Task
The man of 52 y.o address to the surgical cabinet with a complaints on lower lip’s ulcer at left. Ulcer have irregular shape and margin, app. 1.5 cm in diameter. The margin of ulcer is above the skin level, everted and infiltrated. By palpation infiltrate around ulcer movable, size app 4 cm. The submandibular lympho node at left is increase to 2 cm. By cytology – cell of malignant growth/
1.Provisional diagnosis
2.Prescribe additional examinations
3.Prescribe treatment
Task
The man 47 years, has addressed to the dentist with complaints to presence of an painful ulcer of tongue on the right.
Objectively: the ulcer with soft edges in the size 1,0 cm. at the lateral surface of tongue. The bottom is covered by grey-yellowscurf. Submandibular lymph nodes are enlarged from both parts, painful. The doctor supposes a malignant tumour.
1. Whatbasismethods of diagnostics it is possible to verify the diagnosis?
2. What are the diseases and what methods should be differentiated with tongue cancer?
3. How to treat the cancer of tongue?
Task
The man 65 years, complain of a dull pain in right hypochondrium, loss of appetite, bitter taste ina mouth, urine darkening, loss of weight.
Objectively: a skin and visible mucousare icteric, a skin turgor the lowered. The stomach is soft, painfulin right hypochondrium, a liveris enlarged is hilly. At ultrasound in IV and V segments of a liver are found nodal formations of 3 cm and 4 cm in diameter.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
The male 65 y.o. alcohol abused in past, complaint of progressive disphagia for 2 monthes. The last 2 weeks have fluid diet only. During 3 days complaint for bad cough after several sip of fluid. Temperature was increased, breath was complicated. By fibrogastroscopy- at 26 cm circular constriction, by biopsy- planocellular cancer.
1.Provisional diagnosis
2.Prescribe additional examinations
3. Treatment tactics
Task
The patient 65 y.o. complaint for medium pain and abdominal fullness in epigastria after eating, rotteneructation, from time to time appear vomiting, that give relief. The acidity of gastric juice intensively low, appetite is changeable, loss weight, by blood study- anaemia. Be ill over half a year. By fibrogastroscopy – pronounced infiltration of pilloro-antral part mucous, enter to duodenum impossible. By biopsy- signet ring cell adenocarcinoma. By palpation- solid lymphonode 2cm in diameter at left supraclavicularis region.
1.Diagnosis.
2.Prescribe additional examinations
3. Treatment tactics
Task
The patient of 45 years feels a dull ache in right hypochondrium and epigastric area, a skin itch, dyspepsia, dark colour of urine and an acholic feces. Notes that much has lot weight, general weakness, fever up to subfebrile digits.
Objectively: a skin and the visible mucous are icteric. At a stomach palpation – a positive Courvoisier’ssymptom. The general bilirubin of a blood of 278 ml.mol/l. At ultrasound the liver is enlarged in volume, the gall bladder and cholic ducts are dilated, concrements in them is not taped. The pancreas is visualised badly.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
Patient 73 y.o. have complaints for diarrhea with trace of dark blood discharge and mucilage, loss weight. Periodically appear stool delay and meteorism. Be ill over 9 monthes.
Objective: by palpation- light rigidity and painfulness of abdominal wall at left iliac region. Blood Hb -90 g/l, ESR- 42 mm/h. By irrigoscopy with tight filling of bowels for 30 cm after anus- circular constriction for 2/3 of intestine aperture 5 cm length with irregular contour.
1.The most true and full diagnosis
2.Prescribe additional examination
3.Treatment tactics
Task
The patient P., 55 years old, he has the complain of pain and feeling foreign body in the rectum, swelling, constipations which interchange with diarrhea, presence the mucus and blood in excrement, dysuria. He has being ill for 6 months, and does not receive treatment.
The objectiveexamination reveal that his abdomen isswelling, liver is on the verge of costal margin, the irritating signals of peritoneum is negative. The clinical blood analysis has not change. The doctor carry out digital rectal investigation and he diagnosed that on the front wall is the thick nodule which has uneven surface,it is immobile,painless; after rectal investigation on the glove was trail of blood. In sigmoidoscopy was diagnosed that on 5 cm to anus definition the thick nodule onbroadly based, which has uneven surface andcontact bleeding, its diameter is 4cm.
- Set up the most reliable diagnosis.
- What axillary examination must be perform by doctor for diagnose?
- Plan of treatment for this patient.
Task
The man is 65 years old, he has the complain of major cough with mucoid sputum and blood streaks, dyspnea, weakness and pain in the right part of chest, his body temperature is risen. He smoking many years. Impairment the body state he connected with supercooling. The objectiveexamination reveal that his body temperature is 37,9 Celsius degrees, respiratory rate – 24/min., pulse is 98 beats per minute, blood pressure – 130/80 mm of mercury column. Skin is dry and pale in
colour. Over the lung is sounded vesicular respiration, at the right upper part of chest iscontrol of vesicular perspiration,single small bubbling rales. Roentgenological picture: upper lobe density of right lung, peribronchial and root lymphatic nodules are enlarged. By bronchoscopy - luminal narrowing of right proximal bronchus at the cost of endobronchial tumor. By biopsy – small cell cancer.
- Lay down clinical diagnosis.
- Survey design.
- Treatment plan.
Task
The man 40 years, has addressed to the doctor with complaints to weakness in the skeletal muscle.
Objectively:facial flushing, a ptosisof eyelid andmiosison the right, an hypotrophyof muscles of extremities. On X-ray: a shade of a mediastinum with equal contours. On computer tomograms: a tumourof of the anterior-upper mediastinal, lymph nodes are not enlarged.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
The woman of 66 years, half a yearhas noticed an ulcer on the topthird of right hip, on a place of scar after burn. The ulcer was quickly enlarged, has started to bleed. A thermal combustion has received about 20 years ago.
Objectively: on the topthird of right hip the ulcer in the size about 4,0 cm, with infiltrated, jagged edges, a chondroidconsistence, mobile, bleeds. In inguinalarea palpated tight painless movable lymph node to 1.5 cm in diameter. At the cytologicalresearch from a bottom of an ulcer flat epithelial cancercells are taped.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
A young man 16 years, a few months complains about pain in the left buttock. At this time, the pain intensified, especially at night.
Objectively: In the area of the lower quadrants of the left buttock revealed flushed painful tumor of 4x6 cm with no clear borders. The patient is limping. When X-rays in the left buttock metaepiphyseal area of the femoral bone detected area of destruction with ragged edges. The periosteum is destroyed and hangs as a periosteal cap.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
The patient of 60 years, complains on hoarseness of voice,thyroid glandenlargement, difficulty of swallowing. During the inspection thyroid gland it’s hilly, densely welded to the surrounding tissues. In the left supraclavicular area is defined by a single tightly-elastic lymph node 1 cm in diameter.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
Woman is 57 years old, at the menopausal period – 4 years. She has the complain of weakness, anorexia, discomfort as follows
At vaginal research: uterus size is normal, position – anteflectio, at the region of right uterine appendages are palpated tuberoustumor-like mass to 12cm its diameter, it is painless and mobile. Ultrasonic scanning detected tumor of right ovary 10*8 cm, uniform structure, with fuzzy contours,not strained without range of ovary. Peripheral and paraaortic lymphatic nodule is not multiplied, in the liver, kidneys and spleen the focal changes are not detected. There are trace fluid at the abdominal cavity.
1)Set up the previous diagnosis.
2)What axillary examination must be perform by the doctor for diagnose?
3)What special treatment you are planning to give your patient?
Task
The woman of 36 years complains of presence of tumour in low-internal quadrant ofthe left mammary gland.
Objectively: ata palpation of a mammary gland in low-internal quadrant the tumour in the size 6x4 cm, dense, inactive, painful is defined. A skin over a tumour infiltratedasa lemon crust.In the axillary region is a single compact mobile lymph node of 1,5 cm in diameter. The general conditionof the patient the satisfactory. The analyses of blood and urine without changes.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
Man is 57 years old, he has hematuria overa period of 2 months, sometimes his disturb pain in the right lumbar region.
Ultrasonic scanning detected round tumourin the lower pole of right kidney, its diameter is 3 cm. paraaortic nodi lymphatici is not visualized. The general condition is satisfactory.
- Previous diagnosis.
- Survey design.
- Therapeutic approach.
Task
The man 45 years complains of feeling of heaviness in the suprapubic area, frequent urination, stinging when urinating, urine periodically is painted in red colour.
Objectively: Over the pubis is palpated a painful seal.
Rectally: the prostate is not changed. At ultrasound – thickened bladder wall with the wall growths, the volume of the bladder is reduced. Enlarged iliac lymph nodes on the right are visualized.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?
Task
The man, 67 years, complains of a frequent urination at night (to 7 times), feeling of heaviness in the bottom of a stomach. About one month has disturbed pains in a spine and feet.
At manual rectal research the prostate is enlarged, painless, the right share the dense hilly. Level PSA – 16 ng/ml. Active movements in lumbar department of a spine and an axial load on the left hipare painful.
A.Establish the diagnosis.
B. What are necessary researches?
C.What is the treatment of this disease?