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 №8

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 T., 39 years old, is occupied at wool production for 18 years. She complains of attacks of dyspnea, squeezing in throat, gravity in chest, dry cough, quick tiredness, which increases at first working day. At week-ends these symptoms disappear.

Objectively: dry rales are heard over the lungs, exhalation is not difficult. X-ray: lung roots are thickened, tensioned, netting and deformation of lung picture, features of emphysema. Negative response to skin and inhalation tests with allergens of occupational dust.

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 №9

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 B., 52 years, is occupied as a machine operator with increased level of organic dust in the air of working zone. He complains of constant cough and mucous-pus sputum, expiratory dyspnea at slight physical exertion, general weakness, sweating, breathlessness.

Objectively: barrel-like chest, intercostal spaces are expanded, box percussion sound, weakened vesicular breathing with prolonged exhalation, dry rales in lower parts of the lungs. X-ray: lung picture is diffusely intensified and deformed, roots are expanded, features of diffuse atrophic endobronchitis, dystony of wall of trachea and large bronchi, mucous layer is moderately thickened, signs of emphysema. Bronchoscopy: atrophy of bronchial glands. EFV₁ – 62% from normal, its increasing after ß₂-agonist inhalation – 4%.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk