Medicine Practice Exam questions Latest 2024

Patient Z., 16 years old, student. The patient suffered with rheumatic fever at the age of 8 years. She was treated with antibiotics and aspirin permanently (according to her mother). Mitral insufficiency was formed. The patient felt herself satisfactorily, studied in a high school, was active. Within 5 years, she received the autumn and spring courses of bicillinum prevention. A month ago she passed through an acute respiratory disease with fever up to 38 °C. She stayed at home for 5 days at home without treatment and was discharged to the university in a satisfactory condition. However, after two weeks there were fatigue, malaise, the temperature began to rise at night up to 37.2 - 37.5 °C, pain in the knee joints appeared. The diagnosis was: post-virus asthenia (viral verification agent was not carried), the patient was recommended a course of vitamins. On examination: a satisfactory condition. Skin covers were clean. There were no rales above lungs. There were weakening of the first tone and a systolic murmur at the apex of the heart, and an accent of the IInd tone above the pulmonary artery. 1. Formulate a preliminary diagnosis. 2. Propose a plan for examining the patient. 3. What are the main principles of treating this condition? Preliminary Diagnosis → Mitral stenosis-- Rheumatic valve disease is the primary cause of MS. → Severity of MS—Mitral valve area ≤1.5 cm2 Diagnostic Plan TTE(TransThoracicEchocardiograhy) is the imaging modality of choice to elucidate the anatomy and functional significance of rheumatic MS. Chest radiographic findings suggestive of mitral stenosis include left atrial enlargement (eg, double shadow in the cardiac silhouette, straightening of left cardiac border due to the large left atrial appendage, and upward displacement of the mainstem bronchi), prominent pulmonary vessels, redistribution of pulmonary vasculature to the upper lobes, mitral valve calcification, and interstitial edema (Kerley A and B lines) in severe cases. (In moderate to severe cases ) ECG can show signs of left atrial enlargement (P wave duration in lead II >0.12 seconds, P wave axis of +45 to -30 marked terminal negative component to the P wave in V1 [1 mm wide and 1 mm deep]) and, commonly, atrial fibrillation. A mean QRS axis in the frontal plane is greater than 80 and an R-to-S ratio of greater than 1 in lead V1 indicates the presence of rightentricular hypertrophy. As the severity of the pulmonary hypertension increases, the mean QRS axis in the frontal plane moves toward the right.-(In moderate to severe cases ) Lab • ASO titer test ( Streptolysin 0 ) - GAS bacterial antigen • Routine baseline tests (CBC , Renal function test ,Electrolyte status , Liver function test) • Throat culture ,Blood culture (To rule out infective endocarditis,bacterimia) • Arthrocentesis (rule out septic arthritis) -(Usually unnecessary) Medical care • If culture positive Cephalosporin and Metronidazole can be used in this patient • Secondary prophylaxis against group A beta-hemolytic stre