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Problem 35 - PLAGUE

Patient 44yrs has called the physician to house, in connection with sudden increasing of the body temperature above 39c. Simultaneously appeared the headache, muscular pains. 4 days back returned from Astrahanskoy area, where he was a guest.

At check-up: condition heavy, excited, skin of the person hyperemic, eye brilliant. The pulse 140/min, rhythmic. The tones of heart are not heard. In light breathing vesicular, no wheezing. Inguinal lymph node increased up to 3.5 and is sharply painful spyaan with surrounding tissues, skin hyperemic. The liver and spleen are not increased.

1. Preliminary Diagnosis
2. Medical diagnostic tactics
3. The plan of prophylactic actions in the centre

Problem 36 – HEMORRHAGIC FEVER

Patient 32yrs, hunter, seven days has been in the woods. In 14^th day after return fell ill. The disease began sharply, with increase of body temperature up to 39.8c, shivering, painsin muscle and headache. Treated the temperature decreasing facility. The temperature became sub febrile on the 4^th day of the disease., but general state did not improve, Malaise remained, bad appetite. With 5^th day of diseaseon the skin of thorax and internal surface of the limbs appeared ample petechial rash, with this the pains in lumbar area, Pliguria, urine with reddish color appeared and nose bleeding.

At check-up Condition is heavy, weak, the temperature of body 37.3c and heart without changes and liver and spleen not increased.

Positive symptom on tapping on the loin with both sides.

In urine analysis, spirals, erythrocytes up to 20-30 mf. There are hyaline cylinders.

1. Preliminary diagnosis and basis
2. Diseases for differential diagnosis
3. Plan of examination
4. Plan of treatment

Problem 37 – GRIP PNEUMONIA

Patient 19 yrs has entered with permanent establishment of 8^th day disease. Got sick sharply, with shivering and increasing of body temperature up to 38.2c. Headaches in the area of forehead and eyeballs, stuffy nose, dull ache in the whole body, ssadnyenie for breastbone, dry cough, treated in the dispensary with Antigripin, Paracetamol, cough relieving therapy. On background of the treatment general state was perfected. How ever on the 7^th day disease once again appeared. The headache, the temperature of the body increased up to 39c. Increased cough with greenish phlegm. Appeared the pains under the thorax on the right.

Objective: Condition to average gravity, the temperature of the body 38.6c, severe coughing. Mucous membranes soft and back wall of gulp hyperemic. The pulse 110/min, rhythmic. The heart tones muted. In light breathing on the left breathing is vesicular, on the right suprascapular area and below the corner of the blade ***** the sound, at auscultation in the place abundance of micro vesicular, humid wheezing.

1. Preliminary diagnosis and basis
2. Plan of examination
3. Plan of treatment

Problem 38 – ADENOVIRAL INFECTION

Patient R, addressed to physician with complaints of total weakness, increasing temperature up to 37.3-37.8 c, head cold slizothichenye, dry cough, moderate headache. Fell sick 5 days back, when appeared the weakness, small increasing of the body temp. Since first days of the disease patient disturbed with head cold, cough, but at the last 3 days was appeared slizothichenye. The body temo did not rise above 38c.

The similar events of the diseases existed amongst the family.

At check-up condition is satisfactory. The temperature 37.3, with ***** rash. Small catarrhal conjunctivitis, Rhinits. The increased submandibular and cervical lymph nodes 0.5 up to 1.0. painless and mobile. Mucous membranes of the soft palate and back wall of the gulp hyperemic with cyanotic tone.

The pulse 88/min, rhythmic. The tones heart are clean and clear.On light breathing are listened to diffused wheezing on both sides.

The tongue is net, humid. The belly soft and painless. The liver and spleen not increased.

1. Preliminary diagnosis and basis
2. Plan of examination
3. Plan of treatment

Problem 39 – HEPATITIS B

Patient 56yrs has entered in clinic on 25^th day of disease. During 23 days disturbed the pains in knee, ankle, weakness, reduction of appetite. Overnight before hospitalization has got dark urine. The pains in joints decreased. On the 25^th day noticed the icteric sclera.

At check-up In light pathological change is not revealed, tones of heart are muted, pulse 62/min. the tongue is covered with yellowish color. The belly usual form, soft and painless. The liver emerges from the under the rib arc on 3, refer to urine darkening, excrement aholichen. For 3 months before the disease was handled on cause of traumatic break up of spleen.

1. Preliminary diagnosis and basis
2. Plan of examination
3. Plan of treatment