Situational Tasks For Hospital Surgery 6th Course 31-05-01 20201

Ministry of science and higher education of the Russian Federation
federal state budgetary educational institution of higher education

«National Research Ogarev Mordovian State University »
Medical Institute
Department of Hospital Surgery with Courses of Traumatology and Orthopedics, Eye Diseases
The Discipline «Hospital Surgery»
Code and name of the Educational Program 31.05.01 – General Medicine
Course _VI_ Semester _XI_
CLINICAL CASE № 1
The patient M., 52 years old, was taken to the clinic by the ambulance team 12 hours after the disease.
He complaints on a sharp weakness, dizziness, liquid stool feces black. He considers himself sick about 0 12
hours, when he felt weak, was vomiting coffee grounds, followed by a 2-fold, copious liquid stool black. His-
- - -
tory of ulcer is no . Objectively: the patient is lethargic, drowsy. The skin

-
and visible mucous membranes are
pale in color. BP 90/40 mm, heart rate 120 beats/min, weak filling. The abdomen is soft, painless on palpa-
↓
- - - -
tion, auscultation listened to increased peristaltic noises. Symptoms of irritation of the peritoneum are nega-
tive.
What is the clinical diagnosis? Assign examination and treatment.
shock.
px-Acute GI
bleeding, Hypovolemic & IV fluids & continue monitoring vital signs
startAntishock therapy
Immediately
Jrg.-III upper
G1
endoscopy (Both diagnoseinHead of Department V. I. Davydkin
C2) Blood test
find
I of bleeding
source
canterization
↳evaluate Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
for anemia & blood loss
(3) stool test

Rx: xx-> endoscopic
ligation
-
E
octretide
Irel Hemostatic therapy
mg
cans. mx - 100
~
fresh frozen playmen
odanesteron y
my ↳ vit k.
tranxemic acid
Medical Institute
_Course _VI_ Semester _XI_
CLINICAL CASE № 2
Patient E., 47 years old, was admitted to the hospital with complaints of severe pain in the upper half
of the abdomen, which suddenly appeared 2 hours ago. From the anamnesis it is known that the patient suf-
fers from a stomach ulcer for a long time. On examination: the state is relatively satisfactory. The pulse rate
is 84 beats per minute. BP - 110/70 mm. The abdomen is not swollen, sharply tense, painful in all areas dur-
ing palpation. Symptom Blumberg positive. During the review X-ray showed the presence of free gas in the
abdominal cavity.
Dx- perforated peptic ulcer I peritonitis
Inv.
(1) (BL
in abd cavity
Head of Department V. I. Davydkin
12 CEC
ofany
(evaluation gas
13)
Endoscopy Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
I I -Yandicate
cons. Mxe IV fluids (NS) xmx-laparotomy-omental patch repair
King seea re
Antibioticscetotaxime
every Isubtotal resections
tableene
large perforation size
->
Ryle tube
Medical Institute
CLINICAL CASE № 3
Patient A., 56 years old, was admitted to the clinic with complaints of skin itching, aching pain in the
right hypochondrium and epigastric region, weakness, lack of appetite, jaundice, which appeared 1.5
months ago and is rapidly increasing. Attacks of severe pain have never been noted. When examining the
sclera and the skin of a patient with an olive color, the skin turgor was sharply reduced; there are a lot of
scratches. The stomach is soft. The liver is enlarged. In the right upper quadrant, a slightly painful for-
mation of a dense-elastic consistency, ovoid is palpated. Feces are acholic.
Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).

Medical Institute
_
CLINICAL CASE № 4
Patient V., 58 years old, complains of repeated vomiting 2 times a day, weakness, weight loss of 12 kg
in the last 4 months. On examination: state of moderate severity. Skin is with an earthy tinge. Low power.
Turgor of the skin is reduced. Heart rate – 88 beats per minute, BP – 110/60 mm. the Abdomen is retracted,
when palpation is soft, painless, in the epigastric region a dense inactive tumor with a diameter of 10 cm is
palpated. With succussion in the epigastric region – the noise of the splash. Blood count: Erythrocytes –
4,8×1012/l; HB -156 g/l; Leukocytes – 8,4×109/l; ESR – 20 mm/h.
.
Medical Institute
CLINICAL CASE № 5 -
The patient I., 58 years, 10 months ago there was dysphagia, which gradually increased. At the pre-
sent time can hardly swallow a drink of water. On examination: the patient is severely depleted. Heart rate –
76 beats per minute, BP – 140/80 mm. Abdomen is soft, painful in the epigastrium on palpation . Liver is
on the edge of the rib arch. The esophagus has its sharp narrowing in the abdominal region, suprastenotic
expansion on radiography . Tight filling of the stomach could not be obtained, but it seems that there is a
filling defect in the upper third of the body along a small curvature. Esophagoscopy revealed a sharp nar-
rowing of the esophagus by 34 cm from the incisors. It was not possible to carry out an endoscope into the
stomach. Histological examination of the biopsy material revealed a picture of a multilayer flat epithelium.

Medical Institute
CLINICAL CASE № 6
Patient G., 35, complains of intense epigastric pain accompanied by vomiting in the past two months.
The fear of eating is due to severe pain, the patient has lost 18 kg in the last 2 months. He abuses alcohol.
Objective research: low stock, tongue dry. On palpation of the abdomen, the liver protrudes 3 cm from the
edge of the costal arch, and the abdomen is painful in the epigastrium. The tension of the anterior ab-
dominal wall in the epigastrium is determined. Peristaltic noise is common. Rectal examination revealed no
pathology. With ultrasound, the liver thickens, increases in size. Liquid formation with a diameter of up to 5
cm is determined in the projection of the pancreatic head, in the study of the dynamics of changes in the size
of the formation is not determined, the biliary tract without pathology. Urinary diastasis in the midst of an
attack of 256 U. 2.6-21.2 Ju/hr normal range
DX-chronic pancreatitis in acute pancreatic cyst
I
stage
Ix-Lab (BC, 171, PT, s.
-
amylase, wine albumin creatinine
+

Instrumental USG Abd.
-
CT
liner BX
Postop:-
I
Endoscopy Nutritional support
AnalgesicNSA
I
medical mx-
pancreatic enzyme supplements al of cyst one
of shida electrolytes
mx
drainage I roux
prevents of sepsis
scopalaminotampaarehigh the Antibiotics -
if true seen then

cyst remove cyst
proper monitoring
as it
Medical Institute
CLINICAL CASE № 7
Patient N., 52 years old, complained of skin jaundice, dark urine, light feces. The epigastric pain at-
tack suffered 3 months ago, after which sclera jaundice appeared. He was treated in hospital, jaundice was
stopped. Two weeks ago, without an attack of pain, jaundice showed up. In weight during her illness she lost
8 kg. Abuses alcohol. Yellowness is determined by examination of the skin and mucous membranes. The
right lobe of the liver is slightly enlarged, the enlarged painless gallbladder is palpated. Laboratory meth-
ods: total bilirubin - 88 µmol / l, direct - 56 µmol / l, indirect - 32 µmol / l, prothrombin index - 73%, serum
albumin - 32 g / l, blood amylase 48 mg / (h × ml). With ultrasound, the liver is homogeneous, its edge pro-
trudes by 3 cm from under the costal arch, the intrahepatic ducts are dilated, the common bile duct is ex-
panded to 12 mm. The formation of a reduced density of 33 mm in diameter is determined in the head of the
pancreas. What is the clinical diagnosis? Assign examination and treatment.
Dx:-Tumor of pancreatic head, obstructive jaundice
Inv. -> Lab-(B), 171, PT, s. amylase
rurkers
-
I
Sx: Whipple's Operation
pancreaticoduodenectomy)
-
albumin & creatine

-
vrine analysis ->
Instrumental Chest X-ray (to check metastasis Remove (head of pancreas + duodenum+gall
part of bile duct
-
part
-
bladder +
Bx
Esophagogastrodvodenoscopy small upper
+
of bottom of stomach -
ERCP partof small intestine)

Rx: -
Pre-operative preparations USG Anastomosis -
pancreatico jejunostomy
->
Adequate hydration Ministry of science and higher education of the Russian Federation choledocho jejunostomy
->
mannitol
given
IV 3
days prior to ex
federal state budgetary educational institution of higher education gastro jejunostomy
-
wit K10
->
Mg IM
Antibiotic to sy postop:-maintainance of proper
day prior
->
I
mid & electrolytes
↳
cephalosporins/Aminoglycosides Medical Institute Init ina set
Department of Hospital Surgery with Courses of Traumatology and Orthopedics, Eye Diseases Antibiotics.
Course
_ _VI_ Semester _XI_
CLINICAL CASE № 8
Patient Zh., 45 years received 5 days later with complaints of pain in the right hypochondrium, nau-
sea, fever up to 38 C, chills. An objective study: high nutrition, tongue dry. On palpation of the abdomen,
the liver acts from under edge of a costal arch on 3 cm, the abdomen is painful in the right hypochondrium,
which is determined by the infiltration. No symptoms of peritoneal irritation. The rectal examination re-
vealed no pathology. With ultrasound, the common bile duct is 8 mm in diameter, in the gallbladder, stones
are determined, one of which (diameter 12 mm) in the neck, and suspension. The wall thickness of the
gallbladder is 9 mm. blood Leukocytes are 16.0×109/l. Concomitant pathology: hypertension, varicose veins
of the lower extremities. What is the clinical diagnosis? Assign examination and treatment.
with concomitanthim a varicose veins of lower
actremities
Dx- Acute calculous cholecystitis cholelithiasis
Head of Departmenttest V. I. Davydkin
2x+ lab-cBC, analysis, biochemical blood
urine
lipid profile, coagulogram

Instrumental
I I
Usa Abd. Rx-startc ons. Mx x After
3wks-cholecystectomy
-
-nasogastric aspiration
->
mx:-obscrtapas
armoved
cholecysto cholangiography fluids
post. op
-> IV
ECG, ERCP ->

Analgesics Antispasmodics
&
electrolytic balance
spectrum Al (Ceftriaxone i
Broad
->
Nutrition supportif needed
Medical Institute
_Code and name of the Educational Program 31.05.01 – General Medicine
CLINICAL CASE № 9
The general condition of the 61-year-old patient sharply worsened on the 2nd day after appendectomy
for acute phlegmonous appendicitis. There was a huge cold, the body temperature rose to 39.6 ° C, pains
appeared in the right hypochondrium. On palpation, an enlarged and painful liver began to be detected. The
-
abdomen remained soft, moderately painful in the right half. Over the next 2 days, there was a dizzying chill,
the temperature became restless, and the scleral yellowness appeared.
-
Leukocytes in the blood of 20.0 × 109/ l; ESR - 43 mm / hour, a sharp shift of "white blood" to the left.
- -
Radiological changes in the chest and abdominal cavity was not detected.
-

DX: -
postoperative Septicaemia, pylephlebitis
Ex:-cBK, biochemical test, USG Abd.
tactics: -pt me in Intensive care unit
b Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
zu fluids
Antibiotics -
Letoperazone, metronidazole
ventilation support
of abscess
If in use liver abscess found - sy drainage
is needed.
Medical Institute
Code
_ and name of the Educational Program 31.05.01 – General Medicine
CLINICAL CASE № 10
The 36-year-old patient was admitted 4 hours after the onset of the disease. The disease began very
acutely, with sharp pains in the epigastric region. There was a single vomiting. The patient was alone in the
apartment and was able to call a doctor only after 3 hours.
At the time of examination, the General condition of the patient is satisfactory, complains of pain in
the right iliac region, where there is a sharp local soreness, protective muscle tension and positive symp-
toms of Shchetkin – Blumberg and Rousing. A temperature of 37.3°C, pulse 100 beats/min white blood cell
count of 15.0×109/l. He was diagnosed with acute appendicitis, and the patient was taken for surgery. How-
ever, after opening the abdominal cavity, a significant amount of turbid liquid was released with an admix-
ture of pieces of undigested food. What is the clinical diagnosis? Assign examination and treatment.
Dx-perforation of stomach
uker I
peritonitis
Trx.-abd. X-ray lush (surgeon should have checked spijarry's symptoms
of the stomach
Rx-perform a midline laparotomy &
suturing
of perforated opening
the
for localized drainage
- A wound in the iliac
right region can be
partially used
of the abd cavity.
Medical Institute
A patient operated on for acute phlegmonous appendicitis 7 days ago had a fever. It has a restless na-
ture. Pain in the area of the wound of the patient does not notice. He complains of pain during urination,
frequent urge to stool. Tongue dry. Pulse 110 beats / min. The abdomen takes part in the act of breathing,
soft on palpation, painful over the pubic region. Symptoms of peritoneal irritation were not detected.
Leukocytes in the blood of 18.0 × 109 / L. There is no inflammatory reaction in the wound area. Aus-
cultation of the lungs and X-ray examination revealed no pathological changes.
Dx-s'abscess of Doughlas pouch (Pelvic abscess)
rectal examination
E. Digital Head of Department V. I. Davydkin
USG Abd
C1 Abd
fine needle puncture
Rx:-prainage of the abscess

per rectally

Medical Institute
The patient is 38 years old, for the third time in the last 2 years he was brought to the clinic with an at-
tack of acute cholecystitis. Symptoms of peritoneal irritation appeared and gradually increased. Jaundice on
the skin is expressed and enhanced. Blood bilirubin 77.0 µmol / l. There is no urobilin in the urine. The feces
are partially discolored. It was decided to operate the patient by the end of 2 days.
Medical Institute
A 36-year-old patient underwent surgery 12 hours after an inguinal hernia was incarcerated. Two
loops of the small intestine were in the hernial sac. After dissecting the pinching ring, the color of the intes-
tinal loops was normal, they were peristaltic, and the pulsation of the mesentery vessels was good. Both
loops are immersed in the abdominal cavity, plastic posterior wall of the inguinal canal is made. One day
after the operation, the patient was re-operated for diffuse purulent peritonitis. During the operation, a per-
foration of the necrotic loop of the small intestine was detected.

Medical Institute
A patient with a 35-week normal pregnancy had severe pain in the right iliac region, vomiting, tem-
perature 37.8 ° C. The tongue was dry, covered with white bloom. The bottom of the uterus is palpated with
two transverse fingers above the navel. In the right abdomen, often in the pancreas, palpation is determined
by acute pain, protective muscle tension, a positive symptom of Shchetkin - Blumberg. Picking up on the
lumbar region is painless on both sides. The number of leukocytes is 16.0 × 10 9 / l. In the urine traces of
protein, from 5 to 6 leukocytes in the field of view. What is the clinical diagnosis? Assign examination and
treatment.
Medical Institute
_
Two years ago, the patient underwent resection of 2/3 of the stomach of Billroth II in the modification
of Hofmeister - Finsterer with a duodenal ulcer. Anastomotic ulcer developed six months after surgery. After
six months, she was given a second, now subtotal resection of the stomach, together with a padded loop of
the small intestine. However, a few months after the operation, a new peptic ulcer developed. What is the
clinical diagnosis? Assign examination and treatment.

Medical Institute
_
A 32-year-old patient suffering from cardiovascular diseases and atrial fibrillation suddenly devel-
oped sharp pains in his left leg and foot. The patient was examined at home in an hour. She moans in pain.
Leg and lower third of the leg sharply pale, cold. Palpation of the leg is sharply painful, there are no move-
ments in the ankle joint, and tactile sensitivity on the foot is reduced. The pulsation of the femoral artery
immediately below the inguinal ligament is clear, pulse is not detected on other limb arteries.
Medical Institute
_
A 24-year-old patient who had recently suffered amoebic dysentery and was undergoing treatment
with subsequent recovery had a rather severe pain in the right hypochondrium, aggravated by breathing.
The temperature rose and became intermittent. There were exhausting chills. The patient began to lose
weight gradually. On examination, a painful, greatly enlarged liver is determined. Stool and urination are
not disturbed. The number of leukocytes of 17.0 × 109 / L.
infection
Dx-entrehepatic Abscess caused
by amoebic
Jav.-Liver function test

CBC
Usa ICT Head of Department V. I. Davydkin

Blod culture
RY-Use
guided draiange
cans.mx- antiamobic agent-secuidazole
postop care ->

hydration
maintain
healthy diet
monitoring Ministry of science and higher education of the Russian Federation
Medical Institute
-
An ulcer of the duodenal bulb, accompanied by hypersecretion, increased acidity, diarrhea was
found in a 34-year-old patient. The patient has been ill for 2 years. Conservative inpatient treatment was
useless, and he was resected by ½ of the stomach according to the method of Billroth I with selective vagot-
omy. After 4 months, the ulcer recurred, diarrhea continued. Since the patient was severely injured and the
treatment did not help, it was decided to undergo a second operation. During laparotomy, in addition to ul-
cers, a tumor-like formation 1.5 cm in diameter was found in the body of the pancreas.
Medical Institute
The
_ Discipline «Hospital Surgery»
The pain in the right gastrocnemius muscle after passing 50 meters began to appear in a patient of
56 years. The leg began to freeze even in summer and get tired after a short standing. When viewed from the
side of the foot and the lower third of the leg, on the right, it is paler than on the left, colder to the touch. The
pulse on the right limb can only be determined in the femoral artery, it is weakened. Above it is clearly audi-
ble systolic murmur. The general condition of the patient is satisfactory.
Dx + Arterial
insufficiency Coltatherosderosis or
obliterating endarteritis)
-> CBC
IX
upid profile, congulogram

of lower limb/Arterio Head of Department V. I. Davydkin
Angiography
brachial index (ABI)
graphy)
Ankle
vsc(Doppler)
I
↳scan+ Angiography]-s
optional
endarteritis)
postup: -
lifestyle changes
Rx: -
treat underlying
cause -
Catherosclerosis) obliterating Diet(low fatty food)
medical my-vasodilators, anticoagulants. physiotherapy

Sx-balloon angioplasty
artheretory
semoral endarterectomy
bypass grafting federal state budgetary educational institution of higher education
e
stents, prosthetics
Medical Institute
_
A 42-year-old patient suddenly felt a sharp pain in the abdomen of a spastic nature, which was soon joined by fre-
quent vomiting. No stool, no gas. When inspecting the patient's condition of moderate severity, occasionally loud
cries, restless, often changing position. Body temperature is normal, the pulse is 112 beats / min. The tongue is wet.
The abdomen is swollen, more in the upper half, palpation is mild, moderately painful, symptoms of peritoneal irrita-
tion are negative. In the abdominal cavity is determined by the free fluid. The egg-shaped form of the dense elastic
consistency of the reservoir is determined from above and to the left of the navel; peristaltic noise above it is not
heard. Rectal examination revealed no pathological changes. Radiographically there are multiple Kloyber bowls, the
small intestine is swollen. What is the clinical diagnosis? Assign examination and treatment.
small intestine & volvulus of
Dx-> Acute mechanical obstruction of sigmoid
case admitpt.
emergency
-
enema to wash bowel

contents & use siphon
firstly removal of gastric Head of Department V. I. Davydkin
Inv.+ CECT Radiographically alreadydetectedby bow
bee the investigations & Admitit
Rx- Infusion therapy
I
Antibiotics IV postop. mx >
prevention nausea & vomiting
acid-cand obstruction
Give
hyaluronic use scopolamine
dissection of adhesions
Sx- depends on type of obstruction bowel resection
Medical Institute
_
A 39-year-old man woke up in the middle of the night from severe abdominal pain, with constant
temper, accompanied by repeated vomiting. An hour after the onset of the disease, he was hospitalized in a
surgical hospital. The patient's condition is severe. Facial features are sharp, skin, mucous membranes are
cyanotic. Pulse weak filling, 112 beats / min, blood pressure - 90/60 mm. Body temperature is normal. The
patient is restless, constantly changing position, screaming in pain. Vomiting continues. No stool, no gas.
Tongue dry. The abdomen is soft, asymmetrically swollen in the right half, where the tightly elastic form is
not clearly palpable. In some places, stupidity is determined. Blumberg Symptom is negative. "Burst of
noise" is defined. Peristalsis does not obey. With a digital rectal examination: the ampulla of the rectum is
empty. What is the clinical diagnosis? Assign examination and treatment.
intestinal obstruction ofvolvulus of shock
DX-Acute cacum i
hypovolemic
Juv.- Abdomen
X-ray
fibrogastroscopy
CBL
USG
EC4 Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
MX: - start i Antishock therapy post-op - if
vomitinggive
-
-
IV
In
fluids
Antibiotics
scopolamine/ondansterne
2 zu
->
gastric emptying
[Na tube my
xx-cecopely (reposition of cecur & attach it to abd. Wall
Medical Institute
_
Male 24 years old, injured in a car accident, taken to the clinic. In an objective study of BP - 80/60
mm, heart rate - 135 beats. / min, BH - 45 /min., pathological mobility of the sternum, lack of respiratory
noise and crepitus in the left half of the chest are determined. What is the clinical diagnosis? Assign exami-
nation and treatment.
Dx - closed chest trauma sternum fracture
& pneumothoraxor hemothorax
Inv. - Chest
X-ray (to confirm pneumothorax/hemotherap)
ECG
(BC
start
IV fluids - to stabilize vitals Head of Department V. I. Davydkin
If blood loss-blood transfusion
Rx - Pneumothorax Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
I behimosthatawod-
-> chest
insert tube in leftside
Antibiotics
air post. p:
-
& remove
I
It doesn't work so indicated urgentant.thoraconon
xindicated -> video assisted thoracoscopy drainage in 24 has
Medical Institute
_
The patient entered the emergency department after 52 years 2 hours after the onset of the disease.
-
On the eve of a rich supper. In the morning he felt sharp pains in the epigastric region, difficulty in breath-
ing, repeated vomiting, did not give relief, weakness, sweating. Temperature 37.0 ° C. Delay of stool is de-
termined, gases do not leave. On examination, the condition is severe, the patient is pale, pronounced acro-
cyanosis, the skin is covered with cold sweat. The pulse was 140 beats / min, blood pressure - 100/60 mm.
The tongue is dry and covered with white bloom. Peristalsis sluggish. Hepatic dullness preserved. Free fluid
in the abdominal cavity is not defined. The abdomen is soft on palpation. No symptoms of peritoneal irrita-
tion. Sharp pain in the epigastric region. Symptoms of the Resurrection and Mayo - Robson positive. What is
the clinical diagnosis? Assign examination and treatment.
here
pxe tudeemotizing pancreatitis pancreatogenic
i

CBL
Abd. USG Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
if needed
CI/MRI -
i IV fluid
1x- startantishock therapy
nasugastric feeding
Ondansetron
Antiemetics- 4mg
IV Antibiotics
Antispasmodics (Papaverine)
bursa
Sx- of amental Ministry of science and higher education of the Russian Federation
prainage
Antibiotics
post. op: -

pancreatic enzyme
suppliements.
Medical Institute
Course
A patient, 38 years old, complains of a tumor-like formation on the front surface of the neck, which she noticed
about 4 years ago. Tumor-like formation gradually increases in size.
The patient's condition is satisfactory. When viewed from the front of the neck, to the right of the midline, the
-
size of the node is determined to be 4x5 cm, offset when swallowing. The skin above it is not changed. The palpation
node is located in the lower pole of the right lobe of the thyroid gland. It is round in shape, 4x5 cm in size, of a tightly
elastic consistency, with a smooth surface. Cervical lymph nodes are not enlarged. No eye symptoms. Heart sounds
are pure. Pulse - 74 beats / min, the correct rhythm. BP - 120/70 mm .
Dx-> Nodular
Euthyroid Goiter of Rt lobe of
thyroid gland-and degree
of N-BP, pulse a complains Head of Department V. I. Davydkin
enthyroid
no
be
within
thyroid hormones level w range
is
so
of notloss -
Ie uyroidsundancester a hematic Rx:-medical mx-levothyroxine supplies to
I I
->
USG post op:-levothyroxine
28 fails ->
sx-Hemithyroidectomy (it needed
->
echography Alternative -
Radioactive Iodine therapy (II)
(shrink nodulel
Medical Institute
The
A patient, 55 years old, has suffered from a nodal euthyroid goiter for 10 years. For all the years,
the goiter did not cause her any trouble, although she noted its slow increase in size. Over the past 4 months,
he began to grow rapidly and joined the feeling of “discomfort” - the feeling of “awkwardness” in the neck,
tickling in the throat, periodic dry cough.
The patient's condition is satisfactory. On palpation in the left lobe of the thyroid gland is deter-
mined by the node size of 8 x 10 cm, dense consistency, with an uneven surface. When swallowing the node
is limited in mobility. Lymph nodes of the left sternocleidomastoid muscles are enlarged, dense.
Dx- Goiter
Malignancy (Papillary
(A
of thyroid d't long standing goitoe)
function test 17St, 13, 14)
↳x+ Thyroid
Usk Head of Department V. I. Davydkin
fNAB
radical neck dissection
total
Ipsilateral modified
-
thyroidectomy
*
I
Sit any CN is the

Symptomatic Rx:-cough suppressants, dextromethorphen/Acctaminophen
NSAIDS
postop! - Hormone replacementtherapy-levothyroxine
Medical Institute
The patient 46 years old complains of irritability, whining, heartbeat, poor sleep, weight loss of 8
↑
kg in the last 6 months. For medical help did not apply.

The examination reveals swelling on the anterior surface of the neck, respectively, localization of
the thyroid gland. The latter is diffusely increased, soft-elastic consistency, when swallowing moves along
with the trachea. There is a Shine of eyes, tremor of hands. Pulse 106 beats/min. correct rhythm. The liver is
not increased. What is the clinical diagnosis? Assign examination and treatment.
DX-diffuse. thyrotoxic goitre Grave's dis)-2nd degree
x Thyroid function
=
test Head of Department V. I. Davydkin
Usa
i radioactive isotope (12)
Thyroid scan Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Echography
4 anyroidectomy
methimazole 20my
RX
-Pre aid medication propylthiourecil some

-> If
no improvement in e
sympathetic stimulation)
Ablation (I'
12) B-blocker -
propanolol so
my (for
some Pregelastateres
RAI 42
x
-
->
Ablation
↓
Indications
pts
elderly
->
-> pts
T
sx co-morbidities federal state budgetary educational institution of higher education

-> recurrence after ex «National Research Ogarev Mordovian State University »
Medical Institute
The
The patient 34 years old complains of the presence of a tumor on the anterior sur-
face of the neck, attacks of palpitation, shortness of breath with slight exertion, constant weakness, weight
loss of 10 kg over the last 4 months. Within 2 years of suffering from hyperthyroidism. For 1 year, medical
treatment was carried out, against which there was an improvement. The last 4 months the patient's condi-
tion worsened again.
The patient's condition is of moderate severity. There is a diffuse enlargement of the thyroid gland,
visible to the eye and determined by palpation. Positive eye symptoms of grefe and Mobius. Pulse 112 beats
per minute, arrhythmic. The edge of the liver 2 cm protrudes from under the rib arch. There is swelling of
the feet and lower thirds of the shins. On their own rise after squats not can.
DX-Diffuse toxic goitre, and degree thyrotoxicosis (visceropathic stage)
cunction test
-Thyroid
-
UsG
-
Thyroid scan [ RAI (1123)

-
f2G (to assess cardiac function)

against TSH level of
antibody determined
thanonly sx indicated.
check
antibody 28
high
-
therapy methimazole
Re:
Drug 20
mg
-
antithyroid medications propylthiouracil song

-
B-blocker propanolol song

for
diuretics-furosemide
swelling -
Sx Rxe
Thyroidectomy
Medical Institute
In the patient, 48 years old, the examination revealed a dense node size 4 x 5 cm in the lower pole
of the right lobe of the thyroid gland. During radiometry it was found that in 2 hours after receiving radio-
active iodine 30% of it was absorbed by the thyroid gland. A "hot" node was found on the scan. What is the
clinical diagnosis? Assign examination and treatment.
thyroid Adenoma (a type of hyperfunctioning thyroid causing hyperthyroidism)
nodule
Tauc
DX
function test
2x+ Thyroid
USG
RAI uptake
-NAB (to rule out
malignancy) Head of Department V. I. Davydkin
heroing Clinical
Radioactivezodine
&x - (1)
module thyroid Lancee
a normalize
cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
(2) Sx to remove nodule it radioactive therapy is noteffective it is
there a
high risk of
malignancy based on
FNAB or
findings.
imaging
/x->
Gemithyroidectomy (subtotal resection of RH lobes
Medical Institute
_
The patient was operated on for diffuse toxic goiter. Subtotal resection of the thyroid gland was
performed. The next day after surgery she became restless, she had paresthesia in the region of the tips of
the fingers, the feeling of pins and needles, twitching of facial muscles, pain in the muscles of the forearms.
After applying the tourniquet on the right shoulder in the middle third of the brush took the form of "hands of
an obstetrician."
removal I traumatic injury
Dx:-curathyroid insufficiency (Hypoparathyroidism) due to
of theparathyroid glands.
calcium & levels (Biochemical blood analysis)
er:- check serum phosphate
-
PTH lest
-
Eca
-
USG Head of Department V. I. Davydkin
gluconate (calcium
chloride
Rx:- zu calcium
3
Later oral calcium
I to maintain so calcium levels
vit a
supplements
calcium & PTH levels.
of serum
->
monitoring

Medical Institute
In the patient operated on diffuse toxic goiter with severe thyrotoxicosis, 6 hours after the opera-
tion, there was excitement, profuse sweating, nausea, indomitable vomiting, a feeling of fear.
The condition of the patient heavy: severe tachycardia (heart rate – 140 beats/min), blood pressure
– 80/50 mm ., wet skin, body temperature 400C. What is the clinical diagnosis? Assign examination and
treatment.
storm)
DX- Thyrotoxic
crisis (Thyroid
hormone levels
I. - serum thyroid
Ecu
Blood test
usu
Rx + zu fluids &
electrolytes packs (cooling blanket
B-blockers
-
propanolol 50 mg cooling measures-ice

↳ to lower body temp.
Antithyroid medications -
wethemedanene
aucocorticoids -
Hydrocortisone/prevent inflammation & adrenal insufficiency-sweating, fear?
Medical Institute
A 20-year-old patient, operated 8 hours ago for acute gangrenous appendicitis, developed weakness, -
dizziness and the bandage in the drainage area was moderately bloody. The skin is pale, the pulse on the
-
- -
--
-
radial artery is weak, the heart rate is 102 per minute; blood pressure 80/40 mm. The operating surgeon
- -
prescribed an urgent control of the number of erythrocytes and hemoglobin and hemostatic therapy. What
complication did the patient develop after appendectomy? Please comment on the actions of the surgeon in
this situation. Optimal treatment tactics?
Dx-postoperative bleeding
intra-abdominal
count & Mb level
tactic -
urgently
check it's crythrocyte
Surgeon's therapy-include blood transfusion administration of
+
clotting
factors
hemostatic
condition
bleeding
pt's
of the
&
optimal Rx would depend on the

severity
to locate & control bleeding
the source
-> immediate surgical exploration Head of Department V. I. Davydkin
supportive measures
-> IV fluids Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
-> Or
therapy
->
monitoring of vitals
intensive care unit
-> close observation in

Medical Institute
Patient S., 26 years old, was taken to the emergency room. Complaints of pain in the right iliac re-
gion appeared 18 hours after the onset of the disease. Ill acutely: the pain appeared in the epigastrium, then
shifted to the right iliac region. There was one vomiting. When inspecting the state is satisfactory, the body
temperature is 37.3 ° C. Its pulse is 80 beats per minute. Tongue wet, coated with gray bloom at the root.
The abdomen is not swollen, locally painful and tense in the right iliac region. There is the positive symptom
of Blumberg. Leukocytosis - 14.1 × 109 / l. What is the clinical diagnosis? Assign examination and treat-
ment.
i peritonitis
Dx -> Acte perforated appendicitis complicated
x + CBC (WBL4, (RP4) Head of Department V. I. Davydkin
USG
21 scan Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Rx -
Appendectomy, irrigation
of Abd. & insertion of peritoneal drain
IV Antibiotics before & after sx (Cephalosporine/metronidazole)

Medical Institute
_
The patient is 44 years old, operated 3 months ago for diffuse toxic goiter. Appealed with com-
plaints of weakness, drowsiness, fatigue, constipation, increased body mass by 20 kg During the inspection
draws attention to the puffy face, dry and coarse skin. Postoperative scar in good condition. The thyroid is
not palpable.
Dx-Hypothyroidism ditextensive resection of thyroid gland
Ix-Thyroid function test(TSH, Ts, Ty
Thyroid antibody test

(TP0)
USG
Rx-Hormone Replacementtherapy
(levothyroxine) Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).

Medical Institute
Code
Patient V., 69 years old, was delivered by an ambulance team with complaints of abdominal pain, mainly in
the right half, thirst, dry mouth, weakness. For many years she suffers from gallstone disease, manifested by attacks of
hepatic colic. 4 days before admission to the hospital after eating fatty foods, severe pain appeared in the right hypo-
chondrium radiating to the right shoulder and shoulder blade. The pain was accompanied by repeated vomiting,
which did not bring relief, by an increase in body temperature of up to 38 ° C. After the injection of baralgin by the
ambulance doctor, the intensity of pain decreased for a short time. With subsequent vomiting periodically resumed,
the patient continued fever. On the eve of the pain intensified and spread to the lower half of the abdomen. The pa-
tient’s condition is severe; lethargic, adynamic. Tongue is dry. The abdomen is swollen, painful in all departments,
more in the right hypochondrium. A deaf percussion sound is heard on the right side channel. The gallbladder is not
palpable due to marked muscular tension. Symptoms of Blumberg, Ortner are positive. Pulse 120 beats / min with a
single extrasystoles. BP - 110/70 mm RT. Body temperature - 38.5 ° C. Leukocytosis - 20.0 × 109 / l. What is the clini-
- - >
cal diagnosis? Assign examination and treatment.

ox-Diffused biliary peritonitis caused
by perforatetravely altered
gallbladder
Ix-USG, (BC
(ERCP Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
cholangiography
scan
/x-exploratory laparotomy I cholecystostomy
RX-IV fluids
Antibiotics -
ampicillin/sulbactam
Analgesics-meperiden
nee
I irrigation of abdomen peritoneal drain
Medical Institute
_
Patient A., 60 years old, delivered with complaints of abdominal pain, vomiting, delayed stool and
gases. Ill 15 hours before admission to the hospital, when there were sharp cramping pain in the left half of
the abdomen, nausea, stopped gas. There was repeated vomiting of gastric contents and bile. The stool was
not. When examined, the patient's condition is severe. There is shortness of breath up to 24 breaths per mi-
nute. Tongue dry, coated with a white coating. There is an asymmetry of the abdomen due to the swelling of
the left half. Palpation marked tenderness and positive symptom Shchetkina-Blumberg in mesogastric and
hypogastric. Pulse – 110 beats/min, arrhythmic, weak filling and voltage. BP – 90/60 mm . When fin-ger ex-
- -
amination of the rectum of pathological formations is not revealed, soreness and overhanging of the anterior
-
wall is not noted. Hemoglobin – 160 g/l, leukocytosis — 19,0×109/l. What is the clinical diagnosis? Assign
-
examination and treatment.

DX- Acute colonic obstruction & perforation i peritonitis
Ix + usG Head of Department V. I. Davydkin
CECT
xis indicated. Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
emergency
the Pt
Before Sx Stabilize
start IVfluids & electrolytes
monitor vitals
focal contents infected fo
Rx- immediate explorative laparotomy & removal of a
the perforated part & anastomosis

resection of

Medical Institute
Code
Patient U., 64 years old, delivered with complaints of intense, persistent pain throughout the abdomen, vom-
iting gastric contents. Over the past year, periodically noted rumbling and bloating, constipation, alternating diar-
rhea. Lost 10 kg. Acute abdominal pain, vomiting appeared 9 hours before admission. The patient's condition is se-
vere. She lies on his left side with his legs pulled up to his stomach. The skin is earthy-gray color, there is a slight cya-
nosis of the lips. The tongue is dry, coated with a gray coating. The abdomen is somewhat swollen, with percussion,
pain is noted throughout the abdomen, more to the left. There is a pronounced tension of the abdominal wall muscles,
soreness, a positive symptom of Blumberg throughout the abdomen. Pulse – 104 beats/min, correct rhythm. The BP –
100/70 mm. Temperature – 37,5°C, hemoglobin – 100 g/l, leukocytosis – 12,0×109/l. With finger examination of the
rectum no changes were found. What is the clinical diagnosis? Assign examination and treatment.
Medical Institute
The patient G., 59 years old, went to the clinic with complaints of pain in the right Shin, an increase
in body temperature to 38.50 C. Ill a week ago. It was treated independently by using alcohol compresses on
the Shin. The pain is not gone, stood firm high body temperature. On examination: the overall condition is
satisfactory, pulse 96 beats per minute, rhythmic, satisfactory filling. Topically: skin of the lower leg hyper-
emic in the course of the varicose-expanded veins in the lower third of the leg, there is thickening of the skin.
Moderate swelling of the lower leg, movements in the joints of the limb are passive. In the middle third of the
leg ulcer with a size of 2x3 cm with saped edges, mild purulent discharge. There is a fluctuation in the focus
of the vein compaction. What is the clinical diagnosis? Assign examination and treatment.
Dx-> stage 5varicose veins of lower limbs (saphenous veins)
2x -> Doppler USG of leg
vero
graphy
CT
MRI Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Rx-cans: -
Sclerotherapy & user

dressing
NSAIDS
itflows into remoral vein
Sx:-ligation of greatsaphenous vein place where
the
at
in specialized hospital are

there various
options for
thrombectomy
activities
postop! I physical
go easy
-
from water
-
keep affected area awayMinistry of science and higher education of the Russian Federation
-
regular dressing «National Research Ogarev Mordovian State University »

-
leg raise
when
sitting
Medical Institute
The patient T., 39 years old, suffering from varicose disease of the lower extremities, was per-
formed a combined venectomy in the left lower limb. Two days after the operation, he suddenly had a feeling
of lack of air, cough, chest pain. On examination: the patient is excited, the skin is moist, cyanotic, with an
earthy tinge. Shortness of breath to 35-43 in min, tachycardia to 143-151 UD./min, BP – 130 and 80 mm icle
right Above the light vesicular breathing, scattered dry rales transient. Left breathing hard. Against the
background of scattered dry wheezes over the posterior parts of the lung, moist, small-bubbly wheezes are
heard. X-ray examination of the lungs: depletion of pulmonary pattern in the right half of the chest and signs
of interstitial edema in the left lung. What is the clinical diagnosis? Assign examination and treatmen
embolism (complication caused by
3x)
DX-pulmonary
2x-
angiography
D-cimer test
Doppler
use Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
I
therapy Indication x-> failure of medical therapy
Rx-firstgive or
Heparin, warfarin 2/2 to thrombolytics
Anticoagulants
-
Then
thrombolytics
-
streptokinase
Sx->percutaneous embolectory
Medical Institute
The
Patient K., 64 years old, was admitted to the hospital 16 hours after the onset of cramping pains in
the lower abdomen with complaints of delay in the chair and gases, nausea, single vomiting. Suffers from
constipation for 8 years.
General condition of moderate severity. Consciousness clear, position passive. The skin is pale
pink. In the lungs vesicular breathing, no rales; NPV – 20 / min. heart sounds are muffled, regular rhythm
with a frequency of 90 BPM heart rate the intense, good filling. BP – 160 and 90 mm .
The stomach is swollen, asymmetric due to the swelling of its right half; when palpation is soft, not
tense, painful along the course of the colon. The left iliac region is "empty." Symptoms Sklyarov and "Obu-
d
khovskaya hospital" is positive. "Splash noise"is defined. What is the clinical diagnosis? Assign↓examination
and treatment. splash noise sign of low
tract)
Dx- Acute intestinal obstruction (Decompression of GI over
roop
bowel colonic obstruction
biochemical blood test

Ix+ CBC, Head of Department V. I. Davydkin
Abd. X-ray
USG
C, Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Rx-> bowel rest
cleansing chema, antispasmodic (papaverine)

nasogastric drainage
-
IV fluids
decompression
sx-sigmoidectomy, sigmoidoscopic

Medical Institute
In the intensive care unit of the children's hospital delivered a child 6 months from birth in a state
of severe cyanosis. The examination revealed pronounced tachycardia, shortness of breath and cyanosis.
According to the child's parents, cyanosis increases during the child's cry. On the overview roentgenogram
~
~
of the chest there is a marked increase in the shadow of both the left and right chambers of the heart; in the
lungs there are signs of pneumosclerosis. On Echocardiography detected hypertrophy of the right ventricle,
-
-
marked dilatation of all the cavities of the heart, a large discharge of blood from right to left at the level of
the interventricular septum. The average pressure in the pulmonary artery is 40 mm .
e
-

(
Dx-Tetralogy of Fallot [VSD, pulmonary stenosis,
curta
overriding, atventricular hypertrophy
1x -
ECG
ischemic Head of Department V. I. Davydkin
/MR2-1 for
X-ray-Boot shaped
us s determine
all structures of trad
probing of all cavities

3
Rx-Administer Oz
chestpositionsquatting zones measure

treeto blockers (Propanolis
IV fluids Ministry of science and higher education of the Russian Federation
SX «National Research Ogarev Mordovian State University »
Medical Institute
In a patient aged 50 years, after hypothermia, the body temperature increased to 39.5°C, there
were pain in the right half of the chest, increasing with breathing, noted the departure of the meager mucosa
of sputum. High temperature was observed during the week. Then the amount of sputum with an unpleasant
odor increased to 200 ml per day, the General condition of the patient improved, the temperature decreased
to normal. During the examination in the right scapular region, the shortening of the percussion sound,
weakened breathing were determined.
Dx- Acute abscess of Rt
lung.
m)
IX-CXR
es need t
CBC
Bronchoscopy
examinateClinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Sputur
Rx- Antibiotics IV

Medical Institute
Patient A., 47 years of age, was treated with the clinic of acute abscess of the lower lobe of the right
lung. 5 min ago I developed severe pain in the right half of the chest, shortness of breath. The patient is
e -
frightened,
---
pale, covered with cold sweat. With percussion in the right half of the chest, a tympanic
sound is determined, breathing along all pulmonary fields is sharply weakened here.
px-hydropneumothorax (Pyopneumothorace)
Arterial blood gas
2x-CBC Head of Department V. I. Davydkin
infection check
CXR Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
/usG -
ifneeded
Medical Institute
Course
Patient B. 34 years, received complaints of hemoptysis to 40 ml per day, fever to 38°C, shortness of
breath, cough with mucopurulent sputum to 150 ml per day, pain in the left half of the chest. Ill for 3 weeks,
was treated in the therapeutic Department. The state of moderate severity, the patient is somewhat excited.
The pulse was 94 beats/min, BP – 160, and 80 mm. the Left half of the chest lags behind in the act of breath-
ing. Over the lower lobes – the dullness of percussion sound, breathing here is hard, weakened auscultated
dry and wet finely wheezing.
left of leftside
Dx-Abscess of
lung &
empyema pleura on

Medical Institute
_Course _VI_ Semester _XI_ ⑧
The patient I. 45 years old appealed to the clinic with complaints of burning pain behind the sternum,
increasing with the torso tilted forward, hiccups, regurgitation, increased salivation. Ill for 2 years. Objec-
tively: the condition is satisfactory. From the heart and lungs without pathology. The abdomen is not swol-
len, soft, slightly painful in the epigastrium. Symptoms of irritation of the peritoneum are absent.
According to laboratory data, there are no deviations from the norm. In fibrogastroscopy, prolapse of
the gastric mucosa into the esophagus, gastroesophageal reflux, gaping of the cardia were noted. In the ab-
dominal esophagus revealed peptic ulcer on the background of erosive esophagitis.
X-ray examination of the esophagus and stomach with a contrast in the Trendelenburg position re-
vealed the exit of the cardiac part of the stomach into the chest cavity and the leakage of contrast from the
stomach into food-water. What is the clinical diagnosis? Assign examination and treatment.
Medical Institute
Course
In a child of 5 years, the examination revealed the presence of a heart hump, systolic
tremor in the II – III intercostal space at the left edge of the sternum, a rough systolic murmur to the left of
it. X-ray examination of the chest revealed an increase in the shadow of the heart due to the right ventricle.
Pulmonary pattern is not changed. What is the clinical diagnosis? Assign examination and treatment.
Stenosis
DX-Pulmonary Artery
Ix-Geh, Gho
catheterization of cardiac cavily
duid
Rx-
supportive-zu
On therapyHead of Department V. I. Davydkin
B-blockers (Propanolol 50mg)
sx-stent
Balloon
Angioplasty
Medical Institute
The
Patient S., 46 years old, the driver of a heavy vehicle, suffers from varicose veins of the lower extremities for 7
years. For 3 days before hospitalization there were pains in the left Shin, increasing with movement, body temperature
e
increased to 37.8 o C. Such complaints appeared for the first time. He was sent by a General practitioner of ATP to
the clinic to the surgeon.
The General condition of the patient is satisfactory. Pulse of satisfactory voltage and filling, 82 beats per mi-
nute,-BP – 130 and 80 mm. on the left lower limb, along the great saphenous vein, there are varicose veins of mixed
type (see figure), in the area of varicose nodes of the upper third of the lower leg local hyperemia, edema are deter-
mined. Vienna thickened, sometimes beaded, palpable painful cord (see Fig.). The skin is infiltrated, hyperemic, pain-
ful with palpation. No swelling on the foot or Shin. Arterial pulsation in both lower extremities is satisfactory at all
levels. What is the clinical diagnosis? Assign examination and treatment.
vein
DX-Acute thrombophlebitis of left great saphenous Head of Department V. I. Davydkin
justification
of
is varicose.Verbienna beaded, palpable painful de
thickened,
-
2x-Doppler vs/Duplex IT venography Rx-Bed rest I elevated limbs
I I
sx approach
only when persistentsyntomsithrombus
-
- D-dimer NSAIDs, thrombolytics (Strephokinase) .
radioablation
-
Longulogram Anticoagulation (reparin) ·
sclerotherapy
compression stocking
Medical Institute
Course
Patient C., 58 years, was admitted with a hypoglycemic coma clinic. In the history of hypoglycemic
conditions occurred daily, because of what the patient was often forced to eat with a lot of sweet. When the
blood glucose level of 1.5 mmol/l. After the introduction of 40% glucose intravenously improved, the patient
regained consciousness, she does not remember what happened.
DX-Insulinoma
(leading to recurrent
hypoglycemial
1x- 72 hr
fasting glucose
-
check insulin level
-
USG Abd.
-
c/MR2 (in case use is informative
not & need further investigations
Rx- zu fluids,50% dextrose (to immediate raise
glucose)
Octreotide, Diazoxide
x-Pancreactory/Pancreatico Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
duodnectory
level
of blood glucose
postop: close
monitoring
-
Refer to endocinologist

Medical Institute
Patient V. 50 years old, admitted to the hospital with complaints of severe abdominal pain. Sick for days.
The ambulance doctor gave a subcutaneous injection of 1 ml of 0.1 % atropine solution, after which the pain de-
-
creased slightly. At night, the condition worsened, the pain increased. In the past, there were no gastrointestinal dis-
-
eases.
The patient's condition is severe, body temperature 37.5°C, pulse – 100 beats/min, tongue dry, covered with
a white coating. Belly moderately swollen, in the act of breathing is not involved. When palpation, tension and sharp
pain of the anterior abdominal wall are noted. Schetkin – Blumberg's symptom is positive. Hepatic dullness is absent,
intestinal noises are not listened to.
On the overview x-ray under the right dome of the diaphragm, a - gas is detected. The number of leukocytes in
the blood is 8.7×109/l. the urine Test is unchanged. What is the clinical diagnosis? Assign examination and treatment.
DX-pneumoperitoneum, Acute perforated appendicities
blood Head of Department V. I. Davydkin
2x-CBC, biochemical analysis
C/USG Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
X-ray,
Caphalophem/Metronidazole
Appendectory/post
up-and gen.
x-emergency laparotomy
->
leak
monitoring
for
bleeding
or
pre-op->Ies+Analgesics
Medical Institute
Course
Patient A., 17 years old, was admitted for examination to the cardiology Department. Since childhood,
suffers from frequent pneumonias and acute respiratory infections. Previously, about heart disease was not
examined and was not treated. Recently began to complain of shortness of breath and heartbeat during ex-
ercise. Auscultation noise alone was not detected, however, after exercise appears a slight systolic murmur
and accent II tone in the second and third intercostal space left of the sternum. ECG shows signs of right
ventricular hypertrophy and P-pulmonale. Echocardiography shows Doppler signs of blood loss at the atrial
level from left to right. The average pressure in the pulmonary artery is 16 mm. What is the clinical diagno-
-
sis? Assign examination and treatment.

Dx 3
-
ASD
2x+ CXR
cransthoracic echocardiography Head of Department V. I. Davydkin
Rx P t surgical procedure
I
mx
so method
epercutaneous transcatheter closure
result
Indication that in case e
echocardiography
other -> RA/V enlargement I or who symptoms
-> exercise related cyanosis
REshuntI PAH
-> left ->
->
paradacic embolism
Medical Institute
↑

_
A 45-year-old patient was admitted to the cardiology Department with complaints of pain in the
heart area, which increases with exercise, shortness of breath, dry cough attacks, weakness, fatigue, heart-
beat. He considers himself sick for 2 years. The disease is associated with influenza.
Objectively, palpation of the chest revealed a tremor in the heart. Auscultative diastolic murmur at
Botkin's point, amplification of I tone at the apex of the heart, accent of II tone over the pulmonary artery.
Liver 2 cm protrudes from under the rib arch, painless, soft. X-ray examination revealed smoothing of the
waist of the heart. What is the clinical diagnosis? Assign examination and treatment.
Dx-mitral & aortic
value
insufficiency Head of Department V. I. Davydkin
2x- Echocardiography
use
doppler Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
ECG
Rx Pt
mxby x procedure To (valvuloplasty)
repair
-
=
↳ valve replacementx 2 to
replace (using prosthetics)
Medical Institute
Course
The patient is 50 years old, for 8 years suffers from rheumatism, annually receives courses of pre-
ventive anti-rheumatic treatment. Recently, the pain in the heart, shortness of breath, especially during exer-
cise, heartbeat. On examination revealed pastoznost lower extremities, increasing the area of the apex beat
and its displacement to the left. Auscultative – systolic murmur at Botkin's point, weakening of the I tone,
accent of the II tone over the pulmonary artery. ECG shows signs of left ventricular hypertrophy.
DX- Aortic valve stenosis

2x & XXR
Ecu
Echocardiogram Head of Department V. I. Davydkin
usu
Rx-percutaneous balloon
valvuloplasty
OR
cortic value replacement

Indication -
severe value narrowing

Medical Institute
Course
Patient is 52 years old, suffered acute myocardial infarction a year ago. Received complaints of
-
pain in the heart, chest pain, shortness of breath, heart failure. Auscultation heart sounds are muffled, sys-
tolic murmur at the apex. On the ECG is determined by the complex QS, negative t wave, increasing St seg-
ment.
Dx-postinfarction cardiosclerosis ACS or Postinfarction IV
aneurysm
Ix-cardiac markers proponin)
Echocardiography Head of Department V. I. Davydkin
USG
CXR, Doppler
- Holter monitoring Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
Rx-Dor's operation - endoventricular patch plasty reconstruction
-
Aneurysmectomy of
linear repair LV
aneurysm
heartfailure
Indication -
Refractory
other - fail medical therapy/ persistentangine/thromboembolism
Medical Institute
Course
The hospital delivered the patient 18 years, with a car accident. Complains of sharp weakness, diz-
ziness, nausea. At admission, the condition is severe, the skin is pale. Palpation of the chest revealed tender-
ness in the projection of X – XI ribs of the left half of the chest. In the lungs, breathing is vesicular on both
sides, there are no rales. BP – 60 and 0 mm. Pulse – 140 per/min, weak filling and tension. The abdomen is
not swollen, soft, painful in the left hypochondrium. Percussion on the left side channel is determined by the
blunting.
Inemothorax)
What is the clinical diagnosis? Assign examination and treatment. or
-
DX-spleen rupture d'tclosed abdominal trauma intraabdominal bleeding

themorrhagic
shock
case I start
IV fluids
emergency (to preventinfection)
zu Antibiotics
&
Use of Abd. Head of Departmentsepsis V. I. Davydkin
2x-
Rx
splenectory
-
or
angioembolization
splenorrhaphy
Medical Institute
The patient is 40 years old, admitted to the hospital with complaints of pain in the right hypochon-
drium, fever (up to 39°C), icteric skin sclera, abdominal enlargement. Got sick after an injury of the right
subcostal region. Belly moderately increased in size, soft, moderately painful in the right hypochondrium,
where palpated painful, enlarged liver (4 cm protrudes from under the rib arch). Symptoms of peritoneal
irritation and "bubble" symptoms are negative.
Ultrasound revealed an expansion of the portal vein to 1.8 cm, the structure of the liver is not
changed, it is moderately increased. Pathology from the biliary tract was not detected. Blood bilirubin was
increased to 56 µmol/l due to both fractions, the number of leukocytes was 10.2×10 9/l.
DX-Budd ChiariSyndrome (hepatic
outhow Head of Department
venous V. I. Davydkin
obstruction)
USG
Ix- Doppler Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
venography medical Rx-Thrombolysis (window period
wks]
I
2-3
Rx-side to side portocaval shunt

Anticoagulants
Medical Institute
Course
Patient I. 45 years old, admitted to the hospital with complaints of burning pain behind the sternum, increas-
ing with the torso forward, hiccups, increased salivation. Ill for 2 years. Objectively: the condition is satisfactory. The
skin is a normal color. From the heart and lungs without pathology. The abdomen is not swollen, soft, slightly painful
in the epigastrium. Symptoms of irritation of the peritoneum are absent. In fibrogastroscopy, prolapse of the gastric
mucosa into the esophagus, gastroesophageal reflux, gaping of the cardia were noted. In the abdominal esophagus
revealed peptic ulcer on the background of erosive esophagitis. X-ray examination of the esophagus and stomach with
contrast in the Trendelenburg position revealed the exit of the cardiac part of the stomach into the chest cavity and the
leakage of contrast from the stomach into the esophagus.

Medical Institute
Patient D., 45 years old, received complaints of pain in the right half of the chest, which suddenly arose during
exercise, shortness of breath, SLA-Bost.
The state of the patient of moderate severity, in consciousness, blood PRESSURE = 100 and 60 mm ., pulse 110
beats/ min, satisfactory filling and voltage. When viewed, the right half of the chest lags behind in breathing, with pal-
pation rigidity is preserved, pain is not noted. Breathing rate 26 per minute. Percussion on the right pulmonary fields
is determined by the box sound, with auscultation in the same place respiratory noises are not listened to. On the radi-
ograph, the right lung is preloaded to the root (see figure).
When a pleural puncture under pressure released a large amount of air. Drainage of the pleural cavity with
connection to vacuum aspiration was performed. In two days remains pronounced tapping the air. What is the clinical
diagnosis? Assign examination and treatment.
ox -
spontaneous pneumothorax
2x
E Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
-
Brochoscopy
I
shortness of breath-a supplementation therapy
rx-Drain air from pleural cavity
chest tub - and intercostal mid davide Indication x-2 or more episodes
needle aspiration partially collapsed lung
Medical Institute
The patient is 50 years old, complains of constant headaches, dizziness, ringing in the ears, short-term
loss of consciousness, "shaky gait", decreased visual acuity, double vision, weakening of muscle strength in
the right upper limb.
Blood PRESSURE on the left upper limb – 130 and 70 mm ., on the right – 130 and 90 mm icle by por-
tography revealed occlusion of the mouth of the brachiocephalic trunk atherosclerotic plaque. Distal main
bloodstream saved.
DX-stenosing atherosclerosis of brachiocephalic trunk
I
USG lipid profile
2x- Doppler
ech
angiography
coagulogram
Biochemical blood test
MR 11
Aspirin, warfarin, Clopidogrel Head of Department V. I. Davydkin

-Antiplatelet
-
Rx
cholesterol
-
Lovastatin, Atrovastatin
for but I
-Radical endarterectory
hollow tube
Indications -
severe symptoms
stanting
-
failed medical Rx
sx
By pass

Medical Institute
CLINICAL CASE № 57 51
The patient is 50 years old, for 8 years suffers from rheumatism, annually receives courses of preven-
tive anti-rheumatic treatment. Recently, the pain in the heart, shortness of breath, especially during exercise,
heartbeat.
On examination revealed pastoznost lower extremities, increasing the area of the apex beat and its
displacement to the left. Auscultative – systolic murmur at Botkin's point, weakening of the I tone, accent of
the II tone over the pulmonary artery. ECG shows signs of left ventricular hypertrophy.
Medical Institute
Course
According to emergency indications, a 42-year-old patient was hospitalized two hours after the on-
set of the disease. Sick 2 hours. Bloody vomiting occurred suddenly. But the patient notes that with-
in 2 years the bleeding begins for the 3rd time. In the history of infectious disease. When viewed, a
venous network on the abdomen in the form of a "head of jellyfish"is expressed. Palpated large
spleen and dense edge of the liver at the costal arch. You were diagnosed with bleeding from vari-
cose veins of the esophagus. What is the clinical diagnosis? Assign examination and treatment.
DX-cirrhosis of liver, esophageal varices bleeding I portal HiN
-Liver function test

justification Marocagish-portal
-
an
splenomegalyvomiting
22 endoscopy
upper
Abd.
- -zyrs-3 time
USG
Doppler
(BL
So progressive disease.
RX- huid resuscitation Clinical cases were approved at the council of the department on November 26, 2020 (protocol No. 18).
I
-
In saline
blood How reduce sa-portosystemic shuntsx
vasopressin-varical Devascularization
survey
Blood transfusion (if needed)
IV ceftrixone
-
to preventsepsis postup-vital monitoring
B-blocker-propanolol-reduce ported pressure monitoring
Blood test
Guid electrolyte balance
Sx indications - severe
bleeding
severe Ministry of science and higher education of the Russian Federation
varies
liver failure federal state budgetary educational institution of higher education
↳ Liner «National Research Ogarev Mordovian State University »
transplantation
Medical Institute
CLINICAL CASE № 59 sO
A 45-year-old patient was admitted to the cardiology Department with complaints of pain in the
heart area, which increases with exercise, shortness of breath, dry cough attacks, weakness, fatigue, heart-
beat. He considers himself sick for 2 years. The disease is associated with influenza.
Objectively, palpation of the chest revealed a tremor in the heart. Auscultative diastolic murmur at
Botkin's point, amplification of I tone at the apex of the heart, accent of II tone over the pulmonary artery.
Liver 2 cm protrudes from under the rib arch, painless, soft. X-ray examination revealed smoothing of the
waist of the heart. What is the clinical diagnosis? Assign examination and treatment.
Head of Department V. I. Davydkin.
white (inflammation (
pneumonia - more
lungs
side-air (pnemothers)
drainage
chesttube
Tupper
lower side-fluid (hydrothorax
esophages -
stenosis (budging there (
B
spasms;

Situational Tasks For Hospital Surgery 6th Course 31-05-01 20201

Uploaded by

Copyright:

Available Formats

Situational Tasks For Hospital Surgery 6th Course 31-05-01 20201

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Situational Tasks For Hospital Surgery 6th Course 31-05-01 20201

Uploaded by

Copyright:

Available Formats

Ministry of science and higher education of the Russian Federation

federal state budgetary educational institution of higher education

tory of ulcer is no . Objectively: the patient is lethargic, drowsy. The skin

(3) stool test

Head of Department V. I. Davydkin

Ministry of science and higher education of the Russian Federation

Head of Department V. I. Davydkin

Ministry of science and higher education of the Russian Federation

Head of Department V. I. Davydkin

scopalaminotampaarehigh the Antibiotics -

if true seen then

albumin & creatine

vrine analysis ->

ERCP partof small intestine)

Pre-operative preparations USG Anastomosis -

lipid profile, coagulogram

ECG, ERCP ->

What is the clinical diagnosis? Assign examination and treatment.

Rx:-prainage of the abscess

Ministry of science and higher education of the Russian Federation

Head of Department V. I. Davydkin

Head of Department V. I. Davydkin

Ministry of science and higher education of the Russian Federation

Head of Department V. I. Davydkin

Head of Department V. I. Davydkin

Ministry of science and higher education of the Russian Federation

Head of Department V. I. Davydkin

Jav.-Liver function test

Usa ICT Head of Department V. I. Davydkin

postop care ->

Head of Department V. I. Davydkin

upid profile, congulogram

medical my-vasodilators, anticoagulants. physiotherapy

enema to wash bowel

Head of Department V. I. Davydkin

«National Research Ogarev Mordovian State University »

Sit any CN is the

kg in the last 6 months. For medical help did not apply.

-Pre aid medication propylthiourecil some

sx co-morbidities federal state budgetary educational institution of higher education

Thyroid scan [ RAI (1123)

f2G (to assess cardiac function)

antithyroid medications propylthiouracil song

B-blocker propanolol song

Ministry of science and higher education of the Russian Federation

propanolol 50 mg cooling measures-ice

optimal Rx would depend on the

Ministry of science and higher education of the Russian Federation

IV Antibiotics before & after sx (Cephalosporine/metronidazole)

Thyroid antibody test

Ministry of science and higher education of the Russian Federation

cal diagnosis? Assign examination and treatment.

examination and treatment.

the perforated part & anastomosis

Ministry of science and higher education of the Russian Federation

Sclerotherapy & user

in specialized hospital are

regular dressing «National Research Ogarev Mordovian State University »

biochemical blood test