Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №1

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient D., 52 years old, is occupied as a miner at coal mine with increased level of free silicium oxide in the air of working zone. While periodical medical inspection he complains of dry cough, moderate dyspnea at physical exertion, needle-like pain under the shoulder blades.

Objectively: chest of ordinary shape, box percussion sound in lower-lateral parts of lungs, firm vesicular sound is heard. X-ray: lung picture is intensified, the roots are expanded, solitary nodular shadows 1-2 mm in size are visualized in middle-lower regions of both lungs.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №2

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient K., 56 years, is occupied at ceramic materials production, where the concentration of silicium oxide in the air of working zone is constantly increasing. He was admitted to a hospital with complains of cough with small amount of mucous sputum, inspiratory dyspnea at slight physical exertion, pain in chest.

Objectively: the chest is broad, mosaic alternation of box and dull percussion sound. X-ray: lung roots are expanded, deformed, in both lung fields multiply nodular shadows 5-8 mm in diameter are found, symptom of “snow-storm”, lymphatic nodes in the form of “egg-shell”

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk

Ministry of Health Protection of Ukraine

Bukovinian State Medical University

Medical Faculty №3

“Approved”

Central guidance committee of Bukovinian State Medical University

“14” March 2013 year (protocol №6) Head of the central guidance committee, Vice-Rector for scientific-pedagogic work Associate professor ________I.V. Gerush

Clinical Task №3

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical faculty №3

Occupational skill “Algorithm of diagnosis, emergency treatment and rehabilitative measures at occupational pathology”

1. What is preliminary diagnosis?

2. Suggest treating and rehabilitative measures for the patient.

Patient S., 64 years, was occupied as a drifter in a coal mine of quartz extracting for 30 years. He complains of inspiratory dyspnea, which occurs at rest, chest in pain of constant character, cough with mucous-pus sputum, gravity in right subcostal area, lower extremities edema.

Objectively: barrel-like chest, cyanosis of upper part of body and face. Box sound with focuses of dullness are found over the lungs. Regions of firm and weakened vesicular sound, large amount of dry and moist rales predominantly in lower parts of lungs, pleura friction sound. X-ray: nodular shadows which are merged in large conglomerations 4-5 sm in size, pleura-diaphragmatic commissures.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk