Task 1.

The patient with a gunshot wound to the right hip, obtained 15 minutes ago, complaints of pain in the right thigh, and weakness. From a wound received red blood pulsing jet. The patient is conscious, pale, the pulse was 120 beats per minute, blood pressure 90/60 mm Hg. Article., the frequency of 28 breaths per minute. Results of laboratory tests: CBC Red blood cells 5,000,000 / mm Hemoglobin 150 g / l Hematocrit 45% Reticulocytes 1% Color index 1 Leukocytes 5000/mkl Stab 1% 70% segmented Eosinophils 3% Basophils 0% Lymphocytes 23% Monocytes 3% Platelets 200 th / mm ESR 8 mm / h Biochemical analysis of blood Total protein 70 g / l Albumin 60% Globulins 40% Urea, 5 mmol / l Creatinine 80 umol / l The total bilirubin 10 mmol / l Direct 2 mmol / l Indirect 8 mmol / l Iron 20 umol / l Potassium 4.5 mmol / l Sodium 135 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. Which method to stop the bleeding was to be applied to the pre-hospital? 5. Which way is the final stop bleeding is the best in this situation? Task 2. The patient complaints of loose stools in the form of raspberry jelly. Pulse 100 beats per minute, blood pressure 100/60 mm Hg.Article., the frequency of 25 breaths per minute. Results of laboratory tests: CBC Erythrocytes 3.5 million / ml Hemoglobin 100 g / l Color index 1 Hematocrit 30% Reticulocytes 7% Leukocytes 4500/mkl Stab 2% 60% segmented Eosinophils 3%

Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 200 th / mm ESR 40 mm / h Biochemical analysis of blood Total protein 60 g / l Albumin 63% Globulins 37% Urea, 5 mmol / l Creatinine 90 umol / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 16 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. Defeat any of the gastrointestinal tract occurs in this patient? 5. What actions are necessary to clarify the diagnosis? Task 3. The patient complaints of vomiting 2 times.Vomit-colored coffee grounds. Pulse 100 beats per minute, blood pressure 105/70 mm Hg. Article., the frequency of 28 breaths per minute. Results of laboratory tests: CBC Erythrocytes 3.8 million / ml Hemoglobin 110 g / l Color index 1 Hematocrit 33% Reticulocytes 3% Leukocytes 4000/mkl Stab 4% 58% segmented Eosinophils 3% Basophils 1% Lymphocytes 30% Monocytes 4% Platelets 250 th / mm ESR 10 mm / h Biochemical analysis of blood Total protein 70 g / l Albumin 63% Globulins 37% Urea 5.9 mmol / l Creatinine 80 umol / l The total bilirubin 15 mmol / l Direct 2 mmol / l Indirect 13 mmol / l Iron 17 umol / l Potassium 4.5 mmol / l

Sodium 150 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. Defeat any of the gastrointestinal tract occurs in this patient? 5. What actions are necessary to clarify the diagnosis? Task 4. The patient complaints of weakness, dizziness, loose stools black, with an unpleasant smell, repeated vomiting, vomit dark color. The patient is conscious, pale, the pulse was 110 beats per minute, blood pressure 90/60 mm Hg. Article., the frequency of 28 breaths per minute. Results of laboratory tests: CBC Erythrocytes 2.6 million / ml Hemoglobin 85 g / l Color index 1 Hematocrit 26% Reticulocytes 4% Leukocytes 4000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 190 th / mm ESR 10 mm / h Biochemical analysis of blood Total protein 60 g / l Albumin 63% Globulins 37% Urea 3.5 mmol / l Creatinine 100 mol / l The total bilirubin 3 mmol / l Direct 0 mmol / l Indirect 3 mmol / l Iron 13 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. Defeat any of the gastrointestinal tract occurs in this patient? 5. What actions are necessary to clarify the diagnosis? Task 5. The patient on the front surface of the forearm, in the lower third of his wound a linear form from which the pulsating jet enters red blood. Complaints of weakness, dizziness, mild pain in the wound. The patient is conscious, pale, the pulse was 115 beats per minute, blood pressure 85/55 mm Hg.Article., the frequency of 30 breaths per minute. Results of laboratory tests: CBC Erythrocytes 2.8 million / ml

Hemoglobin 88 g / l Color index 1 Hematocrit 25% Reticulocytes 2% Leukocytes 4000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 190 th / mm ESR 10 mm / h Biochemical analysis of blood Total protein 60 g / l Albumin 65% Globulins 35% Urea 4.5 mmol / l Creatinine 80 umol / l The total bilirubin 5 mmol / l Direct 0 mmol / l Indirect 5 mmol / l Iron 14 umol / l Potassium 4.5 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. What a way to stop the bleeding was to be applied to the pre-hospital? Task 6. The patient is unconscious. In the words of the accompanying 8 hours ago struck by a car, receiving a blow to the abdomen. There is a massive bruise in the anterior and lateral abdominal wall to the left. The patient has sudden pallor, the pulse was 120 beats per minute, blood pressure 75/50 mm Hg.Article., the frequency of 32 breaths per minute. Results of laboratory tests: CBC Red blood cells 2,000,000 / mm Hemoglobin 55 g / l Color index 1 Hematocrit 20% Reticulocytes 2% Leukocytes 3500/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 180 th / mm ESR 15 mm / h Biochemical analysis of blood Total protein 55 g / l

Albumin 63% Globulins 37% Urea 3 mmol / l Creatinine 60 umol / l The total bilirubin 3 mmol / l Direct 0 mmol / l Indirect 3 mmol / l Iron 10 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? 4. What kind of damage is most likely in this patient? 5. What actions are necessary to clarify the diagnosis?

Task 7. The patient is unconscious. In the words of the accompanying 2 hours before admission the patient had an episode of vomiting multiple large amount of blood. Patient over 10 years suffer from cirrhosis of the liver. On examination, marked a sharp pale skin, cold clammy sweat, the pulse was 126 beats per minute, blood pressure 70/40 mm Hg.Article., the frequency of 30 breaths per minute. Results of laboratory tests: CBC Red blood cells 2,000,000 / mm Hemoglobin 50 g / l The color index of 0.9 Hematocrit 20% Reticulocytes 3% Leukocytes 3500/mkl Stab 5% 59% segmented Eosinophils 2% Basophils 1% Lymphocytes 30% Monocytes 3% Platelets 180 th / mm ESR 15 mm / h Biochemical analysis of blood Total protein 55 g / l Albumin 60% Globulins 40% Urea 3 mmol / l Creatinine 85 umol / l The total bilirubin 45 mmol / l Straight 10 mmol / l Indirect 35 mmol / l Iron 14 umol / l Potassium 4.3 mmol / l Sodium 147 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome?

4. What disease is most likely in this patient? 5. What actions are necessary to clarify the diagnosis? Task 8. The patient complaints about the presence of hemorrhoids and the periodic appearance of a small amount of blood the color unchanged immediately after defecation. The patient is pale, the pulse was 90 beats per minute, blood pressure 120/70 mm Hg. Article., the frequency of 20 breaths per minute. Results of laboratory tests: CBC Erythrocytes 3.5 million / ml, microcytosis, poikilocytosis Hemoglobin 80 g / l Hematocrit 35% The color index of 0.6 Reticulocytes 1% Leukocytes 6000/mkl Stab 1% 65% segmented Eosinophils 2% Basophils 1% Lymphocytes 21% Monocytes 10% Platelets 280 th / mm ESR 10 mm / h Biochemical analysis of blood Total protein 70 g / l Albumin 65% Globulins 35% Urea, 5 mmol / l Creatinine 100 mol / l The total bilirubin 15 mmol / l Direct 2 mmol / l Indirect 13 mmol / l Iron 8 mmol / l Potassium 4.5 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What actions are necessary to clarify the diagnosis? Task 9. Patient for 15 years is suffering from duodenal ulcer. Complained of feeling unwell, dizziness. The patient is pale, the pulse was 90 beats per minute, blood pressure 120/70 mm Hg. Article., the frequency of 20 breaths per minute. Results of laboratory tests: CBC Erythrocytes 3.3 million / ml, microcytosis, poikilocytosis Hemoglobin 80 g / l Hematocrit 36% The color index of 0.6 Reticulocytes 1% Leukocytes 7000/mkl Stab 3%

63% segmented Eosinophils 2% Basophils 1% Lymphocytes 21% Monocytes 10% Platelets 300 th / mm ESR 10 mm / h Biochemical analysis of blood Total protein 75 g / l Albumin 65% Globulins 35% Urea 7 mmol / l Creatinine 110 mol / l The total bilirubin 8 mmol / l Direct 1 mmol / l Indirect 7 mmol / l Iron 7 mmol / l Potassium 4.3 mmol / l Sodium 140 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What actions are necessary to clarify the diagnosis? Task 10. The patient has an extensive purulent wound of the right thigh with the level of contamination mikr.kl. 109 / g tissue. Twenty-four hours ago, the development of abscess diagnosed pneumonia. Hectic fever up to 400 C, the pulse was 120 beats per minute, respiratory rate 30 per minute, blood pressure 110/70 mm Hg. of Art. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 42% Color index 1 Leukocytes 20000/mkl Metamyelocytes 2 17% of stab 64% segmented Eosinophils 1% Basophils 0% Lymphocytes 14% Monocytes 4% Platelets 200 th / mm ESR 25 mm / h Biochemical analysis of blood Total protein 60 g / l Albumin 50% Globulins 50% Urea 10 mmol / l Creatinine 200 mol / l The total bilirubin 20 mmol / l Line 4 mmol / l

Indirect 16 mmol / l Iron 20 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l Urinalysis Straw-yellow color pH 6 The relative density of 1.025 Protein 0.099 g / l Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells in the field of view 7.8 Cylinders single hyaline Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. The more complicated for the underlying disease? 3. What are the pathological syndromes in a patient? Task 11. In a patient with acute necrotizing pancreatitis developed complications - retroperitoneal abscess. On examination, the patient revealed severe clinical signs of purulent intoxication. Made coagulogram, the following results:

Fibrinogen 8 g / l The clotting time of 3 minutes Prothrombin index of 105% APTT 30 seconds PDF 10 ug / l Platelets 200 th / mm Platelet aggregation 15 seconds 1. List the available patient coagulation disorders. 2. What is a pathological syndrome developed in a patient? 3. The more dangerous the development of this syndrome? Task 12. In a patient with extensive burns, burn disease during the inspection revealed clinical signs of severe intoxication, respiratory failure, oliguria. Made coagulogram, the following results: Fibrinogen 8 g / l The clotting time of 2.5 minutes Prothrombin index of 110% APTT 28 seconds PDF 10 ug / l Platelets 170 th / mm Platelet aggregation 12 seconds 1. List the available patient coagulation disorders. 2. What is a pathological syndrome developed in a patient?

3. Which stage of the syndrome occurs? Task 13. In a patient with acute severe hemorrhage on the basis of a gunshot wound to the lower extremity third day from the date of injury appeared hemorrhagic rash. The examination revealed signs of hepato-renal failure. Made coagulogram, the following results: Fibrinogen 0.3 g / l Clotting time 20 minutes Prothrombin index 60% APTT 2 minutes PDF 90 ug / l 50 thousand platelets / ml 1. List the available patient coagulation disorders. 2. What is a pathological syndrome developed in a patient? 3. Which stage of the syndrome occurs? Task 14. In a patient with pancreatic cancer resection performed pancreatoduodenal. On the 2nd day after surgery the patient's condition suddenly deteriorated and there were hemorrhages in the skin, severe dyspnea, oliguria. Made coagulogram, the following results: Fibrinogen 0.5 g / l Clotting time 22 minutes Prothrombin index 58% APTT 2 minutes FDP 100 mg / l 40 thousand platelets / ml 1. List the available patient coagulation disorders. 2. What is a pathological syndrome developed in a patient? 3. Which stage of the syndrome occurs? Task 15. In a patient after a course of intramuscular injections of complaints appeared for the presence of sharply painful tumor formation in the right quadrant verhnenaruzhnom gluteal region, chills, headache, weakness. On palpation of tumor formation is determined by the fluctuation. On examination, the patient's fever of up to 390 C, the pulse was 100 beats per minute, respiratory rate 26 per minute, blood pressure 120/80 mm Hg. of Art.Results of laboratory tests: CBC Erythrocytes 4.5 million / ml Hemoglobin 140 g / l Hematocrit 45% Color index 1 Leukocytes 13000/mkl 10% of stab 66% segmented Eosinophils 1% Basophils 0% Lymphocytes 20% Monocytes 3% Platelets 300 th / mm

ESR 35 mm / h Biochemical analysis of blood Total protein 70 g / l Albumin 50% Globulins 50% Urea 7 mmol / l Creatinine 100 mol / l Fibrinogen 4 g / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 18 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What disease is present in this patient?What is an emergency medical event is shown in this case? 5. Describe the tentative status localis in this patient Task 16. The patient in the early postoperative period, there were the following symptoms: abdominal pain without a clear localization, bloating, vomiting, weakness. Palpation revealed a protective muscle tension throughout the abdominal wall. Temperature 38.50 C, pulse 100 beats per minute, respiratory rate 28 per minute, blood pressure 120/80 mm Hg. of Art. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 50% Color index 1.03 Leukocytes 15000/mkl 10% of stab 70% segmented Eosinophils 1% Basophils 0% Lymphocytes 16% Monocytes 3% Platelets 300 th / mm ESR 35 mm / h Biochemical analysis of blood Total protein 65 g / l Albumin 50% Globulins 50% Urea 9 mmol / l Creatinine 150 mol / l Fibrinogen 4 g / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 18 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l

Urinalysis Straw-yellow color pH 6 The relative density of 1.02 Protein 0.099 g / l Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are 5-6 in the field of view Cylinders single hyaline Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. Which diseases can occur in this syndrome surgery? 4. What disease is present in this patient?What is an emergency medical event is shown in this case? Task 17. The patient weighing 90 kg in the first 3 days after surgery was not indicated enteral administration of fluids and food. In the postoperative infusion therapy was carried out with the introduction of fluid in a volume of 500 ml. At 2 days after surgery, complaints of thirst, dryness of mucous membranes.Reduced skin turgor, pulse 100 beats per minute, blood pressure 100/60 mm Hg. of Art. Results of laboratory tests: CBC Erythrocytes 5.6 million / ml Hemoglobin 165 g / l Hematocrit 60% Color index 1 Leukocytes 8000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 310 th / mm ESR 5 mm / h Biochemical analysis of blood Total protein 85 g / l Albumin 63% Globulins 37% Urea 8 mmol / l Creatinine 130 mol / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 20 umol / l Potassium 5 mmol / l Sodium 165 mmol / l Urinalysis

Color rich yellow pH 5 The relative density of 1.04 The protein is absent Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are isolated in the preparation The cylinders are absent Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What remedial measures are shown in the first place? Task 18. The patient has a long history of duodenal ulcer. In the past 3 months complaint of a feeling of heaviness in the abdomen, vomiting after eating, dry mouth, weakness, dizziness. Pulse 100 beats per minute, blood pressure 100/60 mm Hg. of Art. Results of laboratory tests: CBC Erythrocytes 5.3 million / ml Hemoglobin 165 g / l Hematocrit 60% Color index 0.95 Leukocytes 9000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 310 th / mm ESR 5 mm / h Biochemical analysis of blood Total protein 75 g / l Albumin 63% Globulins 37% Urea 8 mmol / l Creatinine 130 mol / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 20 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l Urinalysis Color rich yellow pH 5 The relative density of 1.03

The protein is absent Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are isolated in the preparation The cylinders are absent Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What are the priority activities in this case? Task 19. The patient in the postoperative period was not carried out infusion therapy. Complaints of dry mouth. The decrease skin turgor, dry mucous membranes, heart rate 100 beats per minute, blood pressure 100/60 mm Hg.of Art. Results of laboratory tests: CBC Erythrocytes 5.3 million / ml Hemoglobin 165 g / l Hematocrit 60% Color index 1 Leukocytes 9000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 310 th / mm ESR 5 mm / h Biochemical analysis of blood Total protein 85 g / l Albumin 63% Globulins 37% Urea 8 mmol / l Creatinine 130 mol / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 20 umol / l Potassium 3.2 mmol / l Sodium 125 mmol / l Urinalysis Color rich yellow pH 5 The relative density of 1.039 The protein is absent Glucose is not Bilirubin is not Epithelial cells are absent

White blood cells are 1-2 in the field of view Red blood cells are isolated in the preparation The cylinders are absent Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What are the priority measures needed? Task 20. The patient in the postoperative period, parenteral introduced a large number of hypertonic solutions. At the 4th postoperative day the patient complained of severe headache, ringing in the ears, swelling of the legs. Pulse 70 beats per minute, blood pressure 150/95 mm Hg. of Art. Results of laboratory tests: CBC Erythrocytes 3.6 million / ml Hemoglobin 110 g / l Hematocrit 30% Color index 1 Leukocytes 4000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 190 th / mm ESR 5 mm / h Biochemical analysis of blood Total protein 60 g / l Albumin 63% Globulins 37% Urea 3.5 mmol / l Creatinine 50 umol / l The total bilirubin 10 mmol / l Direct 1 mmol / l Indirect 9 mmol / l Iron 15 umol / l Potassium 4.8 mmol / l Sodium 158 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases may occur this syndrome? 4. What are the necessary emergency medical event? Task 21. The patient, during the 10-year-old suffering from gallstone disease: chronic calculous cholecystitis, complained of persistent pains in the right upper abdomen, nausea. Ill during the day, when the full background of the emergence of well-being noted above complaints. On examination, the skin and visible mucous icteric painted, pulse 55 beats per minute, blood pressure 120/70 mm Hg. of Art. Results of laboratory tests: CBC

Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 42% Color index 1 Leukocytes 8000/mkl Stab 2% 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 25% Monocytes 9% Platelets 250 th / mm ESR 15 mm / h Biochemical analysis of blood Total protein 70 g / l Albumin 63% Globulins 37% Urea, 5 mmol / l Creatinine 100 mol / l Prothrombin index 80% Fibrinogen 1 g / l The total bilirubin 250 mmol / l Direct 230 mmol / l Indirect 20 mmol / l Iron 20 umol / l Potassium 4.8 mmol / l Sodium 145 mmol / l Alkaline phosphatase 300 U / L ALT 210 AST 160 Urinalysis Color Brown pH 6 The relative density of 1.02 The protein is absent Glucose is not Bilirubin is Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are isolated in the preparation The cylinders are absent Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. Which diseases can occur this syndrome? 4. What actions are necessary to clarify the diagnosis? Task 22. The patient, who was on long-term mechanical ventilation in the postoperative period developed acute bilateral pneumonia.In determining the parameters of acid-base status, the following results: Blood pH 7.0

The partial pressure of carbon dioxide in arterial blood pCO2 80 mmHg The partial pressure of oxygen in arterial blood pO2 75 mm Hg Base excess BE 3 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. Which diseases in surgical patients with this syndrome can occur? 4. What actions are necessary to correct this condition? Task 23. The patient on the third day from the onset of the disease was hospitalized in serious condition in the surgical hospital. In the course of the survey revealed a clinical picture of widespread peritonitis. In determining the parameters of acid-base status, the following results: Blood pH 7.1 The partial pressure of carbon dioxide in arterial blood pCO2 30 mm Hg The partial pressure of oxygen in arterial blood pO2 95 mm Hg Base deficit BE -22 mmol / l The level of standard bicarbonate SB 6 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. Which diseases in surgical patients with this syndrome can occur? 4. What actions are necessary to correct this condition? Task 24. The patient, during the 10-year-old suffering from peptic ulcer, 12 duodenal ulcer, stenosis of the output conditions of the stomach, accompanied by daily repeated vomiting. In determining the parameters of acidbase status, the following results: Blood pH 7.6 The partial pressure of carbon dioxide in arterial blood pCO2 50 mmHg The partial pressure of oxygen in arterial blood pO2 90 mm Hg BE base excess 14 mmol / l The level of standard bicarbonate SB 38 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. Which diseases in surgical patients with this syndrome can occur? 4. What actions are necessary to correct this condition? Task 25. The patient twice after gastrectomy performed relaparotomy at the joint failure of the anastomosis and the ongoing peritonitis.The patient on mechanical ventilation, skin pale with icteric tinge, oliguria, pulse 120 beats per minute, blood pressure 85/55 mm Hg. of Art. Results of laboratory tests: CBC Erythrocytes 3.5 million / ml Hemoglobin 110 g / l Color index 1 Hematocrit 35% Reticulocytes 1% Leukocytes 9000/mkl 10% of stab 60% segmented Eosinophils 3% Basophils 1% Lymphocytes 17% Monocytes 9%

Platelets 170 th / mm ESR 30 mm / h Biochemical analysis of blood Total protein 55 g / l Albumin 45% Globulins 55% Urea 4.5 mmol / l Creatinine 270 mol / l The total bilirubin 80 mmol / l Straight 10 mmol / l Indirect 70 mmol / l Iron 14 umol / l Potassium 4.5 mmol / l Sodium 145 mmol / l ALT 300 AST 320 Fibrinogen 1 g / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? Task 26. The patient was admitted for 3 days of onset of clinical peritonitis. At surgery, gangrenous diagnosed with ruptured appendicitis, peritonitis. Postoperatively, a serious condition, the patient is pale, complaining of shortness of breath. An examination of respiratory rate 32 per minute in the lower lungs on both sides are heard moist rales, pulse 120 beats per minute, blood pressure 120/70 mm Hg. of Art., urine output 600 ml per day. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 120 g / l The color index of 0.9 Hematocrit 40% Reticulocytes 1% Leukocytes 12000/mkl 12% of stab 61% segmented Eosinophils 0% Basophils 1% Lymphocytes 17% Monocytes 9% Platelets 150 th / mm ESR 40 mm / h Biochemical analysis of blood Total protein 55 g / l Albumin 45% Globulins 55% Urea 15 mmol / l Creatinine 270 mol / l The total bilirubin 20 mmol / l Line 4 mmol / l Indirect 16 mmol / l Iron 15 umol / l

Potassium 4.5 mmol / l Sodium 145 mmol / l 1. List available at the patient pathological symptoms. 2. What is a pathological syndrome in a patient? 3. In any surgical diseases most often encountered this syndrome? Task 27. In a patient with diabetes mellitus for the presence of complaints of painful education on the back of the neck, weakness, malaise, fever up to 380 C. When viewed from the back of the neck inflammatory infiltrate up to 1 cm in diameter with a necrotic core in the center. Results of laboratory tests: CBC Erythrocytes 4.5 million / ml Hemoglobin 130 g / l Hematocrit 43% Leukocytes 12000/mkl 10% of stab 61% segmented Eosinophils 0% Basophils 1% Lymphocytes 19% Monocytes 9% Platelets 250 th / mm ESR 30 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 28. The patient complaints about the presence of sharply painful acinar tumor formation in the left armpit for a few days, the temperature increase up to 37.80 C, the restriction of abduction of his left hand. When viewed from the left axillary area inflammatory infiltrate of the merging of several sites up to 6 cm in diameter in the center is determined by the fluctuation. Results of laboratory tests: CBC Red blood cells 5,000,000 / mm Hemoglobin 135 g / l Hematocrit 45% Leukocytes 11000/mkl Stab 9% 62% segmented Eosinophils 2% Basophils 1% Lymphocytes 19% Monocytes 7% Platelets 300 th / mm ESR 25 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required?

Task 29. The patient complaints about the presence of sharply painful redness on the right leg and the feeling of heat in this area, raising the temperature to 400 C, chills, headache. The patient heart rate 105 beats per minute, respiratory rate 30 per minute. When viewed in the bright center of the right leg hyperemia and edema with clear margins, there is no symptom fluctuations. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 120 g / l Hematocrit 40% Leukocytes 17000/mkl 11% of stab 62% segmented Eosinophils 0% Basophils 1% Lymphocytes 19% Monocytes 7% Platelets 300 th / mm ESR 25 mm / h Urinalysis Straw-yellow color pH 6 The relative density of 1.02 Protein 0.099 g / l Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are 5-6 in the field of view Cylinders single hyaline Mucus is not Single crystals of salt 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 30. In a patient after a course of intramuscular injections in the presence of complaints of painful education in the right gluteal region, the temperature increase up to 37.70 C. When viewed in the right quadrant verhnenaruzhnom buttocks painful infiltration 8 x 6 cm in the center of the infiltrate revealed a symptom fluctuations. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 120 g / l Hematocrit 40% Leukocytes 13000/mkl Stab 8% 62% segmented Eosinophils 2% Basophils 1% Lymphocytes 20% Monocytes 7%

Platelets 300 th / mm ESR 20 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 31. The patient with grade 3 obesity operated on for acute cholecystitis in verhnesredinnogo laparotomic access, complaints of pain in the wound, increasing with movement, headaches, weakness, fever up to 38.70 C. On examination, a painful wound around the seal without clear boundaries, occupying the area up to 20 x 30 cm in the center of the seal is determined by fluctuations of the symptom. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 40% Leukocytes 18000/mkl 12% of stab 62% segmented Eosinophils 1% Basophils 1% Lymphocytes 20% Monocytes 4% Platelets 300 th / mm ESR 35 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 32. The patient with a stab wound in the left thigh suddenly appeared in great pain in the left thigh, chills, temperature of 400 C, headache, meningeal symptoms. On examination, the wound on the anterolateral surface of the left thigh painful seal without clear borders measuring 20 x 15 cm, the skin over them is tense, not hyperemic, a symptom of crepitations positive. When X-rays revealed the presence of hip air in soft tissues. Results of laboratory tests: CBC Erythrocytes 3.5 million / ml Hemoglobin 110 g / l Hematocrit 35% Leukocytes 22000/mkl 12% of stab 62% segmented Eosinophils 1% Basophils 1% Lymphocytes 20% Monocytes 4% Platelets 200 th / mm ESR 30 mm / h Biochemical analysis of blood

Total protein 55 g / l Albumin 50% Globulins 50% Urea 10 mmol / l Creatinine 140 mol / l The total bilirubin 20 mmol / l Line 4 mmol / l Indirect 16 mmol / l Iron 20 umol / l Potassium 4 mmol / l Sodium 135 mmol / l 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. What is needed surgical treatment? 4. Describe the expected picture of the tissue during surgical intervention. Task 33. The patient complaints about the presence of painful compression of the index finger pads of the right arm, severe pain in the finger wearing a pulsating character, raising the temperature to 380 C. When viewed on the palmar surface of the distal phalanx of the index finger of his right hand is sharply painful stress education, the skin over it hyperemia, skin smoothed image. Results of laboratory tests: CBC Red blood cells 5,000,000 / mm Hemoglobin 140 g / l Hematocrit 45% Leukocytes 11000/mkl Stab 8% 62% segmented Eosinophils 2% Basophils 1% Lymphocytes 20% Monocytes 7% Platelets 300 th / mm ESR 25 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? What type of anesthesia is preferred in this situation? Task 34. Patient 5 days ago injured a finger of the right wrist with a violation of the integrity of the skin. At present, complained of acute pain and swelling of 1 and 5 fingers of the right hand, the impossibility of motion in the right hand, raising the temperature to 380 C, headache, weakness. When viewed from the brush swollen, purple, maximum palpable tenderness in the projection of the flexor tendons of fingers 1 and 5. Results of laboratory tests: CBC Erythrocytes 4.5 million / ml Hemoglobin 139 g / l Hematocrit 45% Leukocytes 13000/mkl Stab 8% 62% segmented

Eosinophils 2% Basophils 1% Lymphocytes 20% Monocytes 7% Platelets 280 th / mm ESR 29 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 35. Breast-feeding woman 14 days after birth complained of pain and a feeling of heaviness in the right breast, the presence of seals in its upper part, raising the temperature to 390 C, chills, headache.When viewed from the right mammary gland is enlarged, the quadrant is determined verhnenaruzhnom infiltrate without clear contours, negative symptom fluctuations.Results of laboratory tests: CBC Erythrocytes 4.1 million / ml Hemoglobin 130 g / l Hematocrit 42% Leukocytes 12000/mkl Stab 8% 64% segmented Eosinophils 2% Basophils 1% Lymphocytes 20% Monocytes 5% Platelets 300 th / mm ESR 26 mm / h 1. List the available patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 36. Breast-feeding woman 10 days after birth complained of severe pain in the right breast, headache, fever up to 400C, chills. When viewed from the right mammary gland is greatly increased, on the skin and verhnenaruzhnom nizhnenaruzhnom quadrants bubbles with hemorrhagic content.In patient number 30 in the respiratory movements per minute, pulse 130 beats per minute. Results of laboratory tests: CBC Erythrocytes 4.2 million / ml Hemoglobin 135 g / l Hematocrit 44% Leukocytes 20000/mkl 15% of stab 60% segmented Eosinophils 2% Basophils 1% Lymphocytes 18% Monocytes 4% Platelets 300 th / mm ESR 40 mm / h

Urinalysis Color rich yellow pH 5 The relative density of 1.02 Protein 1 g / l Glucose is not Bilirubin is not Epithelial cells are absent White blood cells are 1-2 in the field of view Red blood cells are isolated in the preparation The cylinders are absent Mucus is not Single crystals of salt 1. List the available patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 37. The patient complaints of sharp pain in the anus during defecation increasing, raising the temperature to 380 C. When viewed in the anus for 6 hours is determined by the formation of painful on palpation, a positive symptom fluctuations. Results of laboratory tests: CBC Red blood cells 5,000,000 / mm Hemoglobin 145 g / l Hematocrit 46% Leukocytes 16000/mkl 7% stab 65% segmented Eosinophils 2% Basophils 1% Lymphocytes 21% Monocytes 4% Platelets 300 th / mm ESR 20 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 38. In a patient with severe post-operative period there were complaints about the difficulty in chewing and swallowing, nausea, chills.Temperature 39.40 C. On examination of the parotid gland swelling, painful, there is no fluctuation. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 40% Leukocytes 18000/mkl 7% stab 65% segmented

Eosinophils 2% Basophils 1% Lymphocytes 21% Monocytes 4% Platelets 270 th / mm ESR 40 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 39. The patient was on penetrating wounds of the chest on the right, hemothorax, wound debridement done, drain the pleural cavity.On the third day drainage of the pleural cavity is removed. On the 6th day of disease onset in a patient came to the painful complaints of dry cough, pain in his right side, shortness of breath. The patient lies on his right side.Temperature 39.80 C, pulse was 120 beats per minute, the breathing is shallow, the frequency of 30 breaths per minute. Chest radiography revealed fluid right up to level 5 edges (due to the rear). Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 40% Leukocytes 20000/mkl Metamyelocytes 2% 17% of stab 58% segmented Eosinophils 2% Basophils 1% Lymphocytes 16% Monocytes 4% Platelets 230 th / mm ESR 40 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. What data percussion and auscultation should be expected in this patient? 4. What is needed an additional method of diagnosis? 5. What treatment is required? Task 40. Patient by the end of the first day of the onset of the disease, on admission to hospital complaints of intense pain around the abdomen. The patient was pale, restless.Low 390S, BP 150/90 mm, the pulse was 120 beats per minute, respiratory rate 28 per minute. On palpation determined the protective muscle tension throughout the anterior abdominal wall, and symptom-SHCHetkina Blumberg, bowel sounds on auscultation did not listen. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 40% Leukocytes 20000/mkl 7% stab 63% segmented Eosinophils 2% Basophils 1%

Lymphocytes 23% Monocytes 4% Platelets 260 th / mm ESR 35 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. What are the release phase of the disease, and which phase of the disease is possible in this case? 4. What is the most accurate method of diagnosing the disease is known to you? 5. What treatment is required? Task 41. A patient with an open fracture of the middle third of the tibia on the left on the 18th day from the date of injury noted the resumption of pain in the limbs, the growth of weakness, malaise, headache, fever up to 380 C. On examination, marked redness and swelling of the left tibia. On radiographs of the fracture zone is not fused uzuratsiya bone fragments, a small cavity with the presence of small plate sequesters around osteoporosis. Results of laboratory tests: CBC Erythrocytes 4.5 million / ml Hemoglobin 140 g / l Hematocrit 45% Color index 1 Leukocytes 13000/mkl 10% of stab 66% segmented Eosinophils 1% Basophils 0% Lymphocytes 20% Monocytes 3% Platelets 300 th / mm ESR 35 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required?

Task 42. The patient has a history of left upper limb injury in violation of the integrity of the skin in the area of the olecranon. Currently, complaints of pain and swelling in the area of the olecranon on the left, a little soreness in the elbow in extension. Temperature 37.50 C. On examination of the olecranon on the left is defined by a painful swelling, positive symptom fluctuation. On the X-ray band Elbow are no changes. Results of laboratory tests: CBC Erythrocytes 4.5 million / ml Hemoglobin 140 g / l Hematocrit 45% Color index 1 Leukocytes 10000/mkl Stab 6% 64% segmented Eosinophils 4% Basophils 1%

Lymphocytes 20% Monocytes 5% Platelets 300 th / mm ESR 25 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What is the diagnostic event will confirm the diagnosis? 5. What treatment is required? Task 43. The patient has a history of trauma of the left knee 10 days ago. Currently, complaints of severe pain and swelling of the left knee joint, limitation of motion in the joint, the temperature of 38.50 C, chills, sweating. On examination, his left leg bent in the knee joint is a painful swelling, a symptom is determined by fluctuations in the balloting and the patella. On radiographs of the left knee joint space expansion. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm Hemoglobin 130 g / l Hematocrit 41% Color index 1 Leukocytes 18000/mkl 10% of stab 64% segmented Eosinophils 1% Basophils 1% Lymphocytes 20% Monocytes 4% Platelets 300 th / mm ESR 40 mm / h 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What is the diagnostic event will confirm the diagnosis? 5. What treatment is required? Task 44. In a patient with varicose veins of the left lower extremity complaints in the presence of ulcers in the inner ankle on the left. On examination, - a deep maloboleznennaya ulcer in the left medial malleolus with a moderate amount of purulent discharge.Results of laboratory examination revealed no pathology. 1. List available at the patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 45. In the words of the patient 2 days ago was wounded by shrapnel glass. When viewed from the front of the right thigh there is a linear wound a length of 5 cm wound edges are smooth, not smashed, gape. From the wound enters the dark blood of non-pulsed jet. Skin around not changed. 1. Determine the type of wound. 2. Determine the type of bleeding. 3. Determine the phase of wound healing. 4. What treatment is necessary in this situation? 5. What type of wound healing can be expected?

Task 46. In the words of a patient is injured four days ago. When viewed from the outer surface of the upper third of the forearm has a wound measuring 5 x 3 cm wound is irregular in shape, with irregular contours, edges smashed, with areas of necrosis and hemorrhage. From the entry wound indicated purulent. The skin around the wound hyperemic, tense. The wound is painful on palpation. 1. Determine the type of wound. 2. What kind of complication occurs? 3. Determine the phase of wound healing. 4. What treatment is necessary in this situation? 5. What type of wound healing can be expected? Task 47. The patient was operated on for acute gangrenous appendicitis, perforated. On the 4th day of the postoperative period there were severe pain in the wound area, pyrexia up to 390 C at night with a fever. In the projection of the wound is marked hyperemia and edema of the skin, extending to the lateral surface of the anterior abdominal wall.On palpation the seal is determined without clear boundaries sizes up to 20 x 10 cm in the center of the seal is determined by the positive symptom fluctuations. On palpation of the wound is marked soreness and receipt of a moderate amount of purulent discharge between the stitches. 1. What is a postoperative complication in a patient? 2. Determine the phase of wound healing. 3. What primary therapeutic measures should be taken in this situation? 4. What type of wound healing can be expected? Task 48. The patient operated on for acute gangrenous appendicitis, perforated, local peritonitis, on the third day there was festering wound. On the 10th day post-operative period following the complex of therapeutic measures in the right iliac region has a wound the size of 10 x 3 cm, a depth of 3 cm Skin around the wound is not changed.Wound edges are smooth, the sides and bottom are made of bright pink granulation tissue, secretions from the wound there.Palpation of the edges of the wound painless. 1. Determine the type of wound on the circumstances of its receipt. 2. Determine the phase of wound healing. 3. What treatment is necessary in this situation? 4. What type of wound healing can be expected? Task 49. The patient, operated on the tangential gunshot wound to the middle third of the right shoulder, made PECVD without suturing the wound. At the 8th postoperative day, the outer surface of the middle third of the right shoulder there is a wound measuring 5 x 1.5 cm, a depth of 2 cm around the wound Skin does not change. Wound edges are smooth, the sides and bottom are made of bright pink granulation tissue, secretions from the wound there. Palpation of the edges of the wound painless. 1. Determine the type of wound. 2. Determine the phase of wound healing. 3. What treatment is necessary in this situation? 4. What type of wound healing can be expected? Task 50. 60 days ago on gastric ulcer perforation, diffuse peritonitis underwent laparotomy.Currently, the midline of the xiphoid process to the navel there is a wide shiny pink scar with irregular contours, rising above the surface of the skin. On palpation of the scar solid consistency, is soldered to the surrounding tissues. 1. Determine the phase of wound healing. 2. The more complicated during the wound healing process? 3. What treatment is necessary in this situation?

Task 51 The patient received 33 years in the surgical department with complaints of weakness, dizziness, palpitations, vomiting, bloody, loose stools black. On examination, pallor and cyanosis of the lips, hemodynamic changes (Ps-100 ud.v 1 min, blood pressure -95/60 mm Hg). In the clinical analysis of blood Hb 67 g / l, Ht 28. At endoscopy revealed an ulcer of 12 duodenal ulcer with signs of bleeding took place. At the time of the inspection is not bleeding. 1. Does the patient in the transfusion of red blood cells? 2. Specify the sequence of your actions if necessary transfusion. Task 52 The patient aged 58 suffering from long time developed liver cirrhosis complication - bleeding from esophageal varices. Clinical and laboratory studies indicate a severe degree of blood loss with the development of hemorrhagic shock and disseminated intravascular coagulation 1. What are blood components requires the patient? Task 53 The patient is 42 years old in connection bleeding started infusion of red blood cells.During the blood transfusion marked pain in the chest and back, feeling the heat, short-term stimulation, shortness of breath, difficulty breathing, facial flushing, heart rate, 110 beats. In 1 minute., Blood pressure 75/40 mm Hg 1. With what may be due to the deterioration of the patient? 2. Your actions. Task 54 You brought the patient to 30 years, after 1 hour after the accident. His condition was grave, confused mind. Heart rate - 130/min, blood pressure -80/60 mm. mercury. of Art., CH.D.D - 28 min. Skin and visible mucous membranes pale. No skin lesions. Over the entire right half of chest auscultation is defined sharply weakened breathing, and on percussion - deadened sound, even in the supine position. 1.Sformuliruyte preliminary diagnosis. 2.How additional methods you designate to clarify the diagnosis? Task 55 Male 40 years old construction worker fell from a height of 2 meters and hit the left side of the concrete block. Wounded in the mind.Restless. Complaints about the lack of air.Respiration is rapid, shallow. Cyanosis person. Heart rate - 96/min, blood pressure -100/60 mm. mercury. of Art., CH.D.D - 26 min. There is a deep wound of the left half of the chest. Severe subcutaneous emphysema of the torso, head and upper extremities. 1. What complications have developed in a patient with a wound to the chest? 2. Specify arrangements for first aid. Task 56 Patient P., 18 years old dropped curbs left side when jogging on physical education.Appealed to the clinic of the Institute and was released with a diagnosis of "contusion left costal arch." Ultrasound and x-rays were not met. During the troubled days of dull pain in the left upper quadrant. You appealed to the emergence of sharp pain in the left half of the abdomen, weakness, dizziness, difficulty breathing in horizontal position. The general condition of a heavy, pale skin. A / D 90/50 mm Hg HR 100 in 1 min. Hb 78g / l. Ht 26%.Abdomen painful divisions in the left, a symptom-SHCHetkina Blumberg doubtful. 1. The diagnosis? 2. What are the mistakes made in the prehospital period? 3. Your medical event? Task 57 At the crash site found the victim with a wound to the abdomen. Moans. At the anterior abdominal wall wound with extensive bowel loops dropped out. The pulse is weak.The general condition of heavy 1.Opredelite nature of injury? 2. What is the procedure of first aid?

Task 58 For you to hospital by ambulance transported the patient is 68 years with complaints of pain in the middle third of the right thigh.Anamnesis revealed that about 2 hours ago ill, slipped on the street, in the fall hit the curbs. When conducting a clinical examination is noteworthy limb deformity in the middle third of the right thigh, a sharp pain on palpation, the inability to axial load. 1. What disease you suspect a patient? 2. What tool do you plan to conduct a survey? 3. What kind of conservative therapy and surgical treatment can be used in the treatment of this patient? 4. What are the complications of this disease can occur in a patient? Task 59 When you contact a doctor the patient notes the presence of edema in the left ankle, severe pain when walking. Anamnesis revealed that some days ago, a patient on a ladder sprained right foot. When conducting a clinical examination of the patient's attention is drawn to a pronounced swelling in the ankle, pain on palpation, abnormal mobility of the foot in abduction to the outside. 1. What disease you suspect a patient? 2. What tool do you plan to conduct a survey? 3. What treatment can be applied in this patient? 4. What are the complications of the disease may occur in this patient? Task 60 To you the patient is taken to hospital with complaints of the presence of nausea, vomiting, headache, brief loss of consciousness. Anamnesis revealed that about 3 hours ago, the patient was in an accident. When interviewing the patient the circumstances of injury does not remember. 1. What disease you suspect a patient? 2. What tool do you plan to conduct a survey? 3. Consultations of experts which shows this patient? 4. Which group of drugs must be applied in the treatment of this patient? 5. If there are any complications the patient showed an emergency surgery? Task 61 In the hospital in critical condition brought a patient who fell from a window four floors. The patient is unconscious, the contact with it is not possible. On examination, drew the instability of central hemodynamics, presence of peripheral paresis of the lower extremities. 1. What disease you suspect a patient? 2. What tool do you plan to conduct a survey? 3. Which treatment strategy can be selected for this patient? 4. Determine prognosis of this disease? Task 62 In the hospital the patient is transported from the accident scene. Anamnesis revealed that the patient during a crash while driving, the collision knocked the chest on the steering wheel. On examination, the patient noted the presence of severe shortness of breath, rapid breathing, the presence of tachycardia, decreased blood pressure to 100 mm Hg.column. Palpation of the right and left half of chest sharply painful, when determined by the tympanic percussion sound over right lung field, the breath does not listen. 1. What disease you suspect a patient? 2. What tool do you plan to conduct a survey? 3. What kind of treatment in this patient is shown? Task 63 You are planning the implementation of the planned surgery on the right-sided inguinal hernia. 1. How will you spend preparing the operative field for surgical intervention? 2. Coke kind of kantominatsii most likely during this surgery? 3. Which set of measures to prevent possible injury suppuration you can offer? Task 64 You went to the patient with the clinical picture of peritonitis of appendiceal origin, confirmed by the data of laboratory and instrumental examination. You are planning the implementation of emergency surgery: laparotomy, appendectomy and drainage of the abdominal cavity. 1. How will you spend preparing the operative field for surgical intervention?

2. Koka type of injury is most likely kantominatsii during this surgery? 3. Which set of measures to prevent possible injury suppuration you can offer? Task 65 In a patient with purulent wound has clinical symptoms of cellulitis of the right thigh? 1. What would be a complex surgical treatment of wounds, and what the main purpose of her? 2. What types of additional treatment of the wound can be used during the surgical treatment? 3. What types of wound drainage are most preferred in the treatment of this patient? 4. Identify the indications for antibiotic therapy in this patient, what kinds of antibiotics can be used? Task 66 To you the patient is admitted with a gunshot wound to his left shoulder. Anamnesis revealed that the patient has received this injury for about 2 hours ago. 1. What would be a complex surgical treatment of wounds, and what the main purpose of her? 2. What types of additional treatment of the wound can be used during the surgical treatment? 3. What types of wound drainage are most preferred in the treatment of this patient? 4. What you'll end up surgery? Task 67 In analyzing the results of treatment of patients undergoing surgery for abdominal organs in the intensive care unit registered a high incidence of pneumonia. 1. What are the most likely reasons for the high incidence of postoperative pneumonia in patients operated on? 2. Define a set of measures aimed at reducing the incidence of postoperative pneumonia. Task 68 A patient aged 52 to 15 years suffering from duodenal ulcer disease. Repeatedly passed courses antiulcer treatment as an outpatient and inpatient. In the past 3 months along with pain in the epigastric and heartburn was celebrating vomiting eaten food, lost weight by 5 kg. On examination, malnutrition, decreased skin turgor. The examination revealed narrowing of the outlet of the stomach in violation of the evacuation of gastric soderzhimogo.Hb-160 g / l., L-thousand eight-ESR 30 mm / h, total protein albumin51-22. The patient will have surgery. 1. How to prepare the patient for the upcoming surgery? Task 69 The patient with cancer 58 years lower third of the esophagus, liver metastases and impaired passage of food into the stomach.During the last three months has lost 10 kg.These laboratory investigations: Hb-160 g / l., L-thousand eight-ESR 30 mm / h, total protein albumin-51-22. 1. What is the nutritional need of the patient? 2. Select the optimal route of administration of nutrient mixtures. 3. What nutrient mix will you use? Task 70 The patient after gastrectomy performed twice relaparotomy. Regarding the failure of seams anastamoza and develop as a result of peritonitis. There are signs of the functions of digestion and absorption in the intestine. In this regard, the patient showed an parenteral nutrition. 1. List the major drugs that should be included in the total parenteral nutrition patients 2. What are the complications of parenteral nutrition should be expected during parenteral nutrition Task 71 To you the ambulance brought the patient is 59 years old. In the mind, adinamichen complains of abdominal pain, pyrexia up to 390S. The state is closer to heavy. Skin normal color, dry. Breath of spontaneous frequency of 24 breaths per minute, auscultatory breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmic pulse of 115 beats per minute. BP = 120/80 mm Hg Inspection of the abdomen, see photos. Palpation: pain in the postoperative scar, a symptomSHCHetkina Blumberg negative. Auscultatory peristaltic active noise and the noise of friction of the peritoneum does not listen. Urine output was adequate, independent chair, designed, normal color on the day of admission.

1. List available at the patient pathologicalsymptoms. 2. What is a pathological syndrome in a patient? 3. Your diagnosis? 4. Your diagnostic and treatment activities and their timing? task 72 You asked the patient to 61 years. Closer toa satisfactory condition. Complaints of pain in the postoperative scar and redness of the skin in this area. Operated on for perforatedgastric ulcer 6 months ago. The body temperature of 37.40 C. Skin normal color, dry. Breath of spontaneous frequency of 18breaths per minute and auscultation the breath is held in all departments, wheezingdoes not listen. Heart sounds are muffled,rhythmic pulse of 89 beats per minute. BP =200/110 mm Hg Inspection of the abdomen, see photos. Palpation: pain in the flushing of the skin, deep palpation painless,symptomSHCHetkina Blumberg negative.Auscultatory peristaltic active noise and the noise of friction of the peritoneum does not listen. Urine output was adequate,independent chair, designed, normal color on the day of admission.

1. List the available patient pathological symptoms. 2. Describe Status localis. 3. Your diagnosis? 4. Your diagnostic and treatment activities and their timing?

Task 73 To you the patient turned 78 years old.Complaints of pain in the back of the neck. In history: a long time suffered from diabetes, 2-3 weeks ago, said the appearance of solid education on the back of the neck, which gradually increased in size, with increasing pain in the area. Medical care are not treated, not treated. On the day of admission noted fever, chills, severe weakness, purulent discharge from the formation of the back of the neck. When you receive a state of moderate severity. The body temperature of 39.40 C. Skin normal color, dry. Breath of spontaneous frequency of 21 breaths per minute, auscultatory breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmic pulse of 100 beats per minute. BP = 160/80 mm HgTongue dry, coated with white bloom. The abdomen is not swollen, soft and painless on palpation, peristaltic noises are heard. A chair-shaped, normal color. Adequate urine output.

1. List the available patient symptoms and syndrome. 2. Describe Status localis. 3. Your diagnosis? 4. Your diagnostic and treatment activities and their timing? Task 74 You asked the patient to 71 years. With complaints of pain in the right gluteal region, chills, headache, weakness, fever up to 390S. In the history of the patient held a course of anti-inflammatory therapy by intramuscular injection on spinal osteochondrosis with radicular syndrome. On examination, the state is closer to a heavy, normal skin color, dry. Breath of spontaneous frequency of 26 breaths per minute, auscultatory breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmic pulse of 110 beats per minute. BP = 160/90 mm Hg The abdomen is not swollen, soft, painless, no peritoneal symptoms, active peristaltic noises. Urine output was adequate, independent chair, designed, normal color on the day of admission. Locally: see photos, palpation of congestion in the center section of the softening of tissues. On admission the patient made a clinical analysis of blood and blood chemistry.Results: Erythrocytes 4.2 million / ml, total protein 70 g / l; hemoglobin of 135 g / l, urea 8 mmol / l; hematocrit 43%, creatinine 100 micromol / l; a color indicator, total bilirubin 10 umol / l; 13000/mkl leukocytes, fibrinogen of 4 g / l; stab 10%, potassium 4.8 mmol / l; segmented 66%, sodium 145 mmol / l. 1% eosinophils; 0% basophils; lymphocytes, 20%; 3% monocytes;

300 thousand platelets / ml; ESR 42 mm / h

1. List the available patient pathological symptoms. 2. Describe Status localis. 3. Your diagnosis? 4. What is an emergency medical event is shown in this case? task 75 You brought the patient to 36 years, with complaints of mild pain in the left ankle, a common weakness. From history we know that about a month ago there was a long time outdoors in temperatures below-50C while intoxicated without shoes on his left leg. When you receive locally, see photos.

1. Presumptive diagnosis? 2. What are the possible formation of a line of demarcation in this pathology? 3. Your treatment policy task 76 You asked the patient to 66 years. A few days before admission, felt unwell, weakness, loss of appetite, diffuse muscle pain. On the eve of receipt of the eveningsaid the rise in temperature to 40.10 C andchills. In the morning there were sharp pains, and the bright redness of the right tibia.Appealed to the clinic in the community, local doctor sent the patient for treatment inhospital. When you receive a state ofmoderate severity. Skin normal color, dry.Breath of spontaneous frequency of 18breaths per minute and auscultation the breath is held in all departments, wheezingdoes not listen. Heart sounds are muffled,rhythmic pulse of 95 beats per minute. BP =150/80 mm Hg Tongue dry, coated with white bloom. The abdomen is not swollen, soft andpainless on palpation, peristaltic noises are heard. A chairshaped, normal color.Adequate urine output. Locally, see photo.

1. Describe Status localis. 2. Presumptive diagnosis? 3. Your medical tactics. task 77 You brought the patient to 68 years. Withcomplaints of back pain, fever. In history: 2 weeks before admission to the skin of the back reddish swelling appeared, whichgradually increased in size, then its projectionappeared multiple bubbles with the accumulation of pus, the generaldeterioration, fever up to 390S, forcing the patient to call a team "Ambulance , "whichbrought to the hospital. When you receive astate closer to the heavy. Skin normal color, dry. Breath of spontaneous frequency of 25breaths per minute, auscultatory breath is held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmicpulse of 110 beats per minute. BP = 160/80mm Hg Tongue dry, coated with white bloom.The abdomen is not swollen, soft andpainless on palpation, peristaltic noises are heard. A chairshaped, normal color.Adequate urine output. Locally, see photo.

1. List the available patient symptoms andsyndrome. 2. Describe Status localis. 3. Your diagnosis? 4. Your diagnostic and treatment activities and their timing? task 78 To you the patient turned 16 years old.Complaints of swelling of the face, left eye, a painful education in the left temporal region.In history: 5 days ago in the left templeappeared "pimple" that the patientthemselves squeezed out, and thenappeared the above complaints. When you receive a state close to satisfactory. The body temperature of 37.40 C. Skin normal color, dry. Breath of spontaneous frequency of 16 breaths per minute, auscultatory breathis held in all departments, wheezing does not listen. Heart sounds are muffled, rhythmicpulse of 89 beats per minute. BP = 110/70mm Hg The language of "pure" wet. The abdomen is not swollen, soft and painless on palpation, peristaltic noises are heard. A chair-shaped, normal color. Adequate urine output. Locally, see photo.

1.Describe Status localis. 2. Your diagnosis? 3. Your diagnostic and treatment activities and their timing? Task 79 You asked the patient to 52 years for the surgical treatment - cholecystectomy on the performance of gallstone disease. The patient's condition is satisfactory. BP 120/80 mm Hg Pulse 78 beats. per minute. 2 months ago, suffered a heart attack. In what time frame you will recommend the implementation of a surgical operation? What additional diagnostic methods should be used to determine the degree of risk the surgery? Task 80 To you the patient turned 58 years old. He was concerned about pain in the left lower limb, resulting in walking and going in alone.Without the pain can go 1000 meters. For what disease is characterized by such symptoms? What to pay attention when examining a patient? What additional methods you prescribe? Task 81 The patient in the first day after surgery for tumors of the abdominal cavity of the total welfare of a sudden there was shortness of breath, chest pain. On examination, cyanosis of the face is determined, swelling of the neck veins. To honor the possible complications? What studies should be carried out to clarify the diagnosis? Task 82

Your patient is 62 years old will have surgery for cancer of the colon. What methods of prevention of deep vein thrombosis will you use? Task 83 Your patient will have surgery. What are the issues you must discuss with him to get the consent for surgery? Task 84 Your patient to be transfused. What are the issues you must discuss with him to get consent for its implementation? Task 85 Your patient will gastroscopy. What are the issues you must discuss with him to get consent for research? Task 86 Your patient will have a laparoscopy. What are the issues you must discuss with him to get the consent for surgery? Task 87 Your patient will have elective surgery for abdominal organs. Previously, the patient underwent mitral valve replacement and receives indirect anticoagulants. INR is 3.0. The risk of any complication is most likely? What kind of correction you make in therapy? Task 88 On examination, the patient with cancer of the stomach you find enlarged lymph nodes in the left supraclavicular region. What additional methods you prescribe? What are the most likely treatment option.

Task 89 An examination of a patient with gastric cancer you have found an increase in the size of the stomach. For percussion dullness identified in sloping areas abdomen. What are the possible reasons for these deviations. Determine the patient's treatment options. Task 90 Your patient will have elective surgery - resection of the colon. What is the preoperative preparation you assign? The task of 91 patients with colon cancer you mentioned yellowness of the skin and sclera. What are the most likely cause discoloration of the skin and sclera. What additional methods you prescribe? Indicate the most likely treatment option for patients. Task 92 Your patient needs surgery. However, the patient does not consent to its execution Your next steps? Task 93 Are you a doctor patient N. What kind of information on health status and in what form you should give to his family? Task 94

Your patient will have surgery for peritonitis.The patient's condition serious. BP = 100/50 mm Hg Pulse was 120 beats. per minute. What is the preoperative preparation should be undertaken to reduce the risk of surgery? Task 95 In a patient with multiple injuries noted increased bleeding and mucosal sites of injections. With what may be associated with these symptoms? What additional methods you prescribe? Task 96 Your patient will have elective surgery for abdominal organs. With regard to coronary heart disease patients receive aspirin. What complication is most likely? What kind of correction you make in therapy? Task 97 You came to the patient with profuse uterine bleeding continued. BP = 110/70 mm HgPulse 110 beats. per minute. In the study showed: hemoglobin 90 g / l. Fibrinogen - 1.0 g / l. Platelets were 100 x 103 / ml. APTT - 40 sec. At what point abnormal hemostatic coagulation parameters? What kind of drugs, and in what order you will use in the treatment of this patient? Task 98 Your patient needs operative treatment for narrowing of the output of the stomach. Within 2 weeks the patient noted vomiting and has lost 8 kg. The patient noted decreased urine output, 4 days there was no chair. What are disorders of homeostasis in this patient and what are they related? What is the preoperative preparation necessary to conduct a patient to reduce the risk of surgical treatment? Based on what criteria you judge the effectiveness of training? Task 99 To you the ambulance arrived from outside the patient is unconscious, it is known that around 6:00 he was in the cold. When you receive a very severe condition. Skin pale, cold to the touch, dry. Breathing shallow, carried out in all departments, BH = 21 min.Heart sounds are muffled, arrhythmia, bradycardia to 58 beats per minute. BP = 60/20 mm Hg The abdomen is not swollen, weakened peristaltic noises. 1. What caused the patient's condition, your diagnosis? 2. What research is needed to produce? 3. What are the therapeutic measures and their sequence? 4. List the potential complications and methods for their prevention. Task 100. To you the ambulance brought a patient from a burning apartment. In conscious, listless, adinamichen, drowsy, complained of intense pain in his hands, stomach, thirst, dry mouth.The skin of both arms, the front half of the body hyperemic, with areas of blistering from 2.0 to 15.0 cm in diameter, filled with serous fluid, the rest of the body, pale skin.Spontaneous breath, tachycardia to 110 beats per minute, pulse weak filling. BP 100/70 mm Hg The abdomen is not swollen, peristaltic noises active. Rectal temperature of 400C. 1. Your diagnosis? 2. Where should the patient be hospitalized? 3. What are the therapeutic measures and their sequence? 4. List the potential complications and methods for their prevention. Task 101 To you turned 30 years old patient complaining of pain in both feet, fever to 38.5 . From history we know that 2 days ago was a long time outside in wet shoes with air temperature, 4 C. 3. Arriving home, said pale skin of both feet, tingling in the fingers of both feet, numbness, until the complete lack of sensitivity; warmed cold feet in hot water.In the morning pointed to the increase in body temperature 38oS, chills, sharp pain and swelling of both feet, the appearance of blisters with serous-hemorrhagic content on the fingers and

back of both feet, forcing the patient to contact the hospital. 1. Presumptive diagnosis? 2. Describe the local status. 3. Your medical tactics. 4. What are the errors in the actions of the patient do you find? Task 102 You brought the patient to 50 years old in serious condition, complaining of pain in the right ankle, general weakness, thirst, fever to 39.5 . From history we know that about a month ago there was a long time outdoors in temperatures below-50C while intoxicated without shoes on the right foot. On admission the patient can not rely on the right foot, a foot of black to the level of the ankle, where there is a clear line of demarcation formed. The right lower leg swelling, skin in the lower third of the hyperemic. 1. Presumptive diagnosis? 2. Your medical tactics. 3. What are the possible formation of a line of demarcation described in the pathology?

Task 103 To you turned 20 years old patient complaining of pain in the first finger of his left foot. Concerned about the pain in one and a half to 2 weeks. On examination, the nail phalanx of a finger of the left foot swelling, hyperemic skin on the medial surface. In the area of the nail shaft in the medial corner of the nail plate are gipergranulyatsii, partially concealing it. In this zone there is detachment of the nail shaft with the accumulation of pus underneath.Area sharply painful on palpation. 1. Your diagnosis? 2. Surgical approach, type of anesthesia? 3. After the operative management of patients, prevention of this disease? Task 104 At 4:00 in the morning to your neighbor, turned 57 years old with complaints expressed, arching pain in five finger right hand, chills, a sharp rise in temperature to 39oS. From the words about a week ago while working in the garden injures thumb piece of glass. Medical care did not address, home processed "wound" with a solution of iodine. On examination, five finger right hand sharply increased in size, skin hyperemic, with the spread of congestion on the palmar surface of the wrist to wrist. Finger in the "forced" position, bent, movements are limited in scope because of the sharp pain, palpation of the thumb and wrist to the ulnar surface of the almost impossible, sharply painful. 1. Presumptive diagnosis, and your actions? 2. The required volume of the patient survey? 3. What is the treatment policy for this pathology?

Task 105 To you the patient turned 52 years old, suffering from pain in his right leg calf muscles when walking, increased sensitivity to cold feet. Without pain it can take up to 150 m On examination, the skin pale legs, cool to the touch. Pulsation is defined only in the right groin. In the popliteal artery and arteries of the rear foot is not defined. The left leg is determined by the ripple throughout. 1. What disease you expect? 2. What are the methods you recommend? 3. What treatment options are possible in this situation? 4. Enter some basic medicines. Task 106 You asked the patient to 38 years. 3 days ago she had a pain and redness on the medial surface of the tibia. Self-applied hot compress. Redness and pain spread to the medial surface of the thigh. When viewed on the tibia are visible varicose veins and flushing of the skin, apply to the medial surface of the thigh. Palpable in these zones is determined by the pain, tight bands. 1. What disease you expect? 2. What are the diagnostic methods will you use?

3. What is the treatment policy? Task 107 In patient 62 years of age undergoing surgery resection of the sigmoid colon for cancer on the 5th day after operation there was tenderness in the calf muscles of the left leg, swelling of legs and thighs. On examination, marked cyanosis of the feet.The pulsation of the arteries is defined on all over the limb. 1. What complications have developed in a patient? 2. What is the threat it represents? 3. What are the methods of diagnosis you take? 4. What treatment you prescribe? 5. What preventive measures should be conducted before, during and after surgery? Task 108 3 days ago, the patient pricked palmar surface of the ungual phalanx II finger of the left wrist. After 2 days, became concerned about severe, throbbing pain in the finger. On the eve before admission to hospital because of severe pain in the strong arching finger did not sleep all night. When you receive a t - 37.6, nail phalanx of the left hand fingers II swelling on the palmar surface of the marked flushing of the skin. 1. What is the nature of the disease? 2. What additional research can be done? 3. The proposed type of treatment. Task 109 The patient 30 years over 10 years has diabetes type I. About 3 months ago he appeared at the foot of the phenomenon of intermittent claudication, and 2 weeks ago, I have pain in the finger of his right foot and nail phalanx of his ulcer appeared. When viewed from the right lower leg has a marble color, the distal part of foot bluish-purple color with lymphangites phenomena.Pulse on the arteries greatly weakened.Tactile, pain, temperature sensitivity absent in both feet and right leg. 1. What is the complication of the disease in a patient? 2. What is the need to conduct further examination? 3. How should the patient be treated? Task 110 To you turned 60 years old patient with complaints about the presence of a wound on the left foot and the phenomenon of intermittent claudication. On examination revealed an ulcer on the plantar surface of the left foot measuring 2 x 3 cm on the pulse of the arteries of both feet dramatically weakened. Showed a reduction in tactile sensitivity and pain sensitivity of both feet to the level of the ankles. According to the Doppler was a sharp weakening of the blood flow in the arteries of both Glen and feet. According to laboratory studies revealed the presence of sugar in the urine and 9.6 mM hyperglycemia \ l. 1. What disease is the patient? 2. What is the treatment policy for this pathology? Task 111 When repairing the victim was hit electrical household electric. The consciousness of the patient is absent. There acrocyanosis. There is no pulse at the carotid arteries. On both hands there were traces of burning. 1. What is the nature of defeat? 2. What is the sequence of first aid? Task 112 As a result of an automobile accident the driver's lower limbs were crushed by a car engine car. Within 2 hours of free limb was not possible. Skin pale patient. Complaints of weakness and nausea. Pulse 100 beats per minute. Blood pressure is 100 \ 60 mm Hg. of Art. The front thighs are visible indentations of the longitudinal compressive parts of the engine. 1. What kind of damage is the patient? 2. What are the sequence and nature of first aid?

Task 113 The patient with diabetes regarding its existing polyps of the colon is supposed to endoscopic removal. In this connection it is recommended for 5-6 days, compliance with sparing diet. One day before the procedure the patient refused to complete the meal.Suddenly, the patient's condition deteriorated. Marked by loss of consciousness, which was preceded by excessive sweating, palpitations, psychomotor agitation, pallor. Systolic blood pressure 80 mm Hg. of Art. Pulse 98 beats per minute, blood glucose - 2.8 mmol \ l. 1. What is the cause of the condition of the patient? 2. What caused it? 3. What are the therapeutic measures are indicated for relief of this disease? Task 114 Patient 48 years operated on for acute destructive cholecystitis complicated by peritonitis. Performed cholecystectomy and drainage of the abdominal cavity. The early postoperative period with symptoms of moderate paresis of the intestine, which effectively stoped the use of drug stimulation.But by the end of 4 days after surgery the patient's condition deteriorated there was growing bloating, cramping pain around the stomach, stopped to withdraw gases, joined nausea and vomiting, and marked with signs of endogenous intoxication. 1. What is the complication of early postoperative period occurred in this patient? 2. What are the possible causes of this complication in the early postoperative period? 3. What methods will allow further investigation to determine the diagnosis? 4. What is the nature and extent of necessary medical action? Task 115 A man 45 years was performed appendectomy and abdominal drainage in the right iliac region over the gangrenous appendicitis. On the 9th day after the operation of the drainage canal noted receipt of enteral contents. The patient's condition of medium gravity, t-37,2-37,5. abdomen is soft, slightly painful in the surgical wound. No peritoneal signs. Independent chair. In finding the silicone drainage channel depth of 10-12cm, which stands for liquid intestinal contents. The skin around the channel with the signs of maceration. 1. What is the nature of postoperative complications? 2. What are the etiology and pathogenesis of complications? 3. Required additional research methods. 4. Principles of medical and operational benefits. Task 116 The patient at the end of the first days after appendectomy performed there was severe weakness, dizziness. On examination, marked pallor, tachycardia, drop in blood pressure. For percussion, and according to the ultrasound study in sloping areas of the abdominal cavity is defined by the presence of free fluid. 1. What explains this state of the patient? 2. What additional diagnostic methods should be applied? 3. What is the treatment policy? Task 117 To you turned 25 years old patient complaining of acute abdominal pain. You are diagnosed with "Acute phlegmonous appendicitis, peritonitis, local," and offered the patient an emergency operation. From the patient refused the proposed surgery. 1. Your next steps? Task 118 Are you a doctor patient 60, who on examination reveals cancer of the colon. 1. What information about the health of you give to the patient, his relatives, friends, co-workers? Task 119 Are you a doctor patient 62 years old, who has to surgery for gastric cancer. 1. What issues you should discuss with the patient to obtain informed consent for surgery? Task 120 You went to a patient 42 years with a clinical picture of gastrointestinal bleeding. The general condition of

the patient of moderate severity. AD 110 \ 70 mm Hg. of Art. Hb - 60 g \ l. Ps - 110 beats per minute. At gastroduodenoscopy revealed a duodenal ulcer, which marked the edge of the red blood flow. Bleeding stopped clipping of the vessel. 1. Make a plan for infusion - transfusion therapy aimed at compensation for blood loss. Task 121 The patient is 58 years old, suffered a gastro - intestinal bleeding, requires transfusion of packed red blood cells. 1. What information do you need to provide to the patient prior to transfusion? 2. Specify how your actions during the transfusion? Task 122. Breast-feeding woman 14 days after birth complained of pain and a feeling of heaviness in the right breast, the presence of seals in its upper part, raising the temperature to 39 C, chills, headache.When viewed from the right mammary gland is enlarged, the quadrant is determined verhnenaruzhnom infiltrate without clear contours, negative symptom fluctuations.Results of laboratory tests: CBC Erythrocytes 4.1 million / ml stab 8% Lymphocytes 20% Hemoglobin 130 g / l Segmented 64% Monocytes 5% Eosinophils Hematocrit 42% 2% Platelets 300 th / mm Leukocytes 12000/mkl Basophils 1% of the erythrocyte sedimentation rate 26 mm / h 1. List the available patient symptoms. 2. Describe the alleged status localis. 3. What disease is the patient? 4. What additional diagnostic methods are needed? 5. What treatment is required? Task 123 Breast-feeding woman 10 days after birth complained of severe pain in the right breast, headache, fever to 40 C, chills. When viewed from the right mammary gland is greatly increased, on the skin and verhnenaruzhnom nizhnenaruzhnom quadrants bubbles with hemorrhagic content.In patient number 30 in the respiratory movements per minute, pulse 130 beats per minute. Results of laboratory tests: CBC Erythrocytes 4.2 million / ml stab 15% Lymphocytes 18% Hemoglobin 135 g / l Segmented 60% Monocytes 4% Eosinophils Hematocrit 44% 2% Platelets 300 th / mm Leukocytes 20000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / h Urinalysis Color rich yellow-Glucose is not Leukocytes 1-2 in the field pH 5 Bilirubin no view The relative density of epithelial cells Red blood cells are isolated in 1.02 missing drug Protein 1 g / liter cylinders missing Mucus is no single crystals of salt 1. List the available patient pathological symptoms. 2. What disease is the patient? 3. Describe the alleged status localis. 4. What treatment is required? Task 124 The patient complaints of sharp pain in the anus during defecation increasing, raising the temperature to 38 C. On examination, the anal area for 6 hours is determined by the formation of painful on palpation, a positive symptom fluctuations. Results of laboratory tests: CBC Red blood cells 5,000,000 / mm stab 7% Lymphocytes 21% Hemoglobin 145 g / l Segmented 65% Monocytes 4% Eosinophils Hematocrit 46% 2% Platelets 300 th / mm

Leukocytes 16000/mkl Basophils 1% of the erythrocyte sedimentation rate 20 mm / h 1. List available at the patient pathological symptoms. 2. Describe the alleged status localis. 3. Describe What disease is the patient? 4. What additional methods are needed? 5. What treatment is required? Task 125 The patient, during the seven days of receiving parenteral nutrition, there were complaints about the difficulty in chewing and swallowing, nausea, chills. Temperature 39.4 C. Examination of parotid gland swelling, painful, there is no fluctuation. Results of laboratory tests: CBC Red blood cells 4,000,000 / mm stab 7% Lymphocytes 21% Hemoglobin 130 g / l Segmented 65% Monocytes 4% Eosinophils Hematocrit 40% 2% Platelets 270 th / mm Leukocytes 18000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / h 1. List available at the patient pathological symptoms. 2. Describe the alleged status localis. 3. What disease is the patient? 4. What treatment is required? Task 126. In the emergency department the patient taken 28 years. complaining of intense pain in the right iliac region. Ill during the day, in relation to employment on the job to a doctor not previously addressed. Ambulance put the preliminary diagnosis of acute surgical pathology. On examination, the patient of average weight, lies on the right side. The temperature of 37.8. Pulse 90 beats per minute, blood pressure 135 \ 90 mmHg st.Dyhanie surface, the frequency of respiratory movements to 18 per minute.Tongue coated with white bloom. Abdomen tense in the right sections, which specifies the positive symptoms of irritation of the peritoneum. CBC Red blood cells 4,000,000 / mm stab 7% Lymphocytes 21% Hemoglobin 135 g / l Segmented 65% Monocytes 4% Eosinophils Hematocrit 40% 2% Platelets 250 th / mm Leukocytes 16000/mkl Basophils 1% of the erythrocyte sedimentation rate 60 mm / h 1.How pathology can be assumed? 2. Does the patient in surgery? 3. Specify what other methods of biochemical or special surveys are needed in this case. 4.Kakie special methods can be used to refine liagnoza? 5. What is the minimum standard of preparation of the patient in the case of the operation. Task 127 In the surgical ward patient received 83 years on the lower extremity atherosclerosis, occlusion of the right femoral artery, chronic arterial insufficiency of the 4 th., Gangrene of right foot On examination, the patient's condition - heavy on the questions are answered with difficulty, but in space and time oriented. The skin and visible mucous membranes are dry and hot to the touch, turgor decreased. Pulse to 120 beats per minute, blood pressure 160 \ 90 mm Hg, heart st.Tony - muffled, rapid breathing up to 20 per minute, scattered dry rales in both lungs. Tongue dry, coated. Abdomen - the soft, painless in all departments. Symptom Pasternatskogo otoritsatelen on both sides.Diuresis - 500ml. Status localis: Skin, right foot, the lower third of tibia dark purple, muscles, legs and thighs gipotrofichnye. On palpation, the foot is cold to the touch, the pulsation in the tibial arteries and popliteal arteries are not operdelyayutsya, the femoral artery - is sharply reduced. Movement and sensitivity on the foot, no. CBC

Erythrocytes 2.2 million / ml stab 15% Lymphocytes 18% Hemoglobin 105 g / l Segmented 60% Monocytes 4% Eosinophils Hematocrit 34% 2% Platelets 300 th / mm Leukocytes 20000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / h Urinalysis Color rich yellow-Glucose is not Leukocytes 1-2 in the field pH 5 Bilirubin no view The relative density of epithelial cells Red blood cells are isolated in 1.02 missing drug Protein 1 g / liter cylinders missing

1. Indicate which methods of laboratory examination are necessary in this case? 2. What are the indications and urgency of surgery? 3. What is the minimum standard of preparation of the patient during the operation 4. What additional methods of investigation of the arterial system of the lower extremities will clarify the diagnosis? 5 Who: the patient or relatives must give written consent for the surgery? Task 128 In trauma the item asked the young man 20 years with complaints about the presence of bite wounds 2 fingers of his left hand. The wound inflicted 3:00 ago an unknown dog in the park area. The patient's condition - satisfactory. The skin and visible mucous membranes - the usual color. Pulse - 74 beats per minute, blood pressure 120 \ 80 mm Hg. Status localis: Skin 2 fingers left hand - hyperemic, edematous. On the palm and dorsum of the middle phalanx - 2 linear wounds 1,5 x1 and 1x1 cm, with irregular edges, and soaking in blood. External bleeding is not expressed. Movement - is sharply limited because of pain. Slight swelling of the back of the hand. 1. Determine the patient's plan of survey 2 Which treatment is the patient? 3.What compulsory medical measures must be performed after the survey 4. Formulate a diagnosis and treatment plan. Task 129 The patient is 55 years in the cardiology department at the posterior transmural myocardial infarction. The department began complaining of right hip in the presence of the bulk density of the formation of elastic consistency that arose three days ago. On examination, the patient of average weight, skin and visible mucous membranes - the pale. Pulse - 88 beats per minute, blood pressure 140 \ 90 mm Hg, wet language, belly - a soft, painless. Status localis: On the medial surface of the right thigh to the level determined by a tight groin painful strand widths up to 10 centimeters. The skin over it hyperemic, palpation of education - is painful. In the middle third of the femur and tibia are defined varicose veins. CBC Erythrocytes 4.2 million / ml stab 1% Lymphocytes 18% Hemoglobin 105 g / l Segmented 65% Monocytes 4% Eosinophils Hematocrit 44% 2% Platelets 300 th / mm Leukocytes 9000/mkl Basophils 1% of the erythrocyte sedimentation rate 40 mm / h Urinalysis Color rich yellow-Glucose is not Leukocytes 1-2 in the field pH 5 Bilirubin no view The relative density of epithelial cells Red blood cells are isolated in 1.02 missing drug Protein 1 g / liter cylinders missing

1. Formulate a preliminary diagnosis

2. Write a plan for further examination the patient 3. Assess the risk of conservative therapy and surgical treatment of the patient. Task 130 In the outpatient to the surgeon asked the patient is 46 years old with complaints of a tumor right hand. The disease developed in three years, obratilsyav clinic, since the formation interferes with work. On examination - the patient's condition is satisfactory. The skin and visible mucous membranes normal color. Do78 pulse beats per minute, blood pressure 150 \ 90 mm Hg.Pathology of abdominal organs were found. Local Status: On the lateral surface of the right shoulder is the formation of three-dimensional 10h15h6 cm soft-elastic consistency, the skin over them is not changed. Movements in the shoulder and elbow joints in full. Ripple on the arteries - is not broken. 1. Formulate a preliminary diagnosis 2. Write a plan of survey of patient 3 How is the risk of surgical treatment of the patient. Task 131 To you turned 62 years old patient complaining of pain in his left leg. The pains occur when walking at a distance of 500 meters and go after the rest. On examination, the patient's condition is satisfactory heart rate and arterial pressure within normal limits. In the study of the lower limbs - the skin pale. The pulsation of the arteries is determined only in the inguinal regions: distal pulse is not detected. 1. What do you expect to pathology? 2. What additional methods do you use for diagnosis? 3. What are your recommendations to the patient? Task 132 In consultation with a surgeon sent the patient 25 years old, top model, with complaints of pain in the left lower limb, resulting in walking, flushing of the skin on the inner surface of the left thigh and subfebrile temperature. An examination of the patient perfectly proper constitution, moderate diet. Pulse and blood pressure within normal limits. Pathological changes in the lungs and abdominal organs were found. On examination of the lower extremity is determined by the flushing of the skin on the medial surface of the tibia and femur to the level of the upper third. On palpation determined painful strand widths up to 8 cm along the areas of hyperemia of the skin. There is a slight swelling of the legs, which specifies the number of painful and enlarged varices. Visible damage to the skin - have been identified. Movement and sensitivity are not violated. The pulsation of blood vessels is determined, at all levels 1. Formulate a preliminary diagnosis of the patient. 2. determine the necessary amount of emergency research 3. What are the most dangerous complications of the disease and ways to prevent Task 133 In the emergency department surgical clinic staff delivered to the private security company for 35 years. After a long stay in the car while on duty, said the appearance of pain in the left lower limb when walking, "a feeling of heaviness in the leg", swelling of the foot and lower leg. An examination of the patient properly built, a moderate diet. Pulse and blood pressure within normal limits.Pathological changes in the lungs and abdominal organs were found. On examination of the lower limb there is an increase in the volume of the left leg at all levels, swelling of the foot and the reinforced venous pattern on the skin of the lower extremity. Flexion in the knee and ankle joints is limited due to soreness. Cutaneous and deep sensitivity is not violated. Visible damage to the skin of the foot and lower leg, did not reveal arterial pulsation is determined, at all levels 1. Formulate a preliminary diagnosis. 2. determine the necessary amount of emergency research 3. What are the most dangerous complications of the disease. 4.Ukazhite special technique examination of the patient 5. What are the main principles of treatment.

Task 134 Patient 80 years of commercial medical center, underwent hip replacement surgery 2 weeks ago. Complaints of chest pain, feeling short of breath.There is shortness of breath at rest to 20 per minute, cyanosis of the face. Pulse - up to 110 per minute, blood pressure 150 \ 100 mm Hg.Cardiac - arrhythmia, muted. In the lungs - breathing weakened the left. Tongue moist.Abdomen - the soft, painless in all departments. Local Status: Postoperative wound on the lateral surface of the left thigh in length and 40 cm, stitches removed, congestion - not detected.There is an increase of the left hip at all levels, swelling of the leg and foot on the medial surface of the left lower limb are visualized varicose subcutaneous veins. The pulsation of blood vessels is determined, at all levels. Movement in the knee and hip joints are limited. The sensitivity is not compromised. 1. Formulate a preliminary diagnosis of established disease. 2. determine the necessary amount of urgent research needed to clarify the diagnosis 3. What are the most dangerous complications of the disease and ways to prevent them. 4. Specify the possible financial adjustment in the final drafting bills for treatment. Task 135 To you turned 53 years old patient complaining of a sudden swelling of the left leg. Seen from the limb: the left leg increased in volume, cyanotic skin. The pulsation of the arteries is defined throughout. Trophic disorders have been identified. 1. With what may be associated swelling of the feet? 2. What additional research do you designate a patient? 3. What are the possible complications? 4. Your recommendations?

Task 136 The patient on the fifth day after surgery for cancer of the sigmoid colon had developed swelling of his left leg. When viewed from the extremities: the left foot to the groin increased in volume, cyanotic skin. The pulsation of the arteries is determined at all urovnyah.Patologii right lower extremity was not detected. 1.C than can be linked to swelling of the feet? 2.How more research you designate a patient? 3.What are the possible complications? 4.Vashi recommendations?