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 №37

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 F., 37 years, is occupied in a warehouse with pesticides. After several hours of work she felt weakness, headache, metal taste in mouth, vomiting, hypersalivation, thirst, hands tremor, eyesight disorders.

Objectively: stable “red dermographism”, hyperhydrosis of feet and palms. Breathing is firm, vesicular. PR-96/min, rhythmical, weak, AP-90/50. Heart tonea are muffled. Ulcerative gingivitis. Abdomen is soft, painful in right subcostal area. Tremor of upper extremities.

Urine analysis: microalbuminuria, microhematuria, leukocytes.

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

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 №38

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 J., 26 years, is admitted to intensive care department. From the anamnesis it is known that he had pickled seeds of wheat by pesticides in room without ventilation for 6 hours without break. Felt ill acutely 3 hours ago.

General condition is grave. Patient is excited, trembles. Tremor of extremities and body, dysarthria, dysphony, decreasing of tendon reflexes are observed. Skin is pale and dry. BR-22/min, breathing is vesicular, firm. PR-110/min, extrasystols. AP90/60. Heart tones are arhythmical, muffled, systolic murmur on apex. Tongue is dry, with white fur, ulcerative injuries of gums and mucous layer of mouth. Abdomen is strained, painful at palpation. Liver is found 2-3 cm lower than right rib arc, its rim is round, smooth, elastic, painful. No peripheral edema.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk