The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical an Medical Pedagogical Faculty
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- Bu səhifədəki naviqasiya:
- Evaluation Perfect Good Satis, Unsatis
- 85%-71% 70-55% 54%-37% 36% and less
- 6. For ulcerative colitis in the acute phase is not typical a) diarrhea b) constipation c) a chair with blood and mucus
- Evaluation Perfect Good Satis. Unsatis
- 10,5-8,25 point 8,1-5,5 point 5,4 point
______________________________________________________________________________ 2). 32 year old woman complains of severe paroxysmal, burning pain in the upper abdomen after eating irradiruyuschie in the back, belching, nausea, vomiting, poor appetite, diarrhea, general weakness. Pain associated with eating and are often accompanied by vomiting and uncertain chair. From history we found that similar attacks in the past bothered after a fatty, spicy food. On palpation marked tenderness in the upper abdomen, more on the right. BP 110/70 mmHg Pulse 96 beats. per min. UAC: 105 g Hb / l RBCs 3.0 × 1012 / L, leukocytes 10.6 x 109 / L ESR 25mm/chas. 1. List at least five probable disease in which the symptoms are above 20-points. 2. Your initial diagnosis, 25 points. 3. What is the difference of vomiting and diarrhea in the pathology of these symptoms in other diseases-25 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. __________________________________________________________________________ 3) Patient K., 54 years old. 3 years ago was diagnosed with chronic abscess of the middle lobe of the right lung. The disease is often exacerbated during the cold season, in which a urinalysis revealed proteinuria. In the last year there were facial swelling in the morning, diarrhea. On examination, swelling in the legs, puffy face, abdominal palpation rumbling and pain along the intestine. UAC: HB-86 g / l; er.-3 2h1012 / l leukocytes -9.6 x109 / L ESR-28 mm / h approximately. Protein -44 g / l. OAM: the share of -1012, protein 6.5 g / L, white blood cells - 9-14/1; erythrocytes -8 -11 / 1, 4-5/1, waxy cylinders. 1. List at least five probable diseases, which are the above symptoms-20 points. 2. Your initial diagnosis, 30 points. 3. What characterizes the overall analysis of sputum in this pathology (specify at least 6 symptoms, specifically) -20 points. 4. The tactics of the GP-10 points. 5. The principles of drug treatment, 20 points. _____________________________________________________________________ 4) The patient 34 years complains of severe pain in the epigastric to eat and a half or two hours after meals .. sick for 1.5 years, there has been persistent course. 6 months. ago was treated for an ulcer 12 duodenal ulcer. Takes two months famotidine 20 mg twice a day, almagel, Trichopolum, without effect. There was a tendency to diarrhea. 1. List at least five probable diseases, which are the above symptoms-20 points. 2. Your initial diagnosis, 30 points. 3. Determine the true nature of pain compliance with abnormalities of the gastrointestinal tract; 1) burning pain behind the breastbone 2) constricting pain in the chest 3) deep, "knife-like" pain 4) increased pain while eating 5) reduction of pain while eating 6) pain, worse when stooping. A) heart disease or esophageal spasm, or B) a stomach ulcer; B) reflux esophagitis, D) I / B stomach D) I / B 12 duodenal ulcer, E) hiatal hernia-20 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. __________________________________________________________________________ 5) 32 year old man turned to the GP complaining of frequent stools 7-8 times a day with blood and pus, cramping abdominal pain, more in the left iliac region, weakness, fever up to 38.5 єS, joint pain . He considers himself sick for three years. Exacerbation connects with a cold and a violation of the diet. Objectively: the patient malnutrition. Skin and visible mucous membranes pale. Heart sounds, rhythmic. Pulse of 100 beats per minute. Tongue coated with white bloom. The abdomen is swollen, painful in the left half of the abdomen. Liver 4 cm UAC: HB-100 g / l; leyk.-10 5h109 / l SOE 29 mm / hr In biochemical analysis of blood total protein 65 g / L, cholesterol 5.7 mg / l, total bilirubin 18.2 mmol / l. Fecal: a large number of red blood cells, white blood cells, intestinal epithelial cells and mucus. Reaction Triboulet sharply positive. 1. List at least 5 of diseases in which the symptoms can be observed above 15-points. 2. Your reservation is complete diagnosis-30 points. 3. Enter instrumental methods of research, which are crucial in the diagnosis and the changes in their 25-points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. __________________________________________________________________________ 6) In the surgical department with suspected acute appendicitis enrolled 26 year old patient. An objective examination of the right half of the abdomen, tenderness and symptoms of peritoneal irritation. The body temperature of 37.40 C. After the examination to exclude acute appendicitis. From history became clear that the patient has the last 2 months. diarrhea was observed 5-6 times a day, sometimes with blood feces. Patient notes abdominal pain and the pain is aggravated by defecation. X-ray examination of the intestine marked narrowing of the small intestine in its terminal portion - a symptom of the string. In the blood: leukocytes - 18h109 / L, erythrocyte sedimentation rate, 38 mm / h 1. List at least five probable diseases, which are the above symptoms-15 points. 2. Your initial diagnosis, 30 points. 3. Specify at least 8 possible complications of this disease, 25 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. __________________________________________________________________________ 6) 35 year old woman complains of severe cramping pain in the left half of the abdomen, occasionally diarrhea with mucus and blood streaks, tenesmus, abdominal distention, fever up to 38,50 C, weight loss, general weakness. Sick for the past 5 years. Exacerbation of the disease occurs in spring and autumn. The deterioration in the course of 2 weeks. An objective examination of the patient malnutrition, pale and listless. In the lungs, vesicular breathing, no wheezing. Heart sounds, rhythmic, heart rate and pulse - 88 beats per minute. BP 100/60 mmHg On palpation of the abdomen marked pain in the left iliac region. 2 cm liver, the spleen is not enlarged. 1. List at least 5 possible diseases, which are the above symptoms-15 points. 2. Your initial diagnosis, 30 points. 3. What changes are characteristic of this disease in the general analysis of feces and what inspections are crucial in the diagnosis (please specify) -25 points. 4. The tactics of the GP-10 points 5. Treatment with an indication of doses of essential medicines, 20 points. __________________________________________________________________________ 7) 27 year old man turned to the GP complaining of frequent stools 5-6 times a day with blood and pus, cramping abdominal pain, more in the left iliac region, weakness, fever up to 38єS, pain in the joints. He considers himself sick for three years. Exacerbation connects with a cold and a violation of the diet. Objectively: the patient malnutrition. Skin and visible mucous membranes pale. Heart sounds, rhythmic. Pulse of 100 beats per minute. Tongue coated with white bloom. The abdomen is swollen, painful in the left half of the abdomen. Liver 2 + 4 cm UAC: HB-100 g / l; leyk.-10 5h109 / l SOE 29 mm / hr In biochemical analysis of blood total protein 65 g / l, cholesterol-5, 7 mmol / l, total bilirubin, 18, 2 mmol / l. Fecal: a large number of red blood cells, white blood cells, intestinal epithelial cells and mucus. Reaction Triboulet sharply positive. 1. List at least 5 of diseases in which the symptoms can be observed above 15-points. 2. Your reservation is complete diagnosis-25 points. 3. Enter instrumental methods of research, which are crucial in the diagnosis and the changes in their 25-points. 4. The complications observed in this pathology-15 points. 5. Tactics GPs and treatment guidelines, 20 points. __________________________________________________________________________ 8) Patient 19 years, after the common cold was an increase in body temperature, and pain in the abdomen diffuse nature, not related to food intake, nausea, vomiting, diarrhea and pain in the joints. In history: frequent exacerbations of chronic tonsillitis. The last increase in body temperature also connects with the common cold. The general condition of average weight, the skin is moist, marked joint pain, swelling of the knee. Papular, hemorrhagic rash on the legs that do not vanish at pressure. Heart: tachycardia, systolic murmur at the apex, there is an increase in the left border of the heart by 1.5 cm in the lungs of vesicular breathing. Blood pressure 170/110 mmHg Tongue coated, belly swollen, pain on palpation are marked in different areas of varying intensity. Symptom positive peritoneal irritation. 1. List at least five probable diseases, which are the above symptoms-15 points. 2. Your initial diagnosis of 35 points. 3. List the clinical forms of the disease, mainly affecting a particular organ-20 points. 4. The tactics of the GP-10 points. 5. Principles of treatment of 20-points. __________________________________________________________________________ 9) Patient M., age 22, at a reception at the GP complaining of general weakness, fatigue, decreased performance, increased body temperature to subfebrile, weight loss, swelling, bleeding gums, decreased twilight vision, cracks in the corners of the mouth, pain in bones and joints, hair loss, brittle nails. From history: feels sick for three years. Objectively: general condition is serious. Retarded. Pale skin. The face was puffy. On the part of the heart and lungs normal. The abdomen was soft, painful on palpation in the right iliac region, there are tumor formation. The liver and spleen were not palpable. Chair frequent, loose, frothy, mixed with blood, mucus. Urination is free and painless. When X-rays, a sharp narrowing of the final ileum. 1. 4 Determine the minimum diseases for which symptoms can be above 15-points. 2. Your initial diagnosis, 20 points. 3. What additional research is needed to confirm the diagnosis of 10 points. 4. What changes do you expect in these studies, 20 points. 5. What do you understand by the term maldigestion-15 points. 6. The tactics of the GP-based treatment guidelines 20 points. ______________________________________________________________________________ 10) Patient 74 years, turned to the GP complaining of severe pain around the navel in 20-30 minutes after eating, lasting more than 2 hours, which is why he was afraid to eat, headaches, chest pain on exertion. Abdominal pain syndrome accompanied by diarrhea. History of suffering ischemic heart disease, stable angina FC II, sclerotic hypertension for many years. For a long time smoking one pack of cigarettes a day. Objectively: the patient malnutrition, skin and mucous membranes are pale. Tongue dry, coated with white bloom. Heart of: muted tones, accent II tone of the aorta. Pulse 80 beats. 1 min. BP - 170/70 mm Hg In the lungs, vesicular breathing. The abdomen was soft, painful on palpation along the large intestine. The liver and spleen were not zoom. Chair - stool with mucus. Auscultation: rough systolic murmur at a point midway between the xiphoid process and the umbilicus. Scatology: poluoformlenny feces, mucus, undigested plant tissue, leukocytes.
2. A presumptive diagnosis; 3. Informative research methods; 4. Reschayushy research method for confirmation of the diagnosis; 5. The tactics of the GP with a detailed description of administration (medical and non-medical) patients;
Tests. Tests with one correct answer 1. Irritable bowel syndrome treatment of diarrhea does not include: a) broth skin grenades b) psychotherapy c) loperamide (Imodium) or codeine d) calcium carbonate e) M-anticholinergics 2. The symptoms, the presence of which can assume a small bowel Crohn's disease include: a) unstable chair with long low grade fever, inexplicable diseases of other organs b) tenesmus c) constipation g) admixture of red blood in the feces d) the presence of hemorrhoids 3. If you suspect a disease of the small intestine in a patient survey plan does not cover: a) fibrogastroduodenoscopy b) irrigoscopy fibrocolonoscopy or with a biopsy of the small intestine c) X-ray of the small intestine g) sigmoidoscopy e) coprogram
4. Diet patients with chronic enteritis does not include: a) cheese b) cottage cheese c) low-fat meat g) milk and dishes made with milk e) vegetarian soups 5. The most common clinical symptoms of malabsorption syndrome labaratornymi are not: a) the type of diarrhea enteric b) flatulence c) the patient's emaciation g) hypoalbuminemia e) epigastric pain 6. For ulcerative colitis in the acute phase is not typical a) diarrhea b) constipation c) a chair with blood and mucus g) cramping abdominal pain d) false desires (tenesmus) 7. To confirm the diagnosis of ulcerative colitis does not apply: a) sigmoidoscopy b) fibrocolonoscopy with mucosal biopsy c) coprogram g) barium enema e) fibergastroscope 8. Complications of ulcerative colitis does not include: a) sepsis b) toxic dilatation of the colon c) the perforation of the colon g) mezhkishechny fistula e) stomatitis, periodontal 9. Abdominal pain and diarrhea with blood and mucus is not characterized by: a) for Salmonella b) for ulcerative colitis c) for dysentery g) for Crohn's disease e) for colon cancer
a) antibiotics of the penicillin group b) salazopreparaty c) nitrofurans g) tsefaloporiny 11. Enter the pathology for which no characteristic diarrhea: a) pancreatitis b) enteritis c) enterocolitis d) Crohn's disease d) Chronic gastritis hyposecretion 12. Enter the signs of a chronic enteritis, other than: a) sheep feces b) diarrhea c) malabsorption g) dysbiosis e) dyskinesia bowel 13. Select the symptoms are not specific to ulcerative colitis, other than: a) vomiting b) hypertension c) sheep feces d) diarrhea alternating with constipation d) diarrhea 14. Enter the disease, which is necessary to differentiate UC, other than: a) cholera b) salmonella c) Crohn's Disease g) is a cancer of the large intestine d) amoebiasis Tests with two or more correct answers 1. For diarrhea, enteric type is characterized by: a) stool significant in terms of volume b) the presence of false desires c) stool frequency - 2-4 times per day d) the presence of mucus in the stool d) lack of mucus, blood in the stool e) The presence of blood in the stool. 2. Name the three imaging studies of pancreatic cancer: a) X-ray
b) barium enema c) Scan
d) ECG d) colonoscopy e) Ultrasound
a) the presence of digested kletchatok b) steatoreya c) amylorrhea g) kreatoreya d) proteins e) Erythrocytes
a) Novocaine b) promedola c) baralgina g) of morphine e) analgin e) droperidol
a) spanning the epigastric pain b) in the left upper quadrant pain radiating to the back c) Diarrhea g) vomiting, bringing relief d) jaundice e) constipation
b) chronic alcoholism a) diseases of the major duodenal papilla g) hypoparathyroidism d) hyperparathyroidism e) a disease of the stomach g) disease of the esophagus 7. List the three characteristic deficiency syndrome digestion in the small intestine? a) yellow liquid feces alkaline b) a large number of muscle fibers c) significant amounts of fatty acids g) in the feces of a significant amount of undigested fiber d) low phosphorus e) Lack of kletchatok in feces
a) Lack of kletchatok in feces b) a large number of muscle fibers c) significant amounts of fatty acids g) in the feces of a significant amount of undigested fiber d) low phosphorus e) a light-brown liquid feces
a) the fetid mushy stool b) the allocation of a hard stool c) a small number of muscle fibers g) a considerable amount of fatty acids e) in the feces of a significant amount of undigested fiber e) a large amount of digested fiber
a) iliac
b) Rectum c) sigma
g) downstream section of the large intestine e) stomach 11. Enter the signs of a chronic ulcerative colitis, other than: a) diarrhea b) the symptom of pain c) intestinal bleeding g) tenesmus e) vomiting 12. Choose products that are shown in light and moderate during the NUC, other than: a) sulfosalazin b) salazopiridazina c) almagel d) Vitamins d) Albumin 13. Enter basic drugs for the treatment of ulcerative colitis, other than: a) sulfosalazin b) Salofalk c) SCS
d) antacids d) Cytotoxic agents
4.2.2 graphic organizer, "pyramid" 
Means layering ideas. Develops and activates the system, creative, analytical thinking. 1. Acquainted with the rules of construction of the scheme. Individually / in pairs build scheme: write the main problem, then sub-problems, and from each of them assign "small branches" that are essential for a more detailed consideration of sub-problems or tasks. With this trace the development of each of the ideas to a considerable depth in detail. 2. Combined in pairs or small groups, compare and complement their schemes. Reduce the overall scheme 3. Presentation of results. 4.3. The practical part The list of skills that GPs should possess after completing training on the subject 1. Perform a visual inspection of patients with diarrhea. 2. The interpretation of laboratory and instrumental investigations for diarrhea. Diarrhea Diarrhea of infectious and noninfectious etiologies. Hypovitaminosis.
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