Ахмед кхалед Али мохамед

Лд-18-42

CASE 1

NAME: BURMISTROV IVAN SERGEEVICH

AGE: 19 years
SEX: Male
DATE OF ADMISSION: 30.06.2023
CHEIF COMPLAINTS: Headache, heart palpation (Was referred to the endocrinologist by
military commissar after survey)
SYMPTOMS:
- Headache
- Heart palpitations
- Over-weight
- Male pattern hairloss
- Hypercortisolism (32.09 mcg/dl)
- Hyperadrenalism (35.8 pg/ml)
- High thyroglobulin (31.7 ng/ml)
DIFFERENTIAL DIAGNOSIS:
Cushing’s syndrome
Phaeochromocytoma
Conn’s syndrome
Prolactinoma
LABORATORY EXAMINATIONS:
- CBC
- Coagulogram
- Urinanalysis
- Blood culture
- Hormonal monitoring: Prolactin:1260 mME/ml, FSH: 3.9 mME/ml, LH:3 mME/ml
INSTRUMENTAL EXAMINATIONS:
- MRI
- Thyroid gland ultrasound: Minor diffuse changes in gland
- Abdominal ultrasound: Signs of infection in gallbladder
- ECG
- Head x-ray
PRELIMINARY DIAGNOSIS: Hyperprolactemia
TREATMENT and RECOMENDATION:
- Restriction of heavy physical activity
-Blood pressure monitoring
- Weight loss
1) R.p: Tab. Indapamidi 1.5
mg S: Take 1 tablet in the
morning
2) R.p: Tab. Mg 2+ 100 mg + Pyridoxine hydrochloride 10
mg S: Take 2 times a day for 1 month (twice a year)
 CASE 2
NAME: MYASNIKOV MIKHAIL VLADIMIROVICH
AGE: 35 years old
SEX: Male
DATE OF ADMISSION: 30.06.2023
CHEIF COMPLAINTS: Lower abdominal pain, intense pain before the act of defecation,
flatulence, belching, mushy stool (upto 3 times a day), nocturnal diarrhea, blood in stool, increase
in body temperature (upto 38.5°C) , sudden weight loss (10 kgs in 5 weeks).
SYMPTOMS:
- Fatigue ,
- Dehydrations
- Spastic , stabbing pain in lower abdomen (This pain Intensifies before defecation)
- Flatulence
- Temperature
LEADING SYNDROMES:
Pain syndrome
Dyspeptic syndrome (intestinal)
Malabsorption syndrome
DIFFERENTIAL DIAGNOSIS:
Food intolerance (Celiac disease, lactose intolerance)
Irritable bowel syndrome
Ulcerative colitis
Infectious colitis
LABORATORY EXAMINATIONS:
- CBC
- Biochemical blood analysis
- Stool culture: Occult blood +
- Serology
- Blood culture
- AntiTransglutaminase antibodies
- H2breathe test
- Peripheral antineutrophil cytoplasmic antibodies
INSTRUMENTAL EXAMINATIONS:
- Esophagogastroduodenoscopy - Moderately Hyperemic at folds in the Antrum,
complete erosion was seen (4mm) - 2 Samples were taken for biopsy
- Abdominal ultrasound: Moderate diffuse changes in parenchyma liver
and pancreas
- CT - Without contrast: single cyst (2mm), Unexpressed
Hepatomegaly With contrast - Hepatomegaly
- Colonoscopy- Terminal ileitis , baugint
- Biopsy- Intestinal Mucosa with Focal crypts Hyperplasia , Edema , Fibrosis ,
Moderate Lymphocytic Infiltrates with admixture of small amount eosinophils
and
 single neutrophils lumen
- Proctoscopy
DIFFERENTIAL DIAGNOSIS:
Food intolerance (Celiac disease, lactose intolerance)
Irritable bowel syndrome
Ulcerative colitis
Infectious colitis
LABORATORY EXAMINATIONS:
- CBC
- Biochemical blood analysis
- Stool culture: Occult blood +
- Serology
- Blood culture
- AntiTransglutaminase antibodies
- H2breathe test
- Peripheral antineutrophil cytoplasmic antibodies
INSTRUMENTAL EXAMINATIONS:
- Esophagogastroduodenoscopy - Moderately Hyperemic at folds in the Antrum,
complete erosion was seen (4mm) - 2 Samples were taken for biopsy
- Abdominal ultrasound: Moderate diffuse changes in parenchyma liver
and pancreas
- CT - Without contrast: single cyst (2mm), Unexpressed
Hepatomegaly With contrast - Hepatomegaly
- Colonoscopy- Terminal ileitis , baugint
- Biopsy- Intestinal Mucosa with Focal crypts Hyperplasia , Edema , Fibrosis ,
Moderate Lymphocytic Infiltrates with admixture of small amount eosinophils
and single neutrophils lumen
- Proctoscopy
PRELIMINARY DIAGNOSIS: Crohn’s Disease
TREATMENT:
1) Rp.:Tab.Budesonidi 9mg
S. Take one tablet once day orally for 8 weeks
2) Rp.: Tab.Mesalamini 1g
S. Take 4 times daily for 8 weeks
3) Rp.:Tab.Metronidazoli 250mg
S.Take 3 Times a day for
10days
4) Rp.:Tab. Mebeverini 200 mg
S. Take orally 3 times a day
5)Rp.:Capsules omeprazoli 20mg
S. Take 2 tablets once a day before meal
 CASE 3
NAME: DROZDOV VLADIMIR KONSTANTINOVICH
AGE: 70 years old
SEX: Male
DATE OF ADMISSION: 15.06.2023
CHEIF COMPLAINTS: Dyspnea with minimal physical exertion, upper limb swelling, swelling of
scrotum, heart palpitations.
SYMPTOMS:
- Anaemia
- Peripheral edema (+++)
- Scrotal edema
- Anasarca?
- Peripheral hyperaemia
- Distended abdomen (pancreas)
- Tachycardia
- Hypertension (stage 3)
- Harsh breath sounds
- Diminished breath sounds in lower lobes
- Psoraisis
LEADING SYNDROMES:
Cardiovascular syndrome
Heart failure syndrome
DIFFERENTIAL DIAGNOSIS:
Myocarditis
Ischemia
Aortic valve stenosis
Mitral valve disease
Dilated cardiomyopathy
LABORATORY EXAMINATIONS:
- CBC
- Biochemical blood analysis
- eGFR
- Cholesterol level
- Thyroid test
- Liver function test
INSTRUMENTAL EXAMINATIONS:
- ECG, Holter ECG: Atrial fibrillation
- Echocardiography: Pronounced strial dilatation, Dilation of the root and
ascending aorta,
- Abdominal ultrasound: Hepatomegaly, Diffuse changes in liver parenchyma
and pancreas, ascites
- Chest x-ray
PRELIMINARY DIAGNOSIS: Arterial Hypertension, Grade 1, Stage 3, moderate to high risk
, Atrial Fibrillation hemodynamically stable, first diagnosed, Heart failure stage
1,II FC
TREATMENT:
1) R.p: Tab. Rivaroxabani 10 mg
S. Take orally once daily
2) R.p: Tab. Bisoprololi 1.25-5mg
S. Take orally one tablet daily
3) R.p: Tab. Spironolactoni 25-100mg
S. Take orally one tablet daily
4) R.p: Tab. Losartini 25-50 mg
S. Take orally one tablet daily
5) R.p: Tab. Digoxini 0.5 mg
S. Take orally one tablet daily
6) R.p: Tab. Furosemidi 100 mg
S. Take orally one tablet twice daily
 CASE 4
NAME: KASATOVA ANNA ALEKSEEVNA
AGE: 65 years old
SEX: Female
DATE OF ADMISSION: 10.07.2023
CHEIF COMPLAINTS: Fatigue, dizziness, bitter taste in mouth, pain in right hypochondriac,
weight loss, melana, burning tongue
SYMPTOMS:
- Anaemia
- Liquid melana
- Decrease in blood pressure
LEADING SYNDROMES:
- Inflammatory syndrome
- Dyspeptic syndrome
- Malabsorption syndrome
DIFFERENTIAL DIAGNOSIS:
- Cardiomyopathy
- GERD
- Liver disease
LABORATORY EXAMINATIONS:
- CBC:RBC 3.6*1012, Hb 106g/L, LSR 30 mm/hr, CRP 21 mg/L
- Urea breath test:
- Serum ferritin level
INSTRUMENTAL EXAMINATIONS:
- Gastroscopy:Duodenal bulb mucosa is oedematous and hyperaemic with
ulcerative defect, cicatricial deformation and stenosis of the bulb, superficial
gastritis
- Abdominal ultrasound:
- Abdominal x-ray contrast
PRELIMINARY DIAGNOSIS: Duodenal bulb ulcer(or GERD?)
COMPLICATIONS:Ulcer rupture, Perforation-peritonitis, Bleeding, Obstruction, Cancer
TREATMENT:
1) Rp: Tab.”Pantaprozole” 40mg
S.Take 2 tablets a day 30 mins before meals for 8 weeks
2) Rp: Tab.”Mebeverin” 135 mg
S.take 3 tablets per day for 5 weeks
3) Rp.Tab.”Ferrous fumarate” 210
mg S.take 2 tablets per day
 RECIPES
I. CARDIOVASCULAR AGENTS

1. Bisoprolol
Rp: Tabl. Bisoprololi 2.5 mg D.t.d. No. 7
S. Take one tablet once a day.

2. Lisinopril
Rp: Tabl. Lisnoprili 10 mg D.t.d No. 20
S. Take one tablet once a day.

3. Valsartan
Rp: Tabl. Valsartani 40 mg D.t.d No. 14
S. Take one tablet twice a day

4. Nifedipine
Rp: Tabl. Nifedipini 40 mg D.t.d No. 14
S. Take one tablet once a day.
Varghese Rosemary LD-18-56

5. Apixaban
Rp: Tabl. Apixabani 2.5 mg D.t.d No. 21
S. Take one tablet twice a day.

6. Clopidogrel
Rp: Tabl. Clopidogreli 75 mg D.t.d No. 20
S. Take one tablet once a day

7. Fluvastatin
Rp: Tabl. Fluvastatini 40 mg
D.t.d No. 20
S. Take one tablet once a day in the evening

8. Amiodarone
Rp: Tabl. Amiodarone 600 mg D.t.d No. 30
S. Take one tablet once a day

II. DIURETICS

1. Furosemide
Rp: Tabl. Furosemidi 40 mg D.t.d No. 10
S. Take one tablet once a day

Or
Rp: Solutionis Furosemidi 10 mg/l - 2 ml D.t.d : No. 5 in ampullis
S. Inject I/V 2 ml once a day
2. Spironolactone
Rp: Tabl. Spironolactoni 50 mg D.t.d No. 15
S. Take two tablets twice a day

3. Indapamide
Rp: Indapamidi 2.5 mg
D.t.d No. 10 in Capsulis
S. Take one capsule once a day in the morning before meals.

4. Hydrochlorothiazide
Rp: Tabl. Hydrochlorothiazidi 25 mg D.t.d No. 10
S. Take one tablet twice a day.

III. GASTROINTESTINAL AGENTS

1. Rabeprazole
Rp: Tabl. Rabeprazoli 20 mg D.t.d No. 20
S. Take one tablet twice a day.

2. Hyoscyamine
Rp: Tabl. Hyoscyamini 0.125 gm
D.t.d No. 25
S. Take one or two tablets under the tongue three times a day.

3. Metoclopramide
Rp: Tabl. Metoclopramidi 10 mg
D.t.d No. 30
S. Take one tablet four times a day 30 minutes before meal and at bedtime

4. Loperamide
Rp. Tabl. Loperamidi 2 mg
D.t.d No. 5
S. Take one tablet once a day by chewing on an empty stomach in the morning.

5. Bisacodyl
Rp: Tabl. Bisacodyli 10 mg
D.t.d No. 7
S. Take one tablet orally once a day.

6. Ursodiol
Rp: Tabl. Ursodioli 250 mg D.t.d No. 30
S. Take one tablet twice a day.

7. Pancreatin
Rp: Tabl. Pancreatini 25 U
D.t.d No. 60
S. Take 2-4 tablets three times a day during meal or right after meal without cracking.
8. Ademetionine
Rp: Tabl. Ademetionini 400 mg
D.t.d No. 30
S. Take one tablet in the morning between meals.

9. Mesalamine
Rp: Tabl. Mesalamini 400 mg
D.t.d No. 60
S. Take one tablet three times a day for 6 weeks

IV. BRONCHODILATORS, MUCOLYTICS, EXPECTORANTS,

ANTITUSSIVES, INHALERS
1. Salbutamol
Rp: Sol. “Salbutamol” 1mg/ml- 2.5ml
D.t.d No. 10 in amp.
S. One ampoule by inhalation with nebuliser three times a day.

2. Salmeterol
Rp. Aer. Salmeterol 25mEq / dosum D.S. Inhale three times a day

3. Formoterol
Rp: Formoteroli 12 mkg
D.t.d No. 30 in Capsulis
S. Inhalation of a single dose, if necessary repeated.

4. Acetylcysteine
Rp: Tabl. Acetylcysteini 600mg D.t.d No. 10
S. Take one tablet once a day.

5. Erdosteine
Rp: Erdosteini 300 mg
D.t.d No. 10 in Capsulis
S. Take one Capsule two times a day regardless of meals

6. Guaifenesin
Rp: Guaifenesini 100mg/5ml D.t.d No.1 in flac
S. Take 5-10mL every four hours.

7. Dextromethorphan
Rp: Caps. Dexamethorphini 15 mg D.t.d. No. 50 in capsulis
S. Take one capsule three times a day.

V. MEDICINES AFFECTING HEMATOPOIESIS

1. Ferrous Sulphate
Rp: Tabl. Ferrous Sulfati 100 mg D.t.d. No. 20
S. Take one tablet two times a day

2. Folic acid
Rp. Acidi folici 1 mg.
D.t.d No. 30
S. Take 1 tablet thrice a day

3. Vitamin B12, Cyanocobalamin

Rp. Sol. Cyanocobalamini 0.5mg/ml-1ml D.t.d No. 10 in ampulis
S. Inject 1 ampoule I/M one time a day.

VI. ANTIBIOTICS
1. Cefepime
Rp: Cefepimi 1000mg
D.t.d No. 20
S. Inject intramuscularly 1000 mg in 3 ml of water 2 times a day

2. Ampicillin
Rp. Tabl. Ampicillini 250 mg
D.t.d No. 30
S. Take one tablet 3 times a day.

3. Meropenem
Rp: Meropenimi 1000mg
D.t.d No. 20
S. Inject intramuscularly 1000 mg in 3 ml of water thrice a day.

4. Kanamycin
Rp: Kanamycini 1000 mg
D.t.d No. 20
S. Inject I/M 1000 mg in 3 ml water twice a day.

5. Tetracycline
Rp: Tabl. Tetracyclini 100 mg
D.t.d No. 30
S. Take one tablet 3 times a day after meals

6. Ciprofloxacin
Rp: Tabl. Ciprofloxacini 500 mg D.t.d. No. 20
S. Take one tablet twice a day.

7. Phthalylsulfathiazole
Rp. Tabl. Pthalylsulfathiazoli 500 mg D.t.d No. 30
S. Take two tablets four times a day.

8. Azithromycin
Rp: Tabl. Azithromycini 250 mg D.t.d No. 6
S. Take one tablet two times a day.

VII. INSULIN AND HYPOGLYCEMIC DRUGS

1. Insulin (short acting)

Rp: Insulin Solubili 100U
D.t.d.No. 10
S. Inject S/C 10 U(3ml) 15- 30 min before meal 3 times a day.

2. Insulin (long acting)

Rp: Insulin Isophani 5 ml(100 U)
D.t.d No. 5
S. Inject S/c 1ml (20 U) two times a day.

3. Exenatid
Rp. Solutionis Exenatidi 250 mkg/ml - 2.4 ml
D.t.d No. 1
S. Inject S/C 5mkg one hour before the meals twice a day

4. Glimperide
Rp. Tabl. Glimperidi 1mg
D.t.d No. 20
S. Take one tablet once a day.

5. Metformin
Rp: “Metformin” 500mg
D.t.d No. 60
S. Take one tablet two times a day during or after meals.

6. Repaglinide
Rp: Tabl. Repaglinidi 1 mg D.t.d.No. 30
S. Take one tablet one time a day

7. Rosiglitazone
Rp: Tabl. Rosiglitazoni 2 mg D.t.d No. 14
S. One tablet two times a day.

8. Dapagliflozin
Rp: Tabl. Dapagliflozini 10 mg
D.t.d No. 30
S. Take one tablet once a day.

9. Acarbose
Rp: Acarbosi 100 mg
D.t.d No. 100
S. Take one tablet 3 times a day.

VIII. NSAIDS
1. Ibuprofen
Rp: Tabl. Ibuprofeni 200mg
D.t.d No. 20
S. Take one tablet three times a day.

2. Celecoxib
Rp: Tabl. Celecoxib 200 mg D.t.d No. 20
S. Take one tablet 2 times a day.

3. Indomethacin
Rp: Tabl. Indomethacini 75mg
D.t.d No. 10
S. Take one tablet once a day after meals

4. Mefenemic acid
Rp: Tabl. Mefenamici acidii 250 mg D.t.d No. 10
S. Take one tablet three times a day.

5. Naproxen
Rp: Tabl. Naproxeni 250
D.t.d No. 20
S. Take one tablet two times a day

IX Thyrostatics

1. Levothyroxine
Rp: Tabl. Levothyroxini 0.1mg
D.t.d No. 60
S. Take one tablet 20- 30 min before meal

2. Liothyronine
Rp: Tabl. Liothyronini 0.1mg
D.t.d. No. 14
S. Take half a tablet in the morning 30 min before breakfast.