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 №14

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 G., a serviceman, was influenced by phosgene during carrying his duties. He complains of pressure feelings in chest, marked dyspnea at slight physical exertion, attack-like cough with serous-mucous sputum.

Objectively: moderate diffuse skin cyanosis, BR-38/min, PR-40/min, rhythmical, tensed, BP-145/90, weakened vesicular breathing and solitary small-bubbling moist rales are heard in the lungs. X-ray: lung picture is not distinct, small ramifications of vessels are differentiated badly, interlobular pleura is thickened, lung roots are expanded with indistinct outlines.

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 №15

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 C., 32 years, who is occupied in chemical laboratory, is admitted to a hospital after an emergency situation at work. She complains of breathlessness, pressure and pain in chest, intensive attack-like cough with mucous-bloody sputum, general weakness.

Objectively: body temperature-37,9°C, diffuse skin cyanosis, BR-26/min, additional breathing muscles take part in act of breathing, breathing is vesicular, firm, dry whistling rales, small amount of medium- and large-bubbling moist rales. X-ray: increased transparency of lung fields, moderate intensification of lung picture.

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 №16

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 Z., 41 years, is occupied at crystal production for 15 years. During periodical medical inspection he complains of general weakness, sometimes – headache.

Objectively: general condition is satisfactory. Skin is pale. PR-60/min, rhythmical. AP-135/80. Heart borders are not changed, heart tones are clear, loud. Lilac border on the gums. Tongue is dry with white stratum. CBC: Er-4,1x10¹²/l, Hb-110g/l, colour index-0,7; basophile-grainy erythrocytes-32%, reticulocytes-24‰, ESR-16mm/h. Serum iron-28mcmol/l. Excretion of Δ-aminolevulinic acid 13 mg per 1g creatine. Excretion of coproporphyrin-276mkg per 1g creatine.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk