Examination Card 2

APPROVED
___________________________________________
Vice-Rector on Academic Work
M.D., Prof. V.V. Simrok
„ ” 2007 y.
MINISTRY OF PUBLIC HEALTH OF UKRAINE

LUGANSK STATE MEDICAL UNIVERSITY
MEDICAL DEPARTMENT
SPECIALTY GENERAL MEDICINE COURSE VI
SUBJECT INTERNAL MEDICINE
EXAMINATION CARD № 20
Patient, 41 year, delivered by the doctor of first-aid in the induction centre. Patient
complained of severe headache, dizziness, scintillation before eyes, heart pain, tremor in
all body. He suffers from hypertention 5 years, level of blood pressure usually 140 and 90
- 150 and 95 mm Hg
Examination: redness of the skin. In lungs vesicular respiration. Heart sounds are
rhythmic, clear, systolic murmur on an heart apex, accent of II tone, above an aorta. Pulse
105 beats per a minute. BP is 195 and 105 mm Hg. Liver at the margin of costal arc. The
peripheral edemas are not present. Blood test: a general cholesterol – 6,0 mmol/L; level of
lipoproteins high density – 1,1 mmol/L; level of lipoproteins low density – 4,04 mmol/L;
level of lipoproteins very low density – 0,86 mmol/L; triglycerides – 2,2 mmol/L.
Electrocardiogram: sinus rhythm, regular, 105 beats per a minute, horizontal electric
heart axis deviation, impairment repolarization of ventricles in leads V5, V6.
Questions:
1. Emergency measures.
Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.
Head of the chair

M.D., Professor Yu. N. Kolchin
APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: patient 45 years, doctor of ambulance. Complains: during a few months

periodically 1-2 times per a month between a 4-5 o'clock a.m. she feels the attack of
tightening pain behind a breastbone, proceeding from 5 to 10 minutes. In daily time she
feels healthy, well carries the physical exercises. At examination: the state is satisfactory,
pulse 86 beats per a minute, the borders of the heart are not changed, Heart sounds are
rhythmic, clear. BP is 125 and 70 mm Hg. Item a menstrual cycle not is broken.During the
rest, after physical exercises,electrocardiogram is normal.
Blood test: HB is 130 gm/dL, WBC - 5,0x109/L, erythrocyte sedimentation rate - 4
mm/hr, beta-lipoproteins 10 mmol/L. In the period of nightly duty in an interruption
between the calls there was the attack described higher, and which proceeded about 10
minutes. On an electrocardiogram during an attack was registered the expressed getting up
of ST interval in leads I, II, aVL, V2-V6. After the reception of nitroglycerine the state of
patient and indexes of electrocardiogram was fully normalized.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: patient, 39 years old, addmitted to cardiologic department in an urgent

condition with complaints on the intensive pain behind a breastbone, not diminishing after
the reception of nitroglycerine, breathlessness. Two last years He was observed by
cardiologist with ischemic heart disease: stable angina on exertion, functional class II.
Examination: skinning covers were pale, death-damp on face. In lungs weakened vesicular
respiration. Heart tones were muffled; regular rhythm, 74 beats per a minute, BP 110/70
mm Hg. Stomach is soft, painless.
On an electrocardiogram the complexes of QR are registered in II and III, aVF, V5-
V6 leads, in the same leads the segment of ST is displaced up with the wave T, high wave
R in the I; in leads V1-V3 the segment of ST is displaced down, meets with the wave T.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: patient 60 years old, at night had an intensive attack of tightening pain behind a
breastbone, by duration more then 2 hour, palpitation.
At examination: he was blurring, skin was pale, acrocyanosis. BP was 80/40 mm Hg.
Pulse 89 beats per a minute, irregular, weak filling. Heart sounds were deaf,
cardiac fibrillation, 140 beats per a minute. Pulse deficit 51 per a minute. From the
other systems any changes not exposed.
Blood test: troponin T - 0,3 mg/L, myoglobin - 94 mg/L, creatine kinase-MB – 120 U/L,
lactate dehydrogenase - 507 U/L, lactate dehydrogenase 1 - 129 U/L.
Electrocardiogram: registered chaotic and irregular, different in a due form and
amplitude of waves with frequency to 200 in a minute, wave Q - duration 0,04
seconds, its amplitude - ¼ amplitudes of wave R, displaced up segment ST and
negative wave T in III, aVF leads.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: patient 44 years old, after physical exercises and jog ride delivered with
complaints about suddenly pain in the right half of abdomen, the pain extending in a right
lumbar region during 2 hours. Before now similar disorders never was. There was the
single vomiting. A patient is uneasy, tumbling, adopts knee-elbow position. The
temperature of body is 37,40C, 90 beats per a minute. The right half of stomach is tense,
sharply painful. Symptom of irritated peritoneum is negative. Symptom of Pasternatsky
positive on the right side. Blood test: WBC -9,2x109/L Hb-132 g/L, RBC - 4,3x1012/L;
erythrocyte sedimentation rate -20 mm/hour. Urine tests: tracks of albumen; fresh RBC -
5-8 in visual fields; leucocytes - 10-12 in visual fields; plenty of salts - acid urates.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: patient 32 years after the emotional overstrain complains about the cramping
pain in the stomach, attended with a frequent liquid defecation with plenty of mucus,
general weakness. At examination: spastic pain in the different parts of colon during
palpation.
Blood test: HB is 130 gm/dL, RBC - 4,3x1012/L, WBC – 4,8x109/L, segmented
neutrophils – 68%, monocytes – 2%, eosinophils – 1%, lymphocytes – 28%, erythrocyte
sedimentation rate - 8 mm/hr. Serum potassium – 3,7 mmol/L, sodium – 135 mmol/L,
calcium – 2,2 mmol/L, urea – 5,7 mmol/L. Urine tests: amount - 100,0, specific gravity -
1015, RBC - 0-1 in visual fields; WBC - 5-8 in visual fields; single epithelial cells. Fecal
test: designed excrement, pH is neutral, single muscular fibers, increased mucus. Result of
colonoscopy: mucous colon of rose color, pathological formation are not exposed.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Task: a young man 19 years old during play the football suddenly felt breathlessness,
sharp pain in the right half of thorax, general weakness, sense of fear of death.
At examination: diffuse cyanosis, tachypnea 32 per a minute. The right half of thorax
does not participate in the act of breathing, intercostal intervals are smoothed out. At
percussion above the right half of thorax a tympanic sound is determined, is not hearkened
to respiratory noises.
Blood test (clinical): hemoglobin - 127 gm/dL, RBC - 4,1x1012/L, reticulocytes – 1%,
Platalets – 250x109/L, WBC – 6,2x109/L, stab neutrophils – 3%, segmented neutrophils –
68%, eosinophils – 1%, basophils – 1%, lymphocytes – 32%, monocytes – 3%,
erythrocyte sedimentation rate - 7 mm/hr.
X-ray of organs of pectoral cavity in a direct projection: left lung without features, in
place of right lung the brightening area deprived pulmonary picture is visible,
displacement of organs of mediastinum in left, flat the right dome of diaphragm.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Patient B., 42 years old, Subacute (pernicious) glomerulonephritis, exacerbation,
chronic renal failure II was diagnosed in nephrological department. During first day the
patients condition got worse bluntly. Patient was blurring, without contact, pain sensibility
was keeped.
Physical findings: skin was dry, pale with the tracks of combs. The face was
puffiness. The abdomen was increased, the legs were edematous, there were muscular
fibrillar cramps. The breath was deep, noisely, with smell of urea from the mouth. The
pupils were narrow. During percussion the short percuting sound was listened in bothside
of low lobes, auscultation - impaired vesicular breathing. The heart tones were rhythmic,
deaf, 96 beats in minutes, the heart borders widened in left side.
Blood analysis: RBC- 2,7×1012/l; Нb – 80 g/L; WBC- 5,0×109/L; creatinine –
1,052mmol/L; urea – 23 mmol/L; Mg – 1,3 mmol/L; Ca – 1,7 mmol/L; GFR – 20 ml/min.
Urine analyses: daily diuresis – 850 ml; spacific gravity – 1005; protein – 1,1 g/L; hyaline
cylinders– 16-18 in visual fields; RBC – 7-9 in visual fields.
Ultrasound findings: size of right kidney 6,0*10,0 sm, left - 6,5*10,5 sm, the size
were decreased, parenchyma was thick with bad differntiation of margions and renal cup-
pelvical system (7,5-12 sm).
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Patient F., 22 years old, addmitted to hospital in severe condition. 4 weeks ago he
suffered from inluenza, severe form.
Physical findings: the patients condition was severe, patients position was obligeted -
orthopnoea. Face was cyanosis, acrocyanosis. Body temparature was 38oC.The breathing
was noiseling, boiling, superficial, arrhythmical, 40 in 1 min. The rosy, foamy sputum
was coughed. During auscultation moist small and middle bubbly rales were listened in
bothside, in some part of lungs the breath wasn`t listened. The heart beats were very deaf,
tachicardia, 120 in 1 min., BP – 175/115 mm Hg. The heart bodies were widered in
bothside. The liver size was increased (12*11*10 sm), The sizes of lien and kidneys
were normal. The legs were edematous.
Laboratory indexis: Blood analysis: RBC-3,9×1012/l; Нb – 120 g/L; WBC –
15,0×109/L, rod nuclear cells – 11%, segmented L. – 53%, lymphocytes – 31%, monocytes
– 5%; Pl. - 250*109/L, ESR – 22 mm/ h, general protein – 58g/L, albumin – 38%,
globulin – 62% (α1 – 9,3%, α2 –15,2%, β – 12,3%, γ - 18%), A/G quotient - 0,61.
X-ray: the bothside clouds in low parts and near the both lungs roots, the heart shadow
was wided in bothside, the pulsation was little.
Electrocardiogram: sinus arrhythmia, RR – 0,55-0,48 sec, PQ – 0,22 seс, voltage QRS
was decreased.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient D., 47 years old, addmitted to hospital in severe condition and suffered
from frequent attacks of dyspnea, cough with poor sticky transparent sputum,
breathlessness during small physical activity. During last 3 years she suffered from
bronchial asthma. About 1 week ago, after influenza the attacks of asthma increased to 2-3
times per day, she used 2 or 3 inhalations of salbutamol. Last attack of dyspnea was more
than 4 hours. During two last hours 8 inhalations of salbutamol was made but attacks of
dyspnea was not removed.
Physical findings: the patients condition was severe, patients position was obligeted -
orthopnoea. Face was cyanosis, acrocyanosis; without peripheral edema;dystanse dry
rales, the breath with prolonged expiration, 30 in minutes; the thoracic muscles
participated in the breath. During auscultation dry whistling rales were listened in
bothside, in some part of lungs the breath wasn`t listened. The heart beats were deaf,
tachicardia, 112 in 1 min., BP – 110/70 mm Hg.
Laboratory indexis: sputum analysis: yellow colour, mucos, sticky, cells of
pavement epithelium - 1-3 in visual fields, epithelium of bronchi - ordinary, alveolar
macrophages - 1-2 in visual fields, WBC - 3-5 in visual fields, eosinophiles – big quantity,
RBC - 1-2, spirals of Curshman, crystals of Sharko-Leiden.
Spirometry: VC - 54,6%, FVC - 66,8% FEV1 - 50,5%, FEF25-75% - 46,1% FEF25% -
49,3% FEF50% - 39,7% FEF75% - 35,3%.
PaO2 - 75 mm Hg, PaCO2 – 60 mm Hg.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient B., 20 years old, addmitted to hospital in comas condition.Relatives said:
during last 4-5 days patient suffered from severe thirst, abudant urination, weight loss,
appetites absence. Patients mother suffered from diabetes mellitus.
Physical findings: the patient wasn`t consciousness, skin was dry, skin turgor
decreased, lips mucous membrane was dry, tongue was covered with white fur, the acetons
smell from the mouth. The pupils were narrow, eyeballs were soft. The breathing was
noisely as Cussmaule - 22 in min.; the heart tones were rhythmic, deaf, 90 beats in
minutes, BP – 100/60 mm Hg. The abdomen was increased in volume a little. The livers
size was normal (9-8-7 sm).
Laboratory indexis: glucose in blood – 25 mmol/L, urine analyses: glucose in urine –
35 g/L, ketonuria - ++, renal epythelium – 10-15 in visual fields, RBC – 10-12 in visual
fields, hyaline cylinders – 2 - 8 in visual fields.
Ultrasound findings: size of liver, gall bladder – without pathology, size of pancreas -
27·15·20 mm, contour was uneven, changing in structure of pancreas; renal structure
wasn`t legible.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The Patient K., 75 years old, after sleeping, during 2 hours, felt muscular
weakness in right arm and leg, disorder of speech.
Physical findings: the face skin was pale, pulse rate was failing, rhythmical, BP was
150/90 mm Hg, consciousness was preserved. He didn`t say any word. He understood
speech. The strength in right extremities was: in arm – 3 points, in leg - 4 points; reflexes
D < S.
Investigation of oculus fundus: optic disks were pale-rozy colour with clear boders,
the arteries were sclerotic, the veins were convolute.
Investigation of liquor: liquor was transparent, without colour, cytosis – 6 cells in 1
mkL, glucose – 3,2 mmol/L, protein 0,3 g/L, Cl – 7,5 g/L.
MRI: There was the focus of falling density in left fronto –temporo-parietal region
with size 26 х 33 х 45 mm.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient A., 52 years old, complained on the severe pain in right subcostal region,
nausea, single vomiting with bile, brash in mouth, constipation. The pain irradiation was in
right scapula and shoulder. During last 6 year patient suffer from the pain attack in right
subcostal region after eating fat food.
Physical findings: patient was thick, body temperature was 37,1oC, in lungs - vesicular
breathing, puls – 82 beats in min., BP – 130|80 mm Hg, tongue was covered with white
fur.The abdomen was painfull in epigastrium, right subcostal region. Symptoms of
Orthner, Ker, Merphy were positive. Symptoms of irritation of peritoneum were negative.
Liver, lien, intestine, colon were normal.
Laboratory indexis: Blood analysis: RBC- 3,85×1012/l; Нb – 130 g/L; WBC –
9,2×109/L; ESR – 22 mm/ h, total bilirubine – 20,1 μmol/L, ALT – 60 U/L, AST –70
μmol/L; α-amylex – 1232 g/h*L.
Ultrasound findings: size of gall bladder - 15,2∗4,8 sm, the wall – 0,4 sm, there were
stones in gall bladder more than 2/3 of gall bladder volume.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
A man, 52 year old, has present to cardiology department with a diagnosis of

macrofocal transmural anteroseptal-apical myocardial infarction.
Objective: auscultation - arrhythmical activity of heart, the sounds are
muffled, blood pressure of 140/90 mmHg. The pulse is 80 beats per one
minute. A gallop rhythm is auscultated. After 5 hours, the state of the
patient has worsened considerably. He complains of a sharp
retrosternal pain. Objective: the patient is uncomfortable. Dermal integuments
cyanotic, to the touch cold and clammy. A blood pressure of 80/40 mmHg. The
pulse is 120 beats per minute, arrhythmical. Pulse is weak and low
volume. The cardiac sounds are considerably weakened, arrhythmical,
tachycardic. Downstroke of a diuresis - 20 mls / h.
Analysis of a blood: RBC - 4,2 x 1012/L; WBC – 12×109/L; еos. - 3%, neut. - 71%,
lymph. - 22%, mon - 6%, ESR - 16 mm/h АSТ – 68 U/L; Creatinine Phosphokinase - 60
U/L.
ECG: a sinus rhythm, frequency of heart is 120/min., sharp rise of
the ST segment and Т waves above isoline in electrocardiographic leads
V1- V4.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient К., 42 years, has called the family doctor to the house. He
complains of an attack of dyspnoea (on expiration), giddiness,
palpitations. He has been sick for more than three years. The general
state has worsened in the last three days with attacks of dyspnoea
becoming more frequent. Constant presence of diurnal and night signs:
restrained in a chest with laboured expiration, marked restriction of
physical activity.
Objective: the patient has dyspnea, respiration rate 30 per minute, in
mild dissipated sonorous dry rhonchi, remote rhonchi. Pulse is 120 per
minute, blood pressure of 120/80 mmHg, heart sounds amplified, the
second hear sound is loud in pulmonary artery. The other organs and
systems are without any essential pathology.
Home use of the peakflowmeter showed variation diurnal of peak
expiratory flow rate (PEFR) of more than 30 %. 2 days ago he was
reviewed in the polyclinic: On spirogram – FEV1 53% of expected.
Analysis of a sputum sample showed - eosinophils up to 20 %. Analysis
of blood: haemoglobin - 130 g/L, WBC - 8,5x109/L, ESR - 8 mm/h.
Positive dermal assays with allergens: a domestic dust, fluff and
feather.
Questions:

Head of the chair
APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient Н., 62 years, presented to hospital with complaints of

infringement of dream, sharply expressed delicacy, headache, pain in
the right hypochondrium, abdomen distension, pruritus of the skin, a
rise in temperature up to 38оС. From the anamnesis: more than 10
years of alcohol abuse. Consists on a dispensary observation at expert
in narcologist, gastroenterologist. Last deterioration has occurred after
an alcoholic excess.
Objective: the patient is adynamic, offensive hepatic breath, skin and
sclerae are discolored with icterus. The face is red and puffy. The skin
on the trunk «vascular sprockets» with traces of pruritus. The heat sounds are
muffled with heat rate of 96 per minute and blood pressure of 100/70
mmHg. The abdomen is distended, dull percussion in the left and right
transabdominal range. The dimensions of a liver of Kurlov 12х10х9 sm.
He has constipation with painless opening of bowels.
Analysis of blood: HBG - 90 g/l, RBS - 2,5 х 1012/L MCH - 30pg, WBC -
10х109/L, ESR-30 mm/h, GGT-160 МЕ, bilirubin - 60 µ mol/L, ALT-64 U/L,
AST-45 U/L, alkaline phosphatase -240 U/L, prothrombin ratio -60 %.
Ultrasound findings: the size of the liver was increased, non-
homogeneous parenchyma with loci of hyperechogenicity, v.porte – 18
mm, ascitic fluid more than 90 ml. Gall bladder, pancreas, kidney are
without pathology.
Questions:

Head of the chair
APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient К., 52 years old had tuberculosis in 20.05.1998г. In the

last 2 years due to intermittent aggravation of symptoms, he has
treated in hospital. There is marked continued present of bacteria of on
analysis of his sputum. Three days ago sputum expectorated in the
morning was streak with blood. Two hours ago the patients condition
deteriorated, having had a fit of coughing, haemophysis, bringing up
half a glass of scarlet blood. Now haemophysis has settled down to
sneaking in sputum coughed up.
Objective: his general state is satisfactory and he is acyanotic. The patient is
euphoric. The pulse is 90 per minute with satisfactory volime. The blood
pressure is 120/80 mm Hg. He is dysphoeic and examination there is
dullness on percussion of the upper right lung and there is bronchial
breathing on auscultation of the subclavial areas bilaterally. Varigated
wet rhonchi are auscultated in this area too. Muffled heart sounds. The
liver is not enlarged.
Analysis of a blood: RBC - 3,6x1012/L, HBG - 82 g/l, WBC - 9,4x109/L,
eos - 1%, neut. - 78 %, lymph. - 17 %, mon - 4 %, ESR - 25 mm / h.
Pneumonogram: In the upper lobe at a level II of the rib there is a cavity
3,5х4 cm irregularly-shaped and thick-walled. An intrinsic contour of the
cavity is picked up and the exterior contour is less dense. Around the
cavity the image shows high density with distortion and loci of various
density. In the left here are mild simple dense loci.
Questions:

Head of the chair
APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
A man of 34 years age is taken to hospital by ambulance after radioactive accident on

production with application of the open radioactive substances. Due to on incident about 4
hours back, he has received an unstated dose of general irradiation. Now he complains of
vomiting with nausea and moderate headache 1,5 hours after eating.
Objective: he is conscious, hyperaemic, seen mucous, in lung vesicular respiration,
pulse 90 beats per minute. His temperature has increased up to 37,4o, other objective
indices are unchanged.
Questions:
Head of the chair

APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
The patient К., 32 years old on presenting to his family doctor with
complains on pain in the lower abdomen, nausea, multiple episodes of
vomiting, dry mouth, delicacy, flaccidity, with temperature up to 38,2o,
opening of bowels up to 10 times with mucous and blood streaks.
Patient was acutelly ill 2 days ago with pain in the abdomen, frequent
opening of bowels up to 10 times and mucous in character. Then the
nausea and vomiting appeared.
Objective: patient is gravely unwell. Adynamic patient, flaccid. Skin
is acyanotic, dry. Mucosae are acyanotic. There is reduced vesicular respiration
in the lung and the respiration rate is 14 per minute. Heart - dummy sounds are a little
weakened with a low, weak pulse of 112 per minute, blood pressure of 70/50
mmHg. There is pain in the left iliac range of abdomen, sigmoid colon is
palpable as a dense cylinder. The liver is not enlarged and lien is not
palpated. A stool – sample reveals mucous with blood streaks.
Analysis of blood: WBC - 10,4x109/L, eos.-2 %, neut. – 75%, lymph.-18 %,
mon.- 5%, ESR-20 mm/h. Analysis of urine: specific gravity -1026,
protein – very little. On proctosigmoidoscopy: there is not obstraction
and hemorrhoidal clusters in range of a rectum. Mucous of sigmoid
colon is hydropic and hyperemic. There are dotted haemorrhages. The
ulcers are not seen.
Questions:

Head of the chair
APPROVED
___________________________________________
„ ” 2007 y.

MEDICAL DEPARTMENT
Patient 19 years old is delivered by the doctor of ambulance in

municipal hospital 12.08.05. The patient complains of edema of the
face and neck, hoarseness of a voice, delicacy, giddiness, laboured
respiration. The oedema has arisen several minutes after ingestion of
honey. Independently, the patient has taken a tablet of Suprastinum,
but the oedema continued to increase, the dyspnoea has amplified and
a cough has appeared. Within one month the rhinitis were marked.
Objective: the oedema of the face and neck, laboured an expiration,
respiration noisy, arterial pressure 110/60 mmHg, pulse 90 beats per
minute. Chest auscultation reveals vesicular respiration without rales.
Cardiac activity is rhythmical and the heart sounds are muffled. The
abdomen is soft and painless.
Analysis of a blood: RBC- 4,5x 1012/L, HGB -120 g/L. MCH – 30 pg,
WBC -7,5x 109/L, eos - 10 %, bas. - 1 %, lymphocytes - 30 %, neut. –
55%, monocytes 4 %. Common IgE 200 mg/mls, cytology of sputum and
rhina secretions - 10 % eosinophils, the thrombocytopenic test - 28 %.
The scarification test in a remission: an allergen an ambrosia plant
-blister diameter - 18 mm, hyperaemia, orach plant- blister 5 mm,
hyperemia.
Questions:
Head of the chair


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APPROVED

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Task: patient 45 years, doctor of ambulance. Complains: during a few months

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Task: patient, 39 years old, addmitted to cardiologic department in an urgent

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

A man, 52 year old, has present to cardiology department with a diagnosis of

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

MINISTRY OF PUBLIC HEALTH OF UKRAINE

The patient Н., 62 years, presented to hospital with complaints of

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

MINISTRY OF PUBLIC HEALTH OF UKRAINE

The patient К., 52 years old had tuberculosis in 20.05.1998г. In the

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

MINISTRY OF PUBLIC HEALTH OF UKRAINE

A man of 34 years age is taken to hospital by ambulance after radioactive accident on

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

Head of the chair

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.

MINISTRY OF PUBLIC HEALTH OF UKRAINE

Patient 19 years old is delivered by the doctor of ambulance in

Approved at the Chair Meeting Minutes №6. The 22.01.2007 year.