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 №10

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 P., 27 years, is occupied at poultry farm. She complains of attacks of asphyxia, which appear periodically (1-2 times a week) during work an are followed by difficult prolonged exhalation, pressing pain in chest, distant whistling rales, and they end in excretion of viscous mucous layer, salbutamol is always effective. During vacations the condition of a patient always improves.

Objectively: percussion sound with box shade over the lungs, vesicular sound with prolonged expiration is heard, dry whistling rales predominantly during exhalation. Sputum investigation: daily amount – 10 ml, mucous character, eosinophilic cells – 10-12 in a sight of view, leukocytes – 2-3 in a sight of view, Kurshman’s spirals, Sharko-Leyden’s crystals. Spirography: FEV₁ – 79% from normal points, daily variation – 28%. After salbutamol inhalation – the measurement have increased 15% from the previous. Allergic skin test – positive reaction to feather.

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 №11

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., 32 years, is occupied in forensic medicine laboratory. He complains of attacks of asphyxia, which appear during work while inhalation of formaldegid vapours. While attack the patient feels breathlessness, pressure in chest, inhalation decreases and exhalation becomes prolonged, distant whistling rales are heard, cough with viscous glass-like sputum is observed.

Objectively: face is pale with cyanotic shade, chest in position of maximal inhalation, percussion sound is with box shade, prolonged exhalation, large amount of dry whistling rales, especially at inhalation. Spirography: FEV₁ – 70% from normal points, daily variation – 32%. After salbutamol inhalation – the measurement have increased 18% from the previous. Positive provoking inhalative test with formaldegid (conducted during remission).

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk