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 №17

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 K., 46 years, is occupied in foundry department of accumulator factory for 20 years. He complains of general weakness, quick tiredness, headache, dizziness, irritability, decrease of memory, worsening of eyesight and taste feeling, hands trembling at excitement, dumbness in extremities, heartburn, nausea, bad appetite.

Objectively: skin is pale. PR-55/min, rhythmical. AP-160/90. Tongue is dry with white stratum. Grey-lilac border on the gums. Liver is of dense consistency, 2 sm below rib arc. CBC: Er-3,5x10¹²/l, Hb-95g/l, colour index-0,7; basophile-grainy erythrocytes-53%, reticulocytes-32‰, ESR-16mm/h. Serum iron-32mcmol/l. Excretion of Δ-aminolevulinic acid 22 mg per 1g creatine. Excretion of coproporphyrin-410mkg 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

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 №18

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 H., 48 years, is occupied as founder in department of steel smelting for 14 years. Air of working zone is of high temperature, has vapors of gases. He complains of headache, quick tiredness, worsening of memory, sleep disorders, loss of appetite, pain and numbness of extremities, dizziness, sleepiness. Sometimes heart palpitation, aching pain in heart region and paresthesia in legs occur.

Objectively: face hypomimia, stable “red dermographism”, hypoalgesia of “socks and gloves” type, hypotonia of extremities muscles, tendon reflexes are moderately decreased from both sides, slight tremor of stretched fingers, instability in Romberg’s pose, walking is slow, positive Hvostek symptom.

Head of the department of internal medicine,

professor O.I. Fediv

Head of subject-methodical commission on

therapeutic disciplines, professor V.K. Taschuk