Control and measurement tools and specification of the final control in the discipline "Principles of diagnosis and treatment of
neuropsychiatric diseases at the outpatient level", educational program "General Medicine", 7th year, for the 2022-2023
academic year
Patient A. is 32 years old, acutely ill. While sitting in the car, he complained to
people next to him that he had suffered a severe heat stroke in the jaw area.
Suddenly there were severe headaches and pains. After stopping the car and
trying to get out, he started vomiting repeatedly and lost consciousness. An
ambulance was taken to the emergency department of the nearest hospital.
On inspection: white 150 / 90mm.criticism.c. Memory is preserved, there is a
slight shock (13 points on the SHKG), communication is difficult. Complains of
headache, runny nose. The pupils are the same. Horizontal nystagmus, with
limited outward rotation of the eyeball. Gesture of needlewomen in full.
Tendon reflexes are triggered in the same way. No pathological reflexes were
detected. Rigidity of the occipital muscles in the size of 4 fingers. Kernig's
symptom is 90° on both sides, Lower Brudzinski's symptom is positive.Focal
neurological symptoms were not detected.
1. identify clinical syndromes, make a topical diagnosis, and prove them.
2. Make a diagnosis and prove the prognosis.
3. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
4. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
of 5. Assign a treatment algorithm (medication and medication-no wear,
specify at least one drug from each group of drugs and specify their dosage),
justify the appointment.
Patient A. is 32 years old, acutely ill. While driving a car, he suddenly
complained to his wife that he felt a "hot blow" in the back of the head.
Immediately there was an intense headache, nausea. Managed to stop the car,
tried to get out, had repeated vomiting, lost consciousness. The ambulance
crew was taken to the emergency department of the nearest hospital.
On inspection: Blood pressure is 150/90 mmHg. Consciousness is preserved,
slight stun (13 points on the SHKG). contact is difficult. Groans, complains of
headache, nausea. The pupils are identical. Horizontal nystagmus, does not
bring the eyeballs to the sides. Movement of the limbs in full. Tendon reflexes
are evenly animated. No pathological reflexes were detected. Rigidity of the
muscles of the occiput 4 transverse fingers. On both sides, the Kernig symptom
is at an angle of 90°, the lower Brudzinski symptom. No focal neurological
symptoms were detected.
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary diagnosis and justify it.
3. What tests should be performed to verify the diagnosis? Describe what you
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.

A 33-year-old patient became acutely ill this morning. Severe headache and
repeated vomiting, body temperature increases by 40°, rapid heartbeat,
shortness of breath and convulsions. At home, having reached the limit of
chills, a major attack of colds occurred. An ambulance was called and taken to
the hospital. On examination: memory was impaired according to the sopor
type (SSC 10 points), pulse 110 beats per minute, blood pressure 100/60 mm
Hg. g. Hemorrhagic rashes were found in the buttocks, thighs and calves.
In the neurological status: pupils D=S, the Mann-Gurevich symptom has a
positive value. No paralysis of the limbs. Tendon reflexes are equally animated.
Stretching of the muscles in the back of the head 4 cm. the Kernig symptom
has a positive value on both sides. Brudzinsky's lower symptom is positive. The
patient underwent a lumbar puncture.
The cerebrospinal fluid is cloudy, 300 mm of water.gr. flows under pressure.
Cytosis-3620 in 1 microliter of neutrophils, protein – 1.1 g/l, glucose-0.22 g/l.
1. identify clinical syndromes, make a topical diagnosis, and prove them.
2. Make a diagnosis and prove the prognosis.
3. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
4. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
6. Assign a treatment algorithm (non-drug and drug-based, specify at least one
drug from each group of drugs and specify their dosage), justify the
appointment.
A 33-year-old patient, acutely ill, complains of severe headaches, repeated
vomiting, body temperature rising to 40*, palpitations, shortness of breath. At
home, at the peak of the fever, a generalized convulsive attack occurred once,
in connection with which the spouse called the carriage of the joint venture.
On examination: the level of consciousness is sopor (SHKG10 points). Blood
pressure of 100/60 mm Hg In the buttocks, thighs and shins revealed
hemorrhagic rash.
Neurological status: pupils D=S, positive Mann-Gurevich symptom. There are
no paresis of the extremities. Tendon reflexes are evenly animated. Stiffness of
the occipital muscles 4 cm, Kernig's symptom is positive on both sides. Positive
lower Brudzinski symptom on both sides. The patient underwent a lumbar
puncture.
The cerebrospinal fluid is turbid, flows out under the pressure of 300 mm of
water. st. Cytosis – 3620 cells in 1 µl due to neutrophils, protein – 1.1 g/l,
glucose – 0.22 g/l.
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary diagnosis and justify it.
3. What tests should be performed to verify the diagnosis. Describe what you
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.
The patient is 23 years old. At the age of 18, I noticed double vision when

Patient, 23 years old. At the age of 18, duality was observed for 3-5 days when
looking to the right. A year later, gait fluctuations were detected, especially to
the right side, leg weakness, difficulty urinating, and these manifestations
were eliminated after hormone therapy. A month ago, after stress, weakness
and swaying of the legs were again observed.
In the neurological status: slight strabismus on the right, horizontal nystagmus,
expressive speech, Lower spastic paraparesis tendon reflexes are very high,
the pathological Babinsky reflex is positive on both sides, abdominal reflexes
are eliminated, the Romberg position does not stand up, gait is changed,
swings. There is an intentional tremor and lethargy in the right hand.The knee
could not perform the heel test due to paralysis.
MRI also revealed foci of multiple myelination in the white matter of the
frontal and temporal lobes, as well as in the warty body.
1. identify clinical syndromes, make a topical diagnosis, and prove them.
2. Prognosis make and prove a diagnosis using the MacDonald criteria.
3. Evaluate the MRI, whether this method is sufficient for making a
diagnosis,whether additional studies are necessary? What conclusions can be
drawn from these studies?
4. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
of 5. Assign a treatment algorithm (non-drug and drug-based, specify at least
one drug from each group of drugs and specify their dosage), justify the
appointment.
looking to the right for 3-5 days. A year later, there was staggering when
walking, more to the right, weakness in the legs, periodically delayed urination,
which passed after hormone therapy. A month ago, after stress, I again felt
weak in my legs and unsteadiness when walking.
In the neurological status: slight converging strabismus on the right, diplopia
when looking to the right, horizontal nystagmus, chanted speech, lower spastic
paraparesis with high tendon reflexes and pathological Babinsky reflexes on
both sides, no abdominal reflexes, instability in the Romberg position, gait with
legs wide apart. Dysmetria and intentional tremor in the right hand during the
finger test. Knee-heel tests are not performed due to paresis.
On MRI, there are multiple foci of demyelination in the white matter of the
frontal and temporal lobes, as well as in the corpus callosum.
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary diagnosis and justify it based on McDonald's criteria.
3. Evaluate the MRI data. Are they sufficient to verify the diagnosis? If
necessary, assign additional examination methods. Describe what you expect
to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.
Patient S., 18 years old, during an appointment with the dentist began to
complain that he was very annoyed by the noise of the drill machine, and after
a few seconds lost consciousness, after which the whole body stretched out in
a string in the chair, all the limbs straightened - this lasted about a minute,
after which the arms and legs began to contract rhythmically. The attack lasted
about 5 minutes, and at the end of the attack, involuntary urination was noted.
After the attack, the patient was very sluggish, the attack is amnesic.
Neurological status after an attack: there is a revival of tendon reflexes,
Patient S., 18 years old, during an appointment with the dentist began to
complain that the noise of the chalk machine was very annoying, after a few
seconds she lost consciousness, then the whole body stretched, all the arms
and legs healed-this lasted about a minute, after which the arms and legs
began to contract rhythmically. Involuntary urination and amnesia were
observed at the end of the seizure. After an attack, activation of tendon
reflexes in the neurological status is observed.
Along with the patient was her mother, who, according to her mother, said
that similar seizures occurred twice in the last 3 months, often before she
woke up in the morning. They sought help from a neurologist, but they did not
complete a full examination and did not take the prescribed drug -
carbamazepine, because they read on the Internet about the many side effects
and the development of lethargy and drowsiness when taking it. In the family,
similar attacks were observed in the brother and grandmother of the mother.
1. identify clinical syndromes and make a topical diagnosis depending on the
presence of atrial aura, prove according to the ILAE 2017 classification.
2. Make a diagnosis and prove the prognosis.
4. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
5. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
6. assign a treatment algorithm (non-drug and drug-based, specify at least one
drug from each group of drugs and specify their dosage), justify the
appointment.
The patient is 42 years old and complains to the hospital of constant seizures
in his right arm, severe menstrual pain and fainting spells. From the
otherwise without focal neurological symptoms.
A mother was present with the patient, who said that similar attacks were
observed twice in the last 3 months, mainly in the morning hours, before
waking up. They sought help from a neurologist, but did not follow up, and did
not take the prescribed drug - carbamazepine - because they read on the
Internet about a large number of side effects and the development of lethargy
and drowsiness when taking it. In the family, similar seizures were observed in
the maternal uncle and grandmother.
1. Identify clinical syndromes, make a topical diagnosis based on the aura
before the attack, and justify it. Describe the type of attack according to the
ILAE 2017 classification.
2. Make a preliminary diagnosis and justify it.
3. What tests should be performed to verify the diagnosis. Describe what you
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.
A 42-year-old patient was admitted with complaints of persistent spasms in
the right arm, which periodically increase, and the patient loses consciousness.
From the anamnesis: after staying in the taiga, he suffered an acute infection
with fever, developing weakness of the arm muscles about 2 years ago. He
received inpatient treatment and doesn't remember his diagnosis. He was
discharged with improvement, but with continued weakness in his hands.
Complaints of seizures occurred about a month ago.
On inspection: cranial nerve disorders symptoms of peripheral paresis of IX, X,
XI and XII pairs of cranial nerves. Reduced strength in the upper limbs to 3.0
points, marked atrophy in them. Anisoreflexia of knee reflexes D>S,
pathological foot reflexes from 2 sides. During the examination, permanent
myoclonic hyperkinesis in the right arm is noted.
anamnesis: two years ago, during a stay in the taiga, I experienced an acute
infection with a high fever, and later developed weakness in my hands. He
received hospital treatment, his condition improved, and both arms were still
weak. The cholera attack started a month ago.
Examination revealed symptoms of peripheral paresis from the nerves of the
brain IX, X, XI and XII. Atrophied visibly in the hands, reduced strength to 3.0
points. With knee reflexes D>Sisoreflexia, bilateral pathological plantar
reflexes. The examination revealed persistent myoclonic hyperkinesis in the
right arm.
1. identify clinical syndromes, make a topical diagnosis, and prove them.
2. Make a diagnosis and prove the prognosis.
4. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
5. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
6. Assign a treatment algorithm (non-drug and drug-based, specify at least one
drug from each group of drugs and specify their dosage), justify the
appointment.
A 29-year-old man suffered excessive exercise after a long break. Against this
background, there were sharp pains in the lumbar spine, pain in the anterior
surface of the lower leg and paresthesia up to the first toes of the right foot.
The pain increases with movement and physical exertion. For five days, the
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary clinical diagnosis.
3. What tests should be performed to verify the diagnosis. Describe what you
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm for the period of exacerbation and remission
(medication and non-medication, specify at least one drug for each group,
their dosages), justify the appointment
of a 29-year-old man against the background of strength loads in the gym,
which he spent after a long break, there were sharp pains in the lumbar spine,
pain in the lower back. and paresthesia along the front surface of the lower leg
to the first toe on the right. The pain increases with movement and physical
exertion, as well as with prolonged sitting. For five days, I applied Diclofenac
ointment topically on my own. The patient's condition did not change, and he
sought help from a general practitioner.
On examination, there is a smoothness of lumbar lordosis, tension of the back
muscles, a sharp restriction of mobility in the lumbar region, a symptom of
Lasseg 40 degrees on the right, hypesthesia corresponding to the localization
of pain, weakness of the back extension of the first toe on the right, no
changes in reflexes from the lower extremities were detected.
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary diagnosis and justify it.
3. What tests should be performed to verify the diagnosis. Describe what you
local ointment Diclofenac was applied with a warming effect. The patient's
condition did not change, and he sought help from a family therapist. During
the examination, there was no smoothing of lumbar lordosis, strengthening of
the back muscles, sharp immobility in the lumbar region, Lassegia symptom 40
degrees on the right, hypesthesia in the pain area, pathological reflexes from
the lower body.
1. identify clinical syndromes, make a topical diagnosis, and prove them.
2. Make a diagnosis and prove the prognosis.
3. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
4. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
of 5. Assign a treatment algorithm (non-drug and drug-based, specify at least
one drug from each group of drugs and specify their dosage), justify the
appointment.
The patient was taken to the hospital an hour after being hit with a blunt
object on the frontal-ceiling part of the head at the age of 40. He lost
consciousness for a short time and had a single vomiting episode. When he
arrived at the hospital, he complained of a minor headache, was a little
shocked and did not remember how he got hit.The examination revealed no
focal organic pathology of the nervous system. On the second day, there were
sudden pains in the head, repeated vomiting, progressive weakening of the
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.
A 40-year-old man was taken to the clinic an hour after he was hit on the head
in the right frontoparietal region with a blunt object. There was a short-term
loss of consciousness, a single vomiting. Upon admission, he complained of a
mild headache, seemed somewhat dazed and did not remember under what
circumstances he was injured. Focal organic pathology of the nervous system
was not detected during the examination.
On the second day after the injury, a sharp headache, repeated vomiting
unrelated to food intake, and progressive weakness of the left arm and leg
appeared.
Objectively: the patient is inhibited. The right pupil is much wider than the left.
The left nasolabial fold is smoothed out. Muscle strength in the left extremities
has been reduced to 3.0 points. Left-sided hemihypalgesia. Tendon reflexes are
animated on the left. Babinsky's symptom is positive on the left. Stiffness of
the occipital muscles and Kernig's symptom on both sides.
CT of the brain revealed a sickle-shaped zone of increased density in the right
frontoparietal-temporal region, compression of the right lateral ventricle, and
a 12 mm displacement of the median structures from right to left.
1. Identify clinical syndromes, make a topical diagnosis, and justify them.
2. Make a preliminary diagnosis and justify it.
3. What tests should be performed to verify the diagnosis. Describe what you
left limb. Objectively: the patient is depressed. The right pupil is much wider
than the left. The left nasolabial fold is flattened. The strength in my left arm
and leg was reduced. Left-sided hemihypalgesia. Tendon reflexes are higher on
the left. Babinsky's symptom from left to right. Occipital muscle spasms and
Kernig's symptom. Computed tomography of the brain revealed an area of
high density in the right frontotemporal lobe and compression of the right
lateral ventricle, the central structure shifted by 12 mm from right to left.
expect to find when you conduct these studies.
4. What diseases do I need to make a differential diagnosis for? List at least
three of them and describe the main differences.
5. Suggest a treatment algorithm (medical and non-medical, specify at least
one drug for each group, their dosages), justify the appointment.

1. identify clinical syndromes, make a topical diagnosis, and prove them.

2. Make a diagnosis and prove the prognosis.
3. What tests should be performed to make a diagnosis? What conclusions can
be drawn from these studies?
4. what diseases can be diagnosed differently? Identify three diseases and
identify the main features
of 5. Assign a treatment algorithm (non-drug and drug-based, specify at least
one drug from each group of drugs and specify their dosage), justify the
appointment.