Viral meningitis

Exam date _________

Examiner ___________________________________________
Criteria for evaluating steps Clinical Case Answer Sample
Questions were asked in right order. All complaints
were supplemented with basic and additional questions.
All questions were asked for differential diagnosis and
anamnesis clarification
Complaints and anamnesis collection. Have all the 1. The student said hello to the actor, made eye contact.
necessary questions been asked?
He gave his first and last name.
1
Yes, they have. General infectious symptoms, generalized symptoms,
meningeal symptoms (fever, headache, nausea, stiff neck, Kerning's sign),
Glasgow coma scale were identified.
Have disease severity criteria and Glasgow coma
2 scale been identified?
Did student conduct assessment by organs and Maintained the accepted sequence of examination by organs and systems
3 systems correctly? in patients with CNS pathology

Was student able to examine and identify general Headache, nausea

4 neurologicalsymptoms?
Was student able to examine and identify neck muscles stiffness, positive Kerning's sign bilaterally
5 meningeal symptoms?
Was student able to examine and identify focal Meningeal syndrome, cranial nerves, reflexes, coordination, sensitivity
6 symptoms? examination
Viral meningitis
7 Preliminary diagnosis
Blood count test
8 Additional examination plan
Neurologist consultation
Brain computed tomography
Plan for the appointment forspecial tests to confirm
Lumbar puncture
9 the diagnosis
Leukocytosis (11000), ESR acceleration (20 mm/h)
10 General clinical tests interpretation
Cerebrospinal fluid (CSF): intracranial pressure 300 mm Hg; colorless,
transparent, pleocytosis, neutrophils - 20 neutrophils field of view, protein
- 0.5 g/L, glucose - 2.5 mmol/L
brain CT: no pathology

11 Special tests interpretation

Viral meningitis: severe headache, nausea, fever, meningeal syndrome
CSF: increased intracranial pressure, colorless, lymphocytic pleocytosis,
cell-protein dissociation, no change in glucose.
Application of diagnostic criteria for viral
12 meningitis
Secondary purulent meningitis: headache, vomiting, hyperthermia,
meningeal syndrome, absence of focal symptoms.
CSF: increased intracranial pressure, orange-gray color, muddy,
neutrophilic pleocytosis, cell-protein dissociation, hypoglycemia, the
presence of primary focal infection.

13 Secondary purulent meningitis was ruled out


14 Primary purulent meningitis was ruled out
15 Subarachnoid hemorrhage was ruled out
16 Preliminary diagnosis justification
17 Has it been developed a treatment plan?
18 Monitoring the treatment effectiveness
19 Communication skills
20
TOTAL SCORE -
Full name of the examiner, signature
Primary purulent meningitis: headache, vomiting, fever, meningeal
syndrome, often herpes zoster on the skin and mucous membranes
СЫА: increased intracranial pressure, orange-gray, muddy, neutrophilic
pleocytosis, cell-protein dissociation, hypoglycemia
Subarachnoid hemorrhage: headache, vomiting, meningeal syndrome,
absence of focal symptoms
CSF: increased intracranial pressure, the presence of a large number of
"obsolete leached" erythrocytes, the color of "meat wash".
Brain CT: strong compaction of basal cistern, bleeding into the ventricle
systems
Viral meningitis. Syndromes: general brain syndrome, meningeal
syndrome.
Yes, it has.
Starting empirical treatment before the CSF test and brain CT results:
1. Ceftriaxone 1.0 g x 2 times in 100.0 physiologicalsolution intravenously
2. ketonal 2.0 intramuscularly
When viral meningitis is detected:
Supportive treatment
The treatment effectiveness depends on disease cause,disease severity,
adequate treatment
Establishing effective communication with the patient/ relatives and
reducing their fear
20. Summarized the results of the patient's appointment.
Checked how well the patient understood the doctor's
recommendations and the plan for further action - asked
him to repeat some recommendations. Said goodbye to
the patien
 Check-list Check-list Check-list

Examinee Examinee Examinee Examinee code Examinee code Examinee code

code code code

score score score score score score

0 0 0 0 0 0
 2.Response templates for the
examiner

on the clinical case ischemic stroke

Examiner ___________________________________________

Criteria for evaluating steps

Complaints and anamnesis collection. Have all the
1 necessary questions been asked?

Have disease severity criteria and Glasgow coma

2 scale been identified?

3 Correct neurological examination

Was student able to examine and identify focal

4 symptoms?

Identifying and evaluation clinical and diagnostic

5 FAS-test (face-hand-speech)

6 Preliminary diagnosis

7 Patient additional investigationplan

Plan for the appointment forspecial tests to confirm

8 the diagnosis

9 Differential diagnosis plan

10 General clinical tests interpretation

11 Special tests interpretation

 Application of diagnostic criteria for ischemic
12 stroke

13 Hemorrhage stroke was ruled out

14 Brain tumor was ruled out

15 Syndromological diagnosis

16 Preliminary diagnosis justification

17 Has it been developed a treatment plan?

18 Evaluation treatment effectiveness

19 Communication skills
 Professionalism

20

TOTAL SCORE -
Full name of the examiner, signature
 Check-list Check-list

Examinee code Examinee code

__________________________
Clinical Case Answer Sample score score

Questions were asked in right order. All complaints were supplemented with basic
and additional questions. All questions were asked for differential diagnosis and
anamnesis
Yes, clarification.
they have. General meningeal symptoms (headache, dizziness, nausea not
related to food intake)

Monitoring neurological examination approach

Yes, she/he was. There were focal symptoms in left side (movement – left
hemiparesis; sensitivity – left hemianesthesia; central pareis of 7 and 12 cranial
nerves)
Face asymmetry while smiling, weakness in extremities, slurred speach

Ischemic stroke. Right middle meningeal artery syndrome. Left hemiparesis.

Blood count test

Blood glucose
ECG
Biochemical test (TC, HDL, LDL)
Ophthalmologist consultation
Neurosurgery consultation
Neurologist consultation
Brain contrast MRT

Ischemic stroke
Hemorrhagic stroke
Mass formation in the brain
High TC and LDL, low HDL

Therapist consultation: hypertension 3, risk 4. Ophthalmologist consultation: signs

of hypertonic angiosclerosis of retina.
Neurosurgery consultation: There is no brain tumor, there is an ischemic lesion. No
need for neurosurgery intervention
Ischemic stroke in the right carotid artery system. Right middle cerebral artery
syndrome. Left hemisyndrome.
Investigation CSF for ischemic stroke shows CSF is colorless, transparent, cytosis =
5 cells.
Ischemic stroke usually occurs at rest. Manifesting withheadache, dizziness, nausea
at the peak of the headache, the appearance of focal symptoms after a vascular
episode (increased blood pressure).
Blood tests: high TC, HDL, LDL.
Brain CT: ischemic lesion in the right hemisphere.
Brain MRI: ischemic lesion in the basin of the right middle cerebral artery.

Hemorrhagic stroke develops as a result of acute bleeding into the ventricles or

subcortical space of the brain and cerebral cortex. It is most often torn in the area of
​branching of middle cerebral artery system vessels. Hemorrhagic stroke causes
obvious swelling
Tumors of the brain
of the forehead tissue
affect the surrounding
psyche, alsothe canhemorrhagic lesion.
cause epileptic In this
seizures,
predominate decreased sense of smell and ataxia. Focal motor epileptic
seizures occur in anterior central gyrus tumors. Damage of spinal cord by a
tumor process is accompanied by upward paresis,but general neurologicaal
symptoms do not
Hemisyndrome wasappear forona the
detected longleft
time.
side (left hemiparesis, left hemianesthesia,
central paresis of the facial nerve and sublingual nerve)

Ischemic stroke in the right internal carotid artery system. Right middle cerebral
artery syndrome. Hemisyndrome was detected on the left side: paresis, sensory loss,
central paresis
Yes, it has of 7 andantihypertensive,
prescribed 12 cranial nerves. Brain MRI:
antiplatelet an ischemic lesion in the
therapy.
right middle cerebral artery system. Presence of atherosclerosis and hypertension.

Neurological status examination. Reconsultation of cardiologist for BP correction.

The effectiveness of treatment depends on the early rehabilitation and treatment
adequacy

Establishing effective communication with the patient/ relatives and reducing their
fear
20. Commenting: during the examination/manipulation, he
explained to the patient what, how and why he would do it,
commented on his actions and warned about discomfort, pain,
etc. Presented the results of the examination in a language
understandable to the patient

0 0
Check-list

Examinee code Examinee code Examinee code Examinee code

score score score score

0 0 0 0
 Response templates for the examiner
on the clinical case "Subarachnoid
hemorrhage"

Examiner ___________________________________________
Criteria for evaluating steps

№ Criteria for step assesment

Complaints and anamnesis collection. Have all the

1 necessary questions been asked?

2 Have disease severity criteria been identified?

3 Did student conduct assessmentstatus praesens?

4 Did student conduct assessmentstatus nervosus?

5 Identifying and assessment of clinical symptoms

7 Preliminary diagnosis

8 Additional examination plan

9 Differential diagnosis plan

Application of diagnostic criteria for subarachnoid

10 hemorrhage:

11 Parenchymal-subarachnoid hemorrhage was ruled out

12 Meningitis was ruled out

13 Preliminary diagnosis justification

 14 Has it been developed a treatment plan?

15 Monitoring the treatment effectiveness

16 Communication skills
17

18

19

20 Professionalism

TOTAL SCORE -
Full name of the examiner, signature
 Check-list Check-list

6 4

_____________________
Clinical Case Answer Sample score score

Answer keys 1 1
Questions were asked in right order. All complaints were supplemented with basic and 1 1
additional questions. All questions were asked for differential diagnosis and anamnesis
clarification.
Yes, they have. Generalized symptoms, meningeal symptoms (fever, headache, repetead 1 1
vomiting, stiff neck, Kerning's and Brudzinski’s sign) were identified

The technique of general examination is correct. Blood pressure, pulse, body temperature 1 1
measures are conducted.
Meningeal syndromes, cranial nerves function, reflexes, sensitivity, coordination were 1 1
assessed.
Meningeal syndrome is positive: stiff neck muscles, Kernig's and Brudzinsky's symptoms 1 1
are positive on both sides.
Subarachnoid hemorrhage 1 1
Brain vessels aneurisms?
Blood count test 1 1
Chest x-ray
Lumbar puncture
Brain CT
Neurosurgery consultation
Brain CT angiography

Subarachnoid hemorrhage 1 1
Meningitis
Parenchymal-subarachnoid hemorrhage
SAH: 1) Vomiting, headache such as "lightning"; 2) meningeal syndromes, the 1 1
absence of focal symptoms.
3) CSF: increased intracranial pressure, the color of which is "meat wash", the
presence of large amounts of "alkaline" erythrocytes.
Parenchymal-subarachnoid hemorrhage: 1 1
1) Headache, vomiting
2) Meningeal syndrome, focal symptoms.
3) Brain CT: hyperdensity zone (lesion)
Meningitis: 1) Fever (due to meningitis). 1 1
2) Headache, vomiting, meningeal syndrome
3) CSF: intracranial hypertension, discoloration (depending on the appearance of
meningitis: serous or purulent), increased number of cells (cellular-protein
dissociation).
4) Blood count test - leukocytosis, increased ESR

Subarachnoid hemorrhage. Syndromes: meningeal and general neurological 1 1

syndromes, the presence of "alkaline" erythrocytes in CSF, brain CT: basal cistern
hyperdensity, ventricular hemorrhage
Yes, it has. 1 1
Nimodipine (5.0 ml. 0.2% solution by infuser). In first hours intravenously (slow
infusion) 0.001 (1 mg) 2 times an hour. After 2 hours dose should be increased - 2 mg
(10 ml) in 1 hour). Hemodynamics should be monitored to prevent hypotension.
Dicinone: 2.0 ml. x 2 times intravenously
Ascorbic acid 5.0 ml. 5% solution, 5% glucose solution intravenously
L - lysine escinate 10.0 ml intravenously
Ketonal 2.0 mleffectiveness
The treatment - 5% intramuscularly
depends on disease cause, diseaseseverity, adequate 1 0.5
treatment. If an aneurysm is detected, neurosurgical treatment is required.

Establishing effective communication with the patient/ relatives and reducing their fear 1 0.5
Establishing effective communication with the patient/ relatives and reducing their fear 1 0.5

Managed the interview appropriately: asked enough open-ended 1 1

questions to encourage the patient to talk. Actively revealed the
patient's point of view - their problems, ideas, expectations,
influences
Summarized the results of the patient's appointment. Checked how 0.5 1
well the patient understood the doctor's recommendations and the
plan for further action - asked him to repeat some
recommendations. Said goodbye to the patien
Commenting: during the examination/manipulation, he explained 1 1
to the patient what, how and why he would do it, commented on
his actions and warned about discomfort, pain, etc. Presented the
results of the examination in a language understandable to the
patient

19.5 18.5
Check-list Check-list Check-list Check-list Check-list Check-list

9 7 13 14 20 22

score score score score score score

1 1 1 1 1 1
1 1 1 1 1 1

1 1 1 1 1 1

0 0 0 0 0 0.5

0.5 0.5 0.5 0.5 1 0.5

1 0.5 1 1 1 1

0.5 1 1 1 1 0

1 1 0.5 1 0 1

0.5 1 1 0.5 1 0

1 1 1 1 1 0

1 1 0.5 0.5 0.5 0

0.5 1 0.5 1 0.5 0

1 1 1 1 1 0
1 1 0.5 0.5 1 0

1 1 1 1 1 0

1 1 1 1 1 1

1 1 1 1 1 1

1 0.5 1 0.5 1 1

1 1 0.5 0.5 0 0.5

1 1 0.5 0.5 1 0.5

17 17.5 15.5 15.5 16 10

Check-list Check-list Check-list Check-list Check-list Check-list

29 30 31 36 43 42

score score score score score score

1 1 1 1 1 1
1 1 1 0.5 1 1

1 1 1 1 1 1

1 0 0 0.5 0 0

1 1 0.5 0.5 0.5 0.5

1 1 1 1 1 1

1 1 1 1 1 1

1 1 1 1 1 1

0.5 0.5 0.5 0.5 0.5 0.5

1 1 1 1 1 1

0 0 0 0 0 0

1 1 1 1 1 1

1 1 1 1 1 1
1 1 1 1 0.5 1

1 1 1 1 1 1

1 1 1 1 1 1

1 1 1 1 1 1

1 1 0.5 0.5 1 1

1 1 0.5 0.5 0.5 0.5

1 1 1 1 1 0.5

18.5 17.5 16 16 16 16
Check-list Check-list

46 45

score score

1 1
1 1

1 1

0 0

0.5 1

1 1

1 1

1 0.5

0.5 0.5

1 1

0 0

1 0.5

1 1
1 1

1 1

1 1

1 1

1 1

1 1

1 1

17 16.5
 1.Evaluation sheet (check-list) on the
clinical case Epilepsy with generalized
tonic-clonic seizures"

Exam date _________

Examiner ___________________________________________
Criteria for evaluating steps

Complaints and anamnesis collection. Have all the

1 necessary questions been asked?
Did student conduct assessment by organs and
2 systems correctly?

3 Correct neurological examination

4 Are there any severe symptoms of epilepsy?

5 The character (features) of epileptic seizures

6 The frequency of seizures

7 The preliminary diagnosis

Research plan for general and special tests to

8 confirm the diagnosis

9 Differential diagnosis plan

10 Common clinical tests interpretation

11 Special clinical tests interpretation

12 Diagnosis of "hysteria" was ruled out

13 Diagnosis of "syncope" was ruled out

Diagnosis of " volume formation of the brain " was

14 ruled out

Application of diagnostic criteria for epilepsy with

15 generalized tonic-clonic seizures

16 It has been determined the treatment strategy

17 Monitoring the effectiveness of treatment

 18 Communication skills

19
20

TOTAL SCORE -
Full name of the examiner, signature
 Check-list Check-list

Examinee code Examinee code

____________________________
Clinical Case Answer Sample score score

Questions were asked in right order. All complaints were supplemented with
basic and additional questions. All questions were asked for differential
diagnosis and anamnesis clarification.

Maintained the accepted sequence of examination by organs and systems in

patients with CNS pathology
Investigation of meningeal syndrome. Neurological status: the study of
functions of cranial nerves, reflexes, coordination, sensitivity were assessed.

Yes, there are. Brain general symptom (headache) wasrevealed. The level of
consciousness is determined (somnolence).

Clonic-tonic convulsions, beginning with autonomicprodromal signs and

accompanied by loss of consciousness.
Tonic-clonic seizures occur once every 2-3 months.
The preliminary diagnosis was correct: Epilepsy with generalized tonic-clonic
seizures
Blood count test
Blood glucose test
Consultation of neurologist
Consultation of neurosurgery
EEG
Brain contrast MRI

Epilepsy with tonic-clonic seizures.

Hysteria
syncope
Brain mass formation

Blood count test: normal

Blood glucose test: normal
ECG: sinus rhythm with a frequency of 78 per minute. EOS vertical position

EEG signs of epileptic active focus

brain contrast MRI: no pathology
Common sings: seizures.
Differences: mostly women suffer, a loss of consciousness lasts for a few
hours, there is no aura, no epileptic activity focus on EEG. Attacks mostly
occur in front of large audience or public.
On brain MRI: no pathology
Common signs: seizures, nausea, abdominal pain, hypersalivation, blood
pressure and heart rate fluctuations
Differences: adolescents are mostly affected, loss of consciousness up to 1
minute, there is no aura.
EEG shoes desynchronization of bioelectric activity, a temporary increase of
β-activity index, EEG wavesamplitude reduction.
There are apathy, lethargy after an attack and feeling of discomfort, discomfort
in the abdomen, heart, lightheadedness before the attack; fluctuation of blood
pressure and tachycardia during the attack, "feeling the ground slipping from
under his feet."

May occur at any age. There is fatique after attack. EEG: synchronization of
bioelectrical activity.
Brain contrast MRI: volume formation is determined
Complaints: tonic-clonic seizures with loss of consciousness up to 2 minutes.
Autonomic aura occurs before the attack as "nausea, abdominal pain,
hypersalivation." After an attack, the patient goes to sleep with snoring.
According to the anamnesis the patient was injured at birth. The first seizure
occurred at the age of 10 and occurred once every 2-3 months. At the age of
17 there was an episode of blurred consciousness (twilight
stateconsciousness). She is under the control of an epileptologist and a
neurologist. She takes anticonvulsants regularly.
On EEG: the epicenter is detected.
Brain MRI: no pathology
Consultation of neurosurgeon: there is no sign of a volumetric formation in the
brain.

From history: the words of the patient's family member - a birth trauma. In 10
years, first appeared epileptic seizure with autonomic aura and tonic-clonic
seizures with a frequency of 1 every 2-3 months. At the age of 17 was an
episode of twilight consciousness. There is a neurologist and epileptologist in
city epilepsy office (CEO). It takes anticonvulsants.
EEG: Epileptic activity focus is present.
MRI of the brain: no pathology.
Consultation of the neurosurgeon: no data for volume formation of the brain.

Yes. Depending on the nature of the seizure, anticonvulsant treatment was

prescribed. Drug dosage was written correctly: Depakin is calculated per kg.

EEG. Epileptologist monitoring.

The effectiveness of treatment depends on the regularity of adequate
anticonvulsants treatment.
Criteria for evaluating the treatment effectiveness were established correctly:
- rarely more than 1 seizure during the day
- rarely 1 seizure per month
- less than 1 seizure per year
- rarely 1 seizure in 3 years
- easily overcome physical and emotional stress
- proper adherence to the computer mode
- adherence to sleep and rest
Evaluation of treatment dynamics by video-EEG-monitoring
Establishing effective communication with the patient/ relatives and reducing
their fear
Managed the interview appropriately: asked enough open-
ended questions to encourage the patient to talk. Actively
revealed the patient's point of view - their problems, ideas,
expectations, influences
Summarized the results of the patient's appointment.
Checked how well the patient understood the doctor's
recommendations and the plan for further action - asked
him to repeat some recommendations. Said goodbye to the
patien

0 0
 Check-list

Examinee code Examinee code Examinee code Examinee code Examinee code Examinee code

score score score score score score

0 0 0 0 0 0
Examinee code

score
0
 2.Response templates for the
examiner
Facial palsy

Examiner ___________________________________________

Criteria for evaluating steps

1 Complaints and anamnesis collection.

Have all the necessary questions been
2 Have
asked? disease severity criteria and
Glasgow coma scale been identified?

3 Did student conduct assessment by

organs and systems correctly?

4 Was student able to examine and

identify general neurological
symptoms?
5 Was student able to examine and
identify cranial nerve pathology?

6 Was student able to examine and

identify focal symptoms?
7 Preliminary diagnosis

8 Additional examination plan

9 Plan for the appointment for special

tests to confirm the diagnosis

10 General clinical tests interpretation

16 Preliminary diagnosis justification

17 Has it been developed a treatment

plan?

18 Monitoring the treatment effectiveness

19 Communication skills

19 Communication skills
 Professionalism

20

TOTAL SCORE -
Full name of the examiner, signature
 Check-list Check-list

Examinee code Examinee code

__________________________
Clinical Case Answer Sample score score

Questions were asked in right order. All complaints were

supplemented with basic and additional questions. All
Yes, theywere
questions have.asked
General infectious diagnosis
for differential symptoms,andgeneralized
anamnesis
symptoms,
clarification.meningeal symptoms (fever, headache, nausea, stiff
neck, Kerning's sign), Glasgow coma scale were identified.

Maintained the accepted sequence of examination by organs

and systems in patients with CNS pathology

nothing

Lagophtalm, Bell’s syndrome

Meningeal syndrome, cranial nerves, reflexes, coordination,

sensitivity examination
Facial palsy

Blood count test

Neurologist consultation

Brain computed tomography

Leukocytosis (11000), ESR acceleration (20 mm/h)

Facial palsy

Yes, it has.

1. Prednisolone by scheme intravenously droply

2. Milgamma 2.0 intramuscularly

3. Supportive treatment (needle therapy, physiotherapy)

The treatment effectiveness depends on disease cause, disease
severity, adequate treatment
Establishing effective communication with the patient/
relatives and reducing their fear

Establishing effective communication with the patient/ relatives and reducing their
fear
20. Commenting: during the examination/manipulation, he
explained to the patient what, how and why he would do it,
commented on his actions and warned about discomfort, pain,
etc. Presented the results of the examination in a language
understandable to the patient

0 0
Check-list

Examinee code Examinee code Examinee code Examinee code

score score score score

0 0 0 0
 2.Response templates for the
examiner
Dorsopathy

Examiner ___________________________________________

Criteria for evaluating steps

1 Complaints and anamnesis collection.

Have all the necessary questions been
asked?

2 Have disease severity criteria been

identified?

3 Правильность проведения
исследования симптомов натяжения
и болевых точек
4
Выявление клинических симптомов, и
их оценка

5
Предварительный диагноз

6 Назначение плана обследования –

общеклинические исследования

7 Назначение плана обследования – спец

8 План дифференциальной
диагностики

9 Интерпретация общеклинических
анализов
10

Интерпретация специальных анализов

11 Kонсультации

12 Применение диагностических
критериев при радикулопатии
13 Обоснование окончательного
диагноза

14 Определил ли тактику лечения

19 Контроль эффективности лечения

Professionalism

20

TOTAL SCORE -
Full name of the examiner, signature
 Check-list Check-list

Examinee code Examinee code

__________________________
Clinical Case Answer Sample score score

Questions were asked in right order. All complaints were

supplemented with basic and additional questions. All
questions were asked for differential diagnosis and anamnesis
clarification.
Yes, they have. Да. Выявлены симптомы натяжения
(симптом Ласега, Нери, вынужденная поза. Отмечается
симптом «посадки» и «кашлевого толчка».

Исследование симптома Ласега, Нери. Выявление

болезненности при пальпации точек Гарра на поясничном
уровне и точек Валле справа

Симптомы натяжения, болевые точки, снижение ахиллова

рефлекса, снижена болевая и тактильная чувствительность по
передне-наружной поверхности правой голени и на тыле
стопы, гипотония ягодичной группы мышц и голени справа.

Радикулопатия с поражением межпозвоночных дисков

пояснично-крестцового отдела позвоночника на уровне L4-S1.

Общий анализ крови.

Общий анализ мочи.
Анализ крови на RW.
Рентгенограмма поясничного отдела позвоночника.
Анализ крови на реакции Райта-Хеддельсона
Анализ крови – проба на СРБ

Консультация терапевта.
Консультация нефролога.
Спондилопатии специфического генеза (туберкузез
позвоночника, бруцеллез, сифилис).
Объемное образование позвоночника (опухоль конского
хвоста, экстрамедуллярная опухоль - невринома).

Общеклинические анализы без патологии

Анализ крови на ревмопрбы: проба на СРБ отрицательная.
Анализ крови на RW: результат отрицательный.
Анализ крови на реакцию Райта-Хеддельсона: результат
отрицательный.
Рентгенография пояснично-крестцового отдела
позвоночника – Заключение: признаки остеохондроза III
степени с переходом в IV степень.
Компьютерная томография: КТ дисков: заключение –
имеются дискогенные изменения в виде протрузии на
уровне L4-L5; L5-S1.

Консультация терапевта. Диагноз: патологии не выявлено.

Консультация нефролога. Диагноз: патологии нет.
Консультация уролога. Диагноз: патологии не выявлено.
Консультация фтизиатра. Диагноз: патологии не выявлено.
УЗИ внутренних органов и УЗИ органов малого таза –
Заключение: без патологии.

Рентгенография пояснично-крестцового отдела позвоночника.

Заключение: признаки остеохондроза III степени с переходом в
IVКомпьютерная
степень. томография: КТ дисков: Заключение: имеются
дискогенные изменения в виде протрузии на уровне L4-L5; L5-
S1.
1) Наличие жалоб: сильные боли в поясничной области
справа, боль иррадиирует в правую ягодичную область и
по задней поверхности правой ноги, боли усиливаются
при движении. Во время ходьбы пациент щадит правую
ногу.
2) Наличие анамнеза – ранее были боли в нижней части
спины, поднял тяжесть, не лечился.
3) Объективно: выявлены вынужденная поза,
положительные симптомы натяжения – Ласега справа под
углом 45ᵒ, симптом Нери, болевые точки Гарра, Ваале;
снижена болевая и тактильная чувствительность по
передне-наружной поверхности правой голени и на тыле
стопы; гипотония ягодичной группы мышц и голени
справа; ахиллов рефлекс снижен справа.
4) КТ дисков: заключение – имеются дискогенные
изменения в виде протрузии диска на уровне L4-L5; L5-S1.
5) МРТ на уровне поясничного отдела позвоночника.
Заключение: выявлены протрузии на уровне L3-L4; L4-L5.
Грыжа диска на уровне L5-S1.

Да. Назначено: нестероидные противовоспалительные

препараты - Кетонал 2,0 мл. - 5% в/м; аналгетики;
спазмолитики, физиолечение
При исследовании отсутствуют симптом «посадки» и «кашлевого толчка»,
симптомы натяжения, болевые точки Гарра и Ваале (регресс болевого
синдрома), восстановление чувствительности и ахиллова рефлекса.
Эффективность лечения зависит от выяснения причины заболевания, тяжести
пациента, адекватности назначенного лечения

Commenting: during the examination/manipulation, he

explained to the patient what, how and why he would do it,
commented on his actions and warned about discomfort, pain,
etc. Presented the results of the examination in a language
understandable to the patient

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