin is hyperemic, swollen and painless with small – of crimson color. Under light hitting on the back (for kidney palpation) is defined – flutter. On the left palpation painful and increased lymph nodes to 1.5 – 2.0; refer to kubitalnie and axillary’s lymph nodes. The heart tones are deaf. Pulse – 120beats/min. AD-118/78 mm.rt.cl. Breathing is light vesicular breathing. Abdomen is soft, painless.
LN: biopsy / CSF
Benzylpenicillin 600mg
P-21 – PSEUDO TB.
Patient 24 years. Addressed to physician on 3rd day of disease. Onset sharply with shivering and increase of temperature to 38.3C. on 2nd day disease was noted one-short retching, appeared the stomachache, pains in knee funny joint, but to evening on skin of the thorax small rash. At checkup condition to average gravity. Complains of pains on the whole belly, more on the right – in knee and funny joint. The joints are not changed. The skin and sklerni mildly yellowish, on lateral surface of the thorax in the field of knee and funny joint spots rash, palm and foots hyperemic brightly. Skiery inesirovni. Back inesirovni. The back wall gulp hyperemic mildly, language is tax (cover)ed by grey raid net on edge with hypertrophic sosochkami.
The pulse – 96, rythemic. The tones of heart is muted. In light vasicular breathing wheeze. Belly soft, sparing painful.
In right pavsdoshnoi of the area. Liver on 2 refer to emerges from under rib arc, palpation of spleen.
Microorganism = yersinia
SOI= animals (pig, cat, dog)
WOI= contact or alimentary
Problem- 22 – YERSINIOSIS
Patient, 23 years. Has entered in infectious hospital on 3rd day disease with diagnosis ‘viral hepatitis’. Onset is sharp, temperature of the body increased with shivering more than 38.7C. Since the –day disease temperature of the body was saved 37.8 – 38.5C was noted bas appetite, discomfort, kachiobraznie chair 2 – 3 times a day. Pain in knew and funnyh joint, rash on lateral surface of the --. On 2nd day disease – darkening coloration of the urine. on 4th day Yellowish sclera and --. The condition at arrival is average gravity. Moderate yellowish skper and skin. On lateral surface in the filed of knee, funny looshezapyastnih joint spots rash. The joints are not changed. Hyperemic. The borders heart is not changed, tones rhythmic muted. The breathing is vesicular, no wheezing. The language is tax(cover)ed belovatim palate, on side with crimson tone. The belly painful in pagvzdoshnoi area. The liver on 2 refers to vistoit from side. The spleen not increased.
Problem-23. – BRUCELLIOSIS
Patient 44 years. The pains seasonally disturb during 3rd years in muscle, joint, weakness, ooglomlyaemost potlivost. Was it sometimes noted paznablivanie, the temperature of changeable within 37.6C. Beside 15 years works the milkmaid. Was ill influenza, ‘poliartritom’ agneksitom. At checkup: condition satisfactory. The skin covers humid, usual coloration, without rash. Lymph nodes are painless. No visible change in joints. It is noted sickness at palpation in places of the output lumbar rootlet. Change on the part of organ heartily- vascular and respiratory system no. the belly is soft. The liver palpation on 2 refers to below edges of rib arc. The spleen size is increased.
Reaction of agglutination/ RAIT reaction
Reaction of Henderson (screening)
Allergic test probe by Burnge.
Treatment – Tetracyclin, rifampicin, Doxy
Problem – 24 – INFECTIOUS PNEUMOSCLEROSIS. “KISS DISEASE”
Patient 23 years old. Disease started 4 days ago when appeared the pains in throat under glotani. Temperature increased with shivering 38.5C. In 2 days appeared pripoohlost in the filed. Temperature of the body on background of the acceptance of temperature reducing facilities and Erythromycin was saved within 37.5 – 38.5C.
At checkup condition was average gravity. The magnified submandibular front – am occipital lymph nodes to 0.5 – 1.0 refer to movable mildly painful at palpation. Axillary lymph nodes are increased not sharply painful at palpation. The tongue is humid, is tax covered by white raid. Mucous is soft and palatal doozhek hyperemic. The palatal tonsils are vastly increased with festering follicular with both sides.
The pulse is rhythmic- 96. The tones of heart are frequent and clear. No changes found during auscultation and percussion. The belly is soft and painless at palpation. The liver on 1 emerges beneath rib arc. Spleen is enlarged.
Problem- 25 – MALARIA
patient 29years. Fortnight back he came back from Iran, where he was for the past 6 months. The disease developed sharply with shivering lasted for 1.5hours, near simultaneously increased the temperature to 38.8C. Headache appeared, pains in lumbar area. The temperature held 6 hours. Critical reduction was accompanied ample afterwards. In following day general stage was satisfactory. On 3rd day disease was repeated shivering, increased temperature to 39C, was noted one shot retching. At checkup: person hyperemic sclera. The pharynx is normal. The tongue is dry and covered by white film. Herpes on lips. The liver is increased on the first point Selezyo HKA(+).
Problem- 28 – VIRAL HEPATITIS. BLEEDING.
Patient 22 years. Disease onset was gradual. It was noted reduction of appetite, sickness and boring pain in hospitalization on 6th day of disease. No contact with infectious person. At arrival condition was satisfactory. The skin covers and visible mucous membrane sparingly yellowish. At study breathing pathology was revealed. The tones of heart are decreased and frequent. Pulse – 72, rhythmic., satisfactory. Blood pressure 110/60mmhg. Tongue is humid and covered by yellowish film. The belly is soft and participates in breathing and not painful. The liver on 2nd point emerges from beneath rib arc. Rubber – painless. Symptom Ragozy is positive.
On 8th day condition sharply worsened. Increased intoxication, appeared jaundice, appeared retching.
The conciousness was not clear, he didn’t answer to questions immediately; disoriented in place and in time. The temperature increased to 38C. on 9th day disease of patient sharply excited. There was hemorrhagic rash. The liver scent found. Tachycardia. The liver palpation was done the emetic of mass of color of coffee vomiting.
Problem- 27. – MENINGITIS
Patient was 16 years, student, has entered in permanent established on 2nd day of disease. With complaint on strong headache, the shivering, increasing of temperature to 39.7C, three phase retching. The disease started sharply, when appeared the shivering, increased the temperature before 38.9C, headache. In three hours the condition worsened. Temperature increased before 39.9C, appeared the retching, dizziness. To evening became dullard, on skin trunk and limbs appeared the separate hemorrhagic rash. At arrival condition was heavy. Sick dullard. The temperature is 38.8C. Pose compelled: sick rests upon side with tightened to belly leg. The patient is hyperemic. Pulse is 98; satisfactory characteristics. BP- 100/55mmHg. Dominated meningeal signs (Occipital rigidity, kerning symptom, symptom of Brudzinskovo). Pathological reflexes are absent.
It is realized that during several weeks quotient events ORZ registered in class.
Problem -28 – LEPTOSPIROSIS
Patient is 44years. Onset was sudden. Already in 1st day of disease, temperature increases to 39.8C, shivering. The following day temp is 38.5 – 40.2C. Complained of strong pains in muscles of back and lower limbs. On 4th day disease has entered in permanent establishment. Intensive hyperemia person is revealed. At auscultation and percussion; no pathological revealed. The belly is soft, painless. The liver on 5 refers to below rib arc. - Thick
palpation edges of the spleen. The jaundice appeared for 5th day of disease and decreased diuresis.
Problem 29 – PSEUDO TB
Patient 29 yrs. Onset is sudden, with shivering, temperature – 38.7C, appeared the headache, weakness, pains in shoulder from knee joint, rumbling and periodic, weak pains in right padvsdochnoi of the area. The appetite grew worse; sickness appeared in evening, but then twice – a retching. The chair was once, executed, normal coloration. Caused district physician has found odutlovatost and expressed hyperemic person and necks, hyperemic pharynx. General state remained bad. Temperature of body in the morning was 37.9C and in evening it rose to 39C. On 3rd day of disease, temperature rose to 39.5C. Patient noticed the bright rash on – but on evening yellowish skin. It is hospitalized with diagnosis “Viral hepatitis”, “allergic rash”. Condition was of average gravity. On skin flexiosurface of hands and legs, epigastric of the troughs, inguinal area, abdomen. Medicine to be taken externally of the surface of the thorax ample point rash, cyst and foots hyperemic brightly. The pulse – 88, rhythmic. BP 120/60mmHg. In light is listened to hard breathing, no wheezing. The tongue is covered with white film. The belly is soft and painless. Liver +2 refer to
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