Clinical cases

Clinical case 1
A 9-year-old girl was admitted to the department complaining of abdominal pain, frequent and
painful urination, and fever up to 38 ° C. Ill for the 3rd day. I got sick for the first time. The
disease was preceded by hypothermia.
A child from the 1st pregnancy, which occurred with nephropathy in the 2nd half, delivered on
time. Body weight at birth is 3500 g., the period of newborn without peculiarities. She suffered
from acute respiratory viral infections, chickenpox, and intestinal infection. The genetic history
is not burdened.
Upon admission to the hospital, the condition is of moderate severity. The skin was pale, there
was no swelling, and the body temperature was 38.5 °C. Heart tones are rhythmic, clear,
tachycardia up to 100 beats/min. Blood pressure is 100/60 mmHg. Vesicular respiration. The
abdomen is soft, painful above the pubis and in the lateral sections. The symptom of pounding is
positive on both sides, more on the left. Palpation of the left kidney is painful. Frequent urination
is noted.
General blood test: Hb - 140 g/L, Er - 4.5xl012/L, Le – 10.5x l09/L, formula: rod-shaped
leukocytes - 10%, segmented WBC - 63%, lymphocytes - 25%, eo – 2%, mono - 8%, ESR - 28
mm/hour.
Urine analysis: 150 ml, cloudy, yellow, protein – 33 mg/l, leukocytes – 30-60 cells in the field of
view, erythrocytes – 5-6 cells in the field of view.
Urine culture: E. coli was sown (1 million bacteria in 1 ml of urine), sensitive to amoxiclav,
cephalosporins of the 2nd and 3rd generation, furagin.
Ultrasound of the kidneys: without pathology.
Task:
1. Make a diagnosis and justify it.
2. Make a differential diagnosis.
3. Prescribe a treatment and tell us how to evaluate its effectiveness.
4. What will be your tactics if the process becomes recurrent

Clinical case 2
When visiting the office of a general practitioner at the age of 6 months, the girl's body weight is
10 kg, body length is 69 cm. The girl is pale, sedentary, muscle tone is reduced, skin-fat folds on
the abdomen and limbs reach 4-5 cm. The breathing in the lungs is puerile, there are no wheezes.
The number of breaths is 36 per minute. The heart tones are clear, loud, and the pulse is 136 per
minute. The abdomen is soft, painless, the liver and spleen are not enlarged. Stools and diuresis
are normal. Mental development corresponds to age. Sleep and appetite are good.
Anamnesis data: from the 1st uncomplicated pregnancy, urgent delivery. Body weight at birth is
3300 g, height is 50 cm. The girl was on natural feeding, and from the age of one month she
began to receive apple and carrot juices with sugar. From 4 months, semolina porridge was
introduced, from 5 months I received semolina porridge 3 times a day.

Task:
1. Make a diagnosis.
2. Specify the main symptoms of the disease.
3. What mistakes were made when feeding a child?
4. Prescribe treatment.

Clinical case 3
The boy is 15 years old.
The boy was ill for about 2 months, when he complained of thirst, frequent urination, increased
appetite, weight loss. A week before admission to the clinic, the complaints intensified, lethargy
and abdominal pain joined.
Anamnesis data: a child from the 2nd, normal pregnancy, from 2 normal and urgent deliveries.
Body weight 3200 g, length 50 cm. The newborn period and early development proceeded
normally. Previous diseases: acute respiratory viral infections-2-3 times a year, measles at 7
years old, rubella at 10 years old, sore throat at 8 and 9 years old. I received vaccinations by age.
Heredity is not burdened.
The data of an objective examination upon admission: the condition of moderate severity. The
dryness of the skin is pronounced, the turgor of the tissues is reduced. Breathing is vesicular. The
number of breaths is 22 per minute. Heart tones are loud, systolic noise. The heart rate is 86 per
minute. The edge of the liver protrudes 1.5 cm from under the edge of the costal arch.
Sexual development: Ao Po. Body weight 39 kg, height-165 cm.
Survey data:
• blood sugar -17 mmol/l,
• in urine (350 ml)-4% sugar, acetone ++

Task:
1. Make a diagnosis. Explain the phase of the disease.
2. Continue the examination.
3. Prescribe treatment.
4. Evaluate your physical development.

Clinical case 4
A girl of 7 years old
In the morning, the temperature rose to 40 ° C, repeated vomiting, unrelated to eating. The girl
was taken by ambulance to an infectious diseases hospital.
Anamnesis data: a child from the 1st, normal pregnancy, from 1 normal and urgent delivery.
Body weight 3350 g, length 52 cm. The newborn period and early development proceeded
normally. Previous diseases: acute respiratory viral infections-2-3 times a year. She received
vaccinations according to her age.
The data of an objective examination upon admission. The condition at admission is severe.
consciousness is preserved. There are no meningeal symptoms. On the cheeks, on the side
surfaces of the chest, abdomen, on the flexor surfaces, in the elbow, inguinal and armpits -
abundant small-point rash of red color on a bright pink background and elements of small-point
rash. There is bright hyperemia in the throat, the tonsils are loose, purulent yellow overlays in the
lacunae, they can be easily removed with a spatula. The tongue is densely overlaid with a whitish
coating. Tonsillar lymph nodes are enlarged to 2 cm, dense, painless on palpation. In the lungs,
vesicular respiration, BH 24 per minute. The heart tones are rhythmic, muffled, and systolic
noise is heard at the top. Heart rate 120 v min. The belly is soft, painless. Healthy bladder and
bowel habits.

Task:

1. Make and justify the diagnosis.

2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 5
A 3-year-old girl
She was admitted to the children's department on the 3rd day of the disease. She became acutely
ill: the temperature rose to 38.5 °, a cough appeared, nasal discharge. She was treated with home
remedies, the day before hospitalization, lethargy grew, breathing became difficult.
Anamnesis data: Born on time, screamed immediately, discharged for 3 days. From the first days
of her life, she was on artificial feeding. In the first year, pronounced manifestations of atopic
dermatitis were noted. She suffered from obstructive bronchitis three times. The girl's mother
has bronchial asthma, allergic rhinitis, and her father has neurodermatitis.
The data of an objective examination upon admission: the condition of moderate severity. There
is a frequent spastic cough. The skin is pale, cyanosis around the mouth. The pharynx is slightly
hyperemic, the tonsils are swollen. Nasal breathing is difficult. Breathing is hard, exhalation is
elongated, whistling dry wheezes on exhalation and separate small-bubbled wet ones in the
anterior sections on the right, BH 42 per minute. Heart tones are clear, a rough short systolic
murmur at the apex, heart rate 130 per minute. The abdomen is soft, the liver is palpated at the
edge of the costal arch. Healthy bladder and bowel habits
Survey data:
Chest X-ray: expansion of intercostal spaces, diaphragm domes are lowered. The roots are
reinforced, the right one is poorly structured, the pulmonary pattern is enriched, on the right at
the upper pole of the root there is a group of focal infiltrative shadows.

Task:

1. Make and justify the diagnosis.

2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 6
The boy is 7 months old.
He was admitted to the children's hospital on the 7th day of the disease with complaints of fever
up to 39 °C, vomiting (3-4 times a day), loose stools. The disease began gradually -
regurgitation, then vomiting once, subsequently up to 2-4 times a day. The stool is initially
liquefied, then watery, abundant, yellow-green in color (water and feces separately) up to 6-8
times a day with a small amount of mucus.
Anamnesis data: a child from the 1st, normal pregnancy, from 1 normal and urgent delivery.
Body weight 3200 g, length 50 cm. The newborn period and early development proceeded
normally. He does not receive vaccinations.
Upon admission: temperature 38.9 °, sluggish, body weight 7000g. I have lost up to 6% in
weight in the last 3 days. Thirst, sharpened facial features, sunken large fontanel, dry tongue and
skin. Heart tones are muffled, rapid, heart rate 150 in 1 min. In the lungs, breathing is hard,
scattered small and moist wheezes on both sides, BH 68 in 1 minute. The abdomen is swollen,
the liver protrudes 2 cm. The stool is plentiful, watery.

Task:

1. Make and justify the diagnosis.

2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.
Clinical case 7
At the reception, a child of 7 months old, who is only breastfed. Mom complains that the child
stopped leaning on his feet, crawling, and appeared restless.

On examination: a square-shaped head, a sloping nape, a large fontanel 5x6 cm. The chest is
compressed from the sides, the lower aperture is expanded, the rosary is palpated. There is a
sinking of the sternum. The stomach is flattened. For the rest of the organs and the system during
examination without pathology.

Survey data:
Phosphorus in the blood is 0.90 mmol/l, calcium is 1.30 mmol/l.
On radiographs, the growth zones are expanded, blurred, and excessive growth of osteoid tissue.

Task:
1. Make a diagnosis.
2. Specify the main symptoms of the disease.
3. What mistakes were made when feeding a child?
4. Prescribe treatment.

Clinical case 8
A 7.5-year-old boy was admitted to the admission department. About 40 minutes. He ate smoked
fish back, and soon there was a tingling sensation in the lip area, followed by swelling, itching,
and hyperemia.

Anamnesis data: a child from the 2nd, normal pregnancy, from the 1st normal and urgent
delivery. Body weight 3200 g, length 52 cm. The newborn period and early development
proceeded normally. Vaccinations by age.

At the time of examination: the condition is of moderate severity, there is significant limited
swelling of the upper lip. There are isolated urticular rashes on the skin of the trunk,
accompanied by itching. For other organs and systems without pathology.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 9
At the reception in the emergency room, the child is 9 months old. The day before, he had a
runny nose and a dry cough. The temperature is 38 ° C. The child has manifestations of atopic
dermatitis. At night, he suddenly woke up and became restless, there was a barking cough,
suffocation, difficulty breathing. Upon examination, the child's condition is of moderate severity,
the child is restless. The voice is hoarse. There is peeling on the cheeks, hyperemia of the skin.
There is a serous discharge from the nose. There is hyperemia in the throat. There are dry
wheezes in the lungs against the background of hard breathing. Auxiliary muscles are involved
in breathing.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 10

A 10-year-old boy was admitted to the hospital with complaints of headache, nausea, lethargy,
decreased diuresis, and discoloration of urine.
Anamnesis of life: A child from the first pregnancy, which proceeded without pathology, urgent
physiological childbirth. Body weight at birth – 3200 g, length - 52 cm. Early development
without features.
Anamnesis of the disease: He suffered from sore throat three weeks ago, was discharged to
school a week ago. During the last two days, headache, nausea, loss of appetite appeared, and he
began to urinate a little. Urine is dark brown, cloudy.
Upon examination, the child is pale, sluggish, complains of a headache. There is puffiness of the
face, dense swelling on the shins. BP – 145/90 mmHg. Auscultation in the lungs – vesicular
breathing, no wheezing. The heart tones are sonorous, systolic noise at the apex, heart rate 78 in
1 min. The abdomen is soft, painless, the liver protrudes 2.5 cm from under the edge of the right
rib arch, the edge of a soft elastic consistency. Urination is not difficult, urine is red-brown,
cloudy. He rarely urinates.
General urinalysis: specific gravity – 1024, protein – 1.5 g/ l, Le - 4-6 cells in the field of view;
Er – altered – cover all fields of vision.
Urine culture: the result is negative.
Clinical blood test: Hb – 105 g/l; er. -3.9×1012/l; thrombocytes. –330x109/l; Le – 8.2×109/l:
formula: rod-shaped leukocytes - 3%, segmented WBC - 71%, lymphocytes - 22%, eo – 1%,
mono - 3%, ESR - 25 mm/hour.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 11
A full-term girl from the 3rd pregnancy of 1 urgent delivery. Obstetric history: 1 pregnancy –
registered from 8 weeks, was observed regularly. Exacerbation of chronic pyelonephritis. At
birth, the condition is satisfactory, the Apgar is 7/8, the scream is immediately loud. Weight –
2780 height 49 cm, attached to the chest in the delivery room, actively sucked. From the first
days of life, the appearance of spilled cyanosis is noted during exercise.
Age 4 days: sucks very sluggishly, the weight curve is decreasing, the maximum decrease in
body weight is 10%. On examination, the reaction is irritated, the cry is short, with anxiety, a
fine–pitched tremor of the limbs and chin is expressed, persistent diffuse cyanosis, noises are
heard over the entire surface of the heart, heart tones are muffled heart rate – 160 beats per
minute, breathing is carried out evenly, there are no wheezes, BH – 64 per minute, the abdomen
is swollen, peristalsis is heard, deep palpation, liver +2.5 cm, spleen is not enlarged. The
umbilical wound is of medium size.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 12
A 12-year-old girl during the 1st year complains of hunger pains in the epigastrium, which
appear in the morning on an empty stomach or at night and are stopped by eating.
Obstetric and early medical history without pathology. She studies at school 6 days a week. The
girl's mother has duodenal ulcer, and her father has gastritis.
Examination: height – 148 cm, weight -34 kg; skin pale pink, clean. Abdomen - soreness in the
epigastrium and pyloroduodenal region. The liver is not enlarged. For other organs and systems
without pathology. Healthy bladder and bowel habits.

General blood test: Hb 128 g/l, Er 4.5x12/ l, leukocytes – 7.3x10x9/l, rod-shaped leukocytes –
3%, segmented WBC – 51%, lymph – 36%, eos – 3%, mono – 7%, ESR – 5 mm/h.
Urine analysis: light yellow color, transparent, specific gravity – 1015, acidic reaction, protein –
no, sugar – no, mucus – a little, leukocytes – 2-3 cells in the field of view.
Biochemical blood analysis: protein – 75 g / l, ALT – 32 u / l, AST – 38 u/ l, amylase – 100 u / l
(norm 10 – 120), total bilirubin – 18 mmol / l.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 13
A 6-year-old boy was examined by a district pediatrician due to a rise in temperature to 39C,
swelling and severe soreness of the right knee joint. Due to suspected osteomyelitis of the right
knee, he was sent to the surgical department of the children's hospital. Osteomyelitis has been
ruled out in the emergency department. The boy was hospitalized in the therapeutic department.
Anamnesis data: from the 1st pregnancy, which proceeded without peculiarities. The mother
suffers from chronic tonsillitis, often suffers from sore throats, and does not carry out systematic
treatment. Delivery on time, birth weight 3200 g, length 51 cm, screamed immediately. He was
on natural feeding for up to 3 months, during which time he gained 2.5 kg. Then he was
transferred to artificial feeding. Vaccinations by age. At 1 year and 2 months, he suffered from
acute respiratory viral infections with obstructive bronchitis. Further vaccinations were not
carried out at the request of the mother. At the age of 3 he suffered from scarlet fever, 2-3 times
a year he suffers from acute respiratory viral infections with bronchial obstruction. 3 weeks
before the present illness, he and his mother had a sore throat. Then he became sluggish, there
was pallor of the skin, blue under the eyes. He began to sweat profusely in his sleep.
The data of an objective examination upon admission: the condition is of moderate severity,
sluggish, pale. There is a pale pink ring-shaped rash up to 5mm in diameter on the flexor
surfaces of the forearms and on the trunk. The throat is clean, the tonsils are hypertrophied,
clean. The teeth are carious. In the lungs, respiration is vesicular, the number of breaths is 32 per
minute. The heart area is not visually altered. The heart tones are loud. The heart rate is 122 per
minute (120 per minute in sleep). With percussion: the right border of the heart is along the right
edge of the sternum, the left one is 1.5 cm outward from the mid-clavicular line at the level of
the 5th rib, the upper one is the 2nd intercostal space.
Systolic noise occupies the entire systole, is associated with the I tone, and is carried beyond the
heart. The abdomen is soft, the liver is + 1 cm along the midclavicular line, the spleen is + 0.5
cm. There is no dysuria, the stool is normal.
Joint examination: the right knee joint is enlarged, hot to the touch, the skin is hyperemic. The
scope of movement is severely limited. The elbow joint on the left is limited in movement,
painful on palpation.
Survey data:
General blood test: Hb-102 g/l, Er-3.5 x 1012/l, Le-18.2 x 109 /L, rod-shaped leukocytes -8%,
segmented WBC -32%, eos-5%, mono-5%, lymph.-50%, ESR-52 mm/hour.
Blood biochemistry: protein - 72 g/l, albumins-54%, alpha-1globulins- 4%, alpha-2 globulins -
12%, betta-10%, gamma -20%, urea-3.1 mmol/l, CRP -++++, seromucoid - 0.4 units.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 14
Pregnancy 5, childbirth 1 at a period of 27 weeks + 3 days. registered for pregnancy from 8
weeks. previous pregnancies ended: 2 early medical abortions, 1 spontaneous miscarriage, 1
frozen pregnancy at 15 weeks. childbirth – I period – 5 hours 15 minutes, II period – 5 minutes,
anhydrous interval – 15 hours, light waters. Prevention of RDS is incomplete – 1 injection of
dexamethasone.
Birth weight 980 g, height 38 cm, cry after tactile stimulation, short, quiet. Sat – 60% at the end
of the first minute, 70% - at the end of 3 minutes, 80% - at the end of 5 minutes, a ventilator
mask with Fi O2 – 0.4 is performed, the use of an oxygen-air mixture - by 10 minutes of life Sat
O2-94%, heart rate > 100, auscultation – breathing is uneven, crepitating wheezes are heard in
43 basal sections, breathing is irregular, there is a slight retraction of the intercostals, cyanosis is
spilled without oxygen support, a decision was made – tracheal intubation at 20 minutes,
surfactant administration at a dose of 200 mg / kg. On the 4th day, he was transferred to CPAP,
hemodynamics is stable, blood gases are compensated.
Age – 6 days, currently the parameters of respiratory support are Pip - 16 cmH2O; FiO2 ≤ 0.3
From the second day of life receives enteral nutrition through a probe mixture for premature
Alfare in volume: 0.5 ml – starting volume, currently 2 ml – 8 times a day. The residual volume
of the stomach is 1 ml, bloating has appeared, stool is scanty, with mucus, yellow

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 15
The girl is 12 days old.
Anamnesis data: a child from the 1st, normal pregnancy, from an urgent delivery. Body weight
at birth 3600, length 52 cm. She screamed immediately, was put to her chest after 12 hours, and
sucked actively. The parents are young and healthy. Heredity is not burdened.
At birth, attention was drawn to the irregular structure of the external genitalia: the labia majora
resembled a scrotum, the clitoris was hypertrophied. After discharge from the 8th day of life, the
child developed vomiting, which has intensified in recent days, the girl began to refuse feeding,
noticeably lost weight.
Objective examination data: the condition is severe, sluggish, vomiting continues, tissue turgor is
reduced, The skin is dry, pigmentation in the nipple area. The large fontanel is sunken. Breathing
is harsh. The heart tones are moderately muted. The abdomen is soft, there is a slight soreness in
the epigastrium. The stool is diluted 1 time. Urination is rare.
Survey data:
Biochemical blood test: total protein 65 g/l, urea 6.4 mmol/L, cholesterol 4.2 mmol/L, total
bilirubin 4 mmol/L, potassium 6.8 mmol/L, sodium 129.0 mmol/L, Ca 2.4 mmol/L, ALT -20
Units/l.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 16
The girl is 8 years old.
Anamnesis data: a child from the 1st, normal pregnancy. The delivery is urgent. She grew and
developed normally. ARVI was ill 3-4 times a year.
A month before admission, she began to complain of abdominal pain, and her appetite worsened.
Short-term temperature increases of up to 38-38.5 degrees were periodically observed without
signs of catarrh of the upper respiratory tract. She didn't go to the doctor. In the last days before
hospitalization, pain appeared in the right knee joint, and the child was hospitalized.
Objective examination data upon admission: the skin is pale with a grayish tinge. The mucous
membranes are pale. Isolated ecchymoses and an abundant petechial rash on the shins and chest.
Posterior cervical, submandibular, tonsillar, axillary and inguinal lymph nodes up to 1x2 cm are
palpated, multiple, mobile. In the lungs, breathing is vesicular, there is no wheezing. The number
of breaths is 25 per minute. Heart tones are muted, systolic murmur is at the top. Tachycardia.
Blood pressure is 96/50 mmHg. The abdomen is soft, moderate soreness on palpation in the
navel area. The liver protrudes from under the edge of the costal arch by 3 cm, the spleen by 2
cm. Urination is free.
The data of the examination:
Blood test: hemoglobin -89 g/l, er.-2.5 x1012/l, platelets-15x109/l, le- 42.0 x109/l, blasts-98%,
lymph- 2%, ESR-29 mm/hour.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 17
The girl is 12 years old.
Anamnesis data: from the 2nd pregnancy, urgent delivery. The newborn period proceeded
normally. From the age of 4, manifestations of atopic dermatitis were noted, which was
associated with artificial feeding. After 1 year, the child periodically had a rash and Quincke's
edema after taking eggs, chocolate, oranges. She often suffers from ARVI.
15 days before hospitalization, she fell ill with follicular sore throat.
She received treatment with antibiotics. On the 14th day of the illness, the child had pain in ankle
joint and rash on the legs. Objective examination data upon admission: on the shins, thighs,
buttocks, symmetrical, more on the extensor surfaces and around the joints, there is an abundant
exudative hemorrhagic rash. The ankle joints are swollen. In the lungs, breathing is vesicular,
there is no wheezing. The number of breaths is 20 per minute. The tones of the heart are
sonorous. The heart rate is 80 per minute. Blood pressure is 110/60 mmHg. The abdomen is soft,
painful when palpated around the navel, at the point of the gallbladder. Appetite is reduced. The
tongue is moist, thickly overlaid with a white coating. The stool was after the enema, decorated,
with a small amount of mucus.
The formula of sexual development: Ma2, P2, A2, Me0.
The data of the examination:
Blood test: Hb-126 g/l, er.-4.0x1012/l, color.index..-0.95, trombocytes.-322x109/l, le.-7.4x109/l,
rod-shaped.-6%,segmented WBC.-64%.eos.-8%, Lymph-18%.mono4%, ESR-24 mm/hour.
Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 18
A 4-year-old girl was admitted to the department with complaints of swelling.
Anamnesis data: a child from the first normal pregnancy, delivery on time. Birth weight 3200
gr., length 50cm. Physical psychomotor development without peculiarities. Previous illnesses:
smallpox, often ARVI. Allergic history: atopic dermatitis up to 3 years old.
After suffering from acute respiratory viral infection, the girl developed swelling on her face,
rare urination. The local doctor was diagnosed with Quincke's edema, and suprastin was
prescribed. Despite the therapy, the swelling increased, and the girl was hospitalized.
Objective examination data: upon admission to the hospital, the condition is serious. The skin is
pale. Pronounced swelling of the face, lower leg, feet, anterior abdominal wall, ascites. In the
lungs, breathing is vesicular, there is no wheezing. The number of breaths is 34 per minute. The
heart tones are muted. Pulse is 110 beats per minute, blood pressure is 90/60 mmHg. The
abdomen is soft and painless. The liver is +2.0 cm from under the edge of the costal arch. He
rarely urinates. She excreted 180 ml of urine per day.
The data of the examination:
In the urine analysis, protein 8.0 g / l, leukocytes 2-3 in the field of vision, red blood cells are
absent.
General blood test: Hb – 127 g/l, ER – 3,8x1012/L, le -10,2x109/L, rod-shaped – 1%, segmented
WBC – 36%, Lymph – 54%, eos – 2%, mono – 8%, ESR -50 mm/hour.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 19
A full-term boy from the 2nd pregnancy of the 1st emergency delivery.
Obstetric history: 1 pregnancy – medical abortion, 2nd – real, registered from 8 weeks, was
observed regularly. From 34 weeks – hypertension of pregnant women. Mild anemia is a medical
correction.
At birth, the condition is satisfactory, the Apgar is 8/9, the scream is immediately loud. Weight –
3280 height 54 cm, attached to the chest in the delivery room, actively sucked.
Age 36 hours: weight 3080 – regurgitated with blood after feeding. On examination, the reaction
is irritated, with anxiety, a fine–grained tremor of the limbs and chin is expressed. The skin is
pale pink, the symptom of a "white spot" is 2-3 seconds, the heart tones are muted, heart rate is
146 beats per minute, breathing is carried out evenly, there are no wheezes, RR- 44 per minute,
the abdomen is moderately swollen, peristalsis is sluggish, deep palpation is available, liver,
spleen are not enlarged. The stool is transitional, it urinates enough.

Laboratory data:
Blood test – Hb-190g/l. Ht – 0.55, RBC – 3.5*1012/l, WBC – 22*109/l, rod-shaped – 12%,
segmented white blood cells -40%, lymph – 40%, mono – 8%; throm. – 250*109/l
Blood glucose -2.7mmol/l, total bilirubin – 200 mmol/l

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.

Clinical case 20
A full-term boy from the 2nd pregnancy of the 1st emergency delivery.
Obstetric history: 1 pregnancy – medical abortion, 2 – real pregnancy, was not registered, is not
interested in pregnancy. The mother's blood type A(II) Rh(-) has been determined. At birth, the
condition is severe, Apgar 4/6 b, primary resuscitation is performed in the delivery room,
tracheal intubation was performed due to persistent respiratory insufficiency, the child was
transferred to a ventilator. Weight – 3780 height 48 cm, marked jaundice-colored amniotic fluid,
umbilical cord membranes, original lubrication; the presence of widespread edema, including
anasarca, pronounced pallor of the skin and visible mucous membranes; very mild jaundice;
hepatomegaly (liver +4.5 cm) and splenomegaly (spleen +2 cm). Heart tones are deaf, rhythmic,
heart rate 108-110 per minute, breathing on a ventilator.

Task:
1. Make and justify the diagnosis.
2. Schedule an examination.
3. Prescribe treatment.
4. Make a differential diagnosis.