Patient B second, 45, came to the hospital complaining of severe head pain, lethargy, shortness of breath. Last 2 hours – expressed with repeated nausea vomiting, colicky abdominal pain. Earlier above mentioned complaints are not disturbed, a history of appendectomy available. With sanitary specifications known that the patient is a farmer on his own farm for 20 years. The last 2 years of work the land with pesticides, which include phosphororganic compounds. The last treatment was made 4 hours ago, had always used personal protective mask, except this time. The general condition of the patient is difficult, retarded. Visible skin and mucous membranes pale, excessively wet. Pulse is 56 for 1 minute, BP – 90/60 mm Hg, respiratory rate – 24 for 1 minute. The temperature is 37,8° C. Auscultation breath weakened, listen damp large-and medium wet wheezing. Cardiac tones – rhythmic, muffled. Stomach is painted in all area, the surface of the liver + 1.5 cm from the edge of the right costal arch. Neurological status: attracts speech disorders, involuntary twitching of facial muscles and upper extremities, horizontal nystagmus found increased tendon reflexes. Miosis. Complete blood count: hemoglobin – 120 g/l, er. – 4.0 х 1012/l, white blood cells – 9.7 х 109/l, erythrocyte sedimentation rate – 18 mm/h. In urine analysis attracts: protein – 0.19 g/l, erythrocyte – 1-3 in sight. Solve the problems: 1. Formulate full (sindromal) diagnosis. 2. Make a complete scheme of examination. 3. Write the diseases for differential diagnosis and write the fundamental criteria for the identification of the disease. 4. Assign the corresponding severity of disease treatment. 5. Solve the question regarding ability of work and disability of the patient.
