Practical exam (stage 1)
SITUATIONAL TASK №37
A 40-year-old pregnant woman with a gestation period of 34 weeks turned to the doctor for an appointment.
Complaints of flashing "flies" in front of the eyes, dizziness, dry skin, brittle nails, hair loss.
From anamnesis: Is registered for pregnancy from 11 weeks. Last menstruation on November 18.
Objectively: The general condition is satisfactory. The skin and visible mucous membranes are pale. Pulse is 100 beats per minute, rhythmic. With auscultation of the heart, the I tone at the apex is weakened, systolic noise is heard over all points of the heart. In the lungs, respiration is vesicular. The liver and spleen are not enlarged.
Test results:
Full CBC: HB − 90 г/л, RBC. − 3,3*1012/л, MCH − 0,7, WBC − 9,8*109/л: EO − 2, LYM − 25, MON − 10, anisocytosis, microcytosis.
Serum iron − 7.2 mmol/l.
Questions:
1. Preliminary diagnosis?
2. Examination plan?
3. Interpretation of test results.
4. Differential diagnosis and final diagnosis.
5. Treatment tactics
Discipline "General medical practice No. 1"
Practical exam (stage 1)
SITUATIONAL TASK №38
A 28-year-old pregnant woman complains of lower abdominal pain more on the right, nausea, single vomiting.
Anamnesis of the disease: Pregnancy 24 weeks. Ill for 5-6 hours. The pain appeared in the epigastric region, then shifted to the right half of the abdomen.
Anamnesis of life: Menstruation from the age of 12, established immediately, for 5-6 days, after 28-30 days, regular, painless, moderate. Sexual life since the age of 26, married. There are 2 births, both with large fetus. There are no gynecological diseases.
Objectively: The Temperature Is 37.50 C. The general condition is satisfactory. The skin of the usual color. Pulse is 94 beats per minute, blood pressure is 110/70 mm Hg. The tongue is dry, overlaid with a white coating. The abdomen is not swollen, soft, painful when palpated in the right iliac region. Symptoms of peritoneal irritation are weakly positive on the right. The uterus is in normal tone, enlarged to 24 weeks of pregnancy.
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