Сase 1 Patient F

НА АНГЛИЙСКОМ ЯЗЫКЕ

Patient F., 43 years old, was admitted to the hospital with complaints of pain in the right half of the chest, cough with sputum, spontaneous fever, up to 39.4 C, chills, shortness of breath with slight exertion, general weakness. Three days ago, during the tooth extraction, he coughed violently (until vomiting), there was a heavy bleeding from the dental cavity. In the morning there was a chill, pain in the chest on the right, cough with profuse purulent sputum with an unpleasant smell, the body temperature increased to 39.4C.

The skin is pale. The right half of the chest lags behind in the act of breathing, shortening of percussion sound is determined from the angle of the scapula. The vesicular breathing in the place of shortening is weakened, there are single moist rales. The heart sounds are muffled. The pulse is 124 per minute; the blood pressure is 110/60 mm Hg.

The examination was scheduled: a general analysis of blood and urine, chest X-ray. The x-ray in the lower lobe on the right determines the infiltration of lung tissue with fuzzy contours.

Сase 16

The dentist is invited to consult the 21–year-old patient in the hematology department, who complains of fatigue, weight loss, subfebrile fever, a tendency to subcutaneous hemorrhage, severe pain in the mouth and pharynx. Because of the pain when swallowing, food and liquid intake is difficult. There is a lack of taste in the food, although the appetite remains.

Objectively: Local status: the mucous membranes of the mouth and pharynx are hyperemic; there is bleed when touched, the gums are ulcerated, the lingual surface of the gums is hyperplastic, the tongue is superimposed; there is purulent plaque on the tonsils.

 On the limbs there are multiple small subcutaneous hemorrhages. The temperature is 37.3 С. The pulse rate is 88 beats per minute and has satisfactory qualities. The blood pressure is 120/80 mm Hg, respiratory rate of 18 per min. Blood test: Er 3.2x1012 / L, Hb 92 g / L, Tr 90x109 / L, white blood cells 30x109 / L, basophils - 0%, eosinophils -1%, blast cells - 80%, myelocytes - 1%, segmented neutrophils - 5%, lymphocytes -13%, monocytes - 0%, ESR - 42 mm / hour.