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 №24

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 aged 30, riveter during 6 years. Complaints on sharp pain in shoulder girdl, especially at night. Numbness and albication of hand fingers at cooling. Increased irritability. Objectively: puffy hands, cold, cyanotic. Greatly decreased all types of sensitivity (pain, temperature, vibrational). At cooling test – symptom of «dead fingers ». Weakness in adductors of V finger, changed electro-irritability. Tendon and periostal reflexes are increased.

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 №25

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 O., 32 years, is occupied as a spinner at a farm for 15 years. She doesn’t use individual defensive measures. Level of noise in working zone comes up to 100 decibel, mainly of high frequency. For last year she complains of periodical headache, increased irritability, sleep disorders, quick tiredness.

While investigation general hyperhydrosis, stable red dermographism, unsteadiness in Romberg pose, decreasing of tendon reflexes of legs and arms, decrease of hearing are revealed. AP-120/85, PR-80/min, rhythmical. Whisper can be perceived at the distance of 2 m.

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 №26

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., 38 years, is occupied as military pilot for 18 years. Last two weeks after flights complains of moderate hearing and eyesight decrease, headache, loss of memory and attention, periodical pain in bones and joints, short loss of consciousness, emotional labiality.

Objectively: general condition is grave. Peripheral lymphatic nodes and thyroid gland is not enlarged. Skin is pale and wet. BR-24/min. Auscultation – vesicular breathing. PR-90/min, rhythmical, weak, AP-90/60. Heart borders are not changed, heart tones are clear, muffled and rhythmical. Tongue is wet. Abdomen is soft, not painful.

Spirography: VLC-70% from normal figures.

ECG: disorders of cardiomiocytes’ polarization.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk