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 №12

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 47 is engaged in production of silica alloys during 15 years. Complaints on dry cough, periodical pain in chest, increased fatiguability, hyperhidrosis. X-ray: transparency of lung is not changed, lung pattern moderately hardened and deformated from both sides, at the background of which there are single nodular shadows of 1-2 mm in diameter predominantly in middle regions. At the upper parts of right lung – polymorphous focal shadows. Small pleurodiaphragmal comissures at the right.

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 №13

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., 36 years, a worker of varnished-painted production, took part in liquidation of an accident with air emission of large amount of nitrogen oxide. He complains of cough with foamy pinkish sputum, pressure in chest, breathlessness, acute dyspnea and asphyxia.

Objectively: cyanosis of skin and mucous layers. BR-48/min, body temperature – 37,9°C, PR-100/min, rhythmical, tensioned, AP-170/95, distantly – gurgling breathing, moderate dullness in lower parts of the lungs, breathing is vesicular, weakened, small-bubbling moist rales. X-ray: lung picture is indistinct, small spotted shadows of low intensity in lower and medium regions of lungs – the appearance of “cloudy” sky. Blood gas composition – hypercapnic hypoxemia.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk