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 №21

for practical-oriented state exam on

internal, occupational and infectious diseases

for 6^th year students of medical ,

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 O., 40 years, is occupied as a polisher for 20 years. She complains of pain in distal phalanxes of fingers, which stops after 10-15 min of usual work, whitening of nail phalanxes of palms, which appears after overcooling, mainly in cold periods of year.

Objectively: skin of fingers is marble-like, nail phalanxes are cyanotic, palms are cold by touch, hyperhydrosis of palms. Positive symptom of “white spot”. Trophic disorders are absent. No pathological changes of internal organs are revealed.

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 №22

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.

Female aged 35, polisher on emery grinderwith working experience of 10 years. Complains on pain in distal parts of hands, whitening of terminal phalanx of upper extremities after general overcooling. Hands are cold, fingertips are edematous and cyanotic, positive syndrome of “white spot”, no trophic disorders. There disturbances of vibrational, pain, temperature sensitivity take place.

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 №23

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.

Male aged 43, has been working as a riveter on machine-building plant with pneumatic instruments, which generate vibration. On admitting to the clinics of occupational diseases complains on pains and numbness in hands, whiteness of hand fingers after local cooling, headache, dizziness. On examining: hypoesthesia in distal parts of hands; they are cold, humid. Tendon reflexes are expressed. On electrothermometry the temperature of distal parts of hands: right - 24°, left - 22°. Restoration to initial temperature after cooling test took takes 40 minutes. Test for acrospasm is positive. Capillaroscopy of nail-bed: background is pale, capillaries are convoluted, arterial bend is narrowed, venous – dilated. Vibrational and pain sensitivity are decreased.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk