Sample task and standard answer in the discipline of infectious diseases for the state exam

Task

Patient H. was taken by the ambulance to the infectious department in serious condition. He got ill 5 days ago, when intense pain in the calf muscles appeared, body temperature increased to 40° C, a rash on the body and extremities rose-papular with a hemorrhagic component, scleral ictericity, and urine darkened.

Objectively: hyperemia and puffiness of the face, hemorrhages in the sclera, icteric sclera, hemorrhagic rash on the skin, hemorrhages, nosebleeds. The liver is enlarged, sensitive, spleen +2 cm, diuresis 500 ml. With epidemiological history: the patient works as a storekeeper.

1. Formulate a clinical diagnosis.

2. Make a plan for the examination of the patient to confirm the diagnosis, describe the expected results.

3. Make a treatment plan, indicate the dose and frequency of administration, duration of treatment.

4. What diseases need a differential diagnosis?

5. Possible complications of the disease.

The standard of the answer

1. Leptospirosis, icteric form, renal, hemorrhagic syndromes, severe course.

2. Clinical tests of blood, urine, biochemical blood analysis (renal, liver tests).

Bacteriological examination of blood, urine. Serological examination: microagglutination and lysis reaction (1:100 titre), indirect hemagglutination test, necessarily with a sick person’s bivalent serums, immune- enzyme analysis. PСR.

3.Antileptospirosis immunoglobulin 10 0 IM 3 days. Ceftriaxone 2.0 - 2 times a day iv for 7-10 days. Detoxification therapy (5% glucose solution 400.0 iv / 5), diuretics, Heparin, Contrical. Symptomatic treatment.

4. Acute viral hepatitis, hemorrhagic fever with renal syndrome, yellow fever, pseudotuberculosis.

5. Acute renal failure, acute liver failure, toxic shock, bleeding.