a) pneumonia
b) pulmonary embolism
c) subphrenic abscess
d) violation of the drainage function of bronchi
d) right lung atelectasis
4. The reasons постхолециститэктомического syndrome is not considered to be:
a) The formation of stones in the common bile duct
b) the "forgotten" bile duct stones
c) constrictive duodenal papillitis
d) chronic pancreatitis, an unrecognized preoperatively
d) Biliary bile duct
5. The causes of jaundice after cholecystectomy for cholelithiasis, some time after the "light gap" can not be:
a) Gilbert's syndrome
b) constrictive duodenal papillitis
c) cicatricial narrowing of the common bile duct
d) newly formed rock in general duct
e) cancer of the pancreatic head
6. The patient was 30 years old made resection of two thirds of the stomach over the perforated ulcer, Billroth I.
Subsequently, the patient in 30-40 minutes after a heavy meal there was a heartbeat, dizziness, profuse perspiration, orthostatic hypotension. It is most likely that the patient:
a) acute pancreatitis
b) acute cholecystitis
c) Gilbert's syndrome
g) Zollinger - Ellison
e) the dumping syndrome
7. The reasons постхолециститэктомического syndrome is not considered to be:
a) The formation of stones in the common bile duct
b) the "forgotten" bile duct stones
c) constrictive duodenal papillitis
d) chronic pancreatitis, an unrecognized preoperatively
d) Biliary bile duct.
8.Testy with two or more correct answers
When dumping syndrome, as appropriate:
a) meals of solid food
b) receive only liquid food
c) the relative power of indigestible food
r) drug therapy, a similar treatment with acute peptic ulcer
e) frequent smaller meals
e) acceptance of spicy and fried food
9. Sophisticated tests.
Patient 38 years old, weighing 87 kg. In the history underwent cholecystectomy. Asked the GP with complaints of epigastric pain encircling radiating to the back, nausea, vomiting, frequent diarrhea.
1.Predpolagaemy diagnosis
a) UC
b) peptic ulcer, 12 duodenal ulcer
c) hypoacid gastritis
d) chronic pancreatitis
e) chronic cholecystitis
2. Laboratory and instrumental tests for the differential diagnosis:
a) barium enema
b) a study of duodenal contents
c) EFGDK
d) analysis of feces
d) Abdominal ultrasound and determining amylase
3. Recommended products:
a) sulfosalazopiridazin antibiotics
b) antifermental drugs
c) NSAIDs
g) N2gistaminovye blockers
d) diet.
The evaluation criteria
Maximum score 20-19
|
18-17 point
|
16-15 point
|
14-13 point
|
12 point
|
Perfect
|
Good
|
Satisfactorily
|
Unsatisfactorily
|
bad
|
100%-86%
|
85%-73%
|
70-56%
|
53%-46%
|
43% and less
|
4.2.2.Grafichesky organizer "fishbone".
The purpose of the scheme "fishbone" to describe the whole range of field problems and try to solve it, develops and activates the system, creative, analytical thinking.
Progress chart: students get acquainted with the rules of construction of the scheme. Individually or in pairs to write down the top bone wording of sub-problems and on the bottom - the facts prove that these problems exist.
Together in a mini group, compare and complement your scheme.
Next, conduct a presentation of the results. Presentation of the completed scheme to demonstrate the relationship of sub. Their comprehensive.
Worn similar latency simulation
clinical symptoms of the disease
dyspepsia
diagnostics---------------------------------------------------------------------------------------------------------------------------
lack ill shortage economic
laboratories in time equipment lack
didn’t come
doctor doctor doctor doctor
illiterate inattentive negligent nonprogressive
dyspepsia
diagnostics
-------------------------------------------------------------------------------------------------------------------------------
nurse nurse nurse
dereliction of duty illiterate Non-executive
The evalution criteria
Max. Point 20-19
|
18-17 point
|
16-15 point
|
14-13 point
|
12 point
|
Perfect
|
Good
|
Satisfactorily
|
Unsatisfactorily
|
bad
|
100%-86%
|
85%-73%
|
70-56%
|
53%-46%
|
43% and less
|
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 dyspepsia.
2. The interpretation of laboratory and instrumental studies in dyspepsia.
dyspepsia
Gastritis, duodenitis, peptic ulcer disease, biliary dyskinesia, cholecystitis, postcholecystectomical syndrome, a disease of the operated stomach
stage number
|
indicators \
interpretation
|
not done
|
Achieved in full
|
|
examination of the patient
|
|
|
|
Complete blood
|
0
|
50
|
|
enzymes diastase
|
|
Analysis of gastric juice
|
|
EGDFS
|
|
X-rays of the gastrointestinal tract
|
|
Ultrasound of the liver, gallbladder, pancreas
|
|
infectious disease consultation
|
|
surgical consultation
|
|
differential diagnosis
|
0
|
20
|
|
The diagnosis
|
0
|
10
|
|
tactics GP
|
0
|
10
|
|
preventive measures
|
0
|
10
|
TOTAL
|
|
0
|
100
|
The evaluation criteria
Max. point 20-19
|
18-17 point
|
16-15 point
|
14-13 point
|
12 point
|
Perfect
|
Good
|
Satisfactorily
|
Unsatisfactorily
|
bad
|
100%-86%
|
85%-73%
|
70-56%
|
53%-46%
|
43% and less
|
5. Control forms of knowledge, skills and abilities
• Verbally
• In writing
• The decision of situational problems
• Demonstration of practical skills mastered
5.1. Criteria for evaluation of knowledge and skill to practical skills studentov.kov
№
|
evaluation
|
Perfect
|
Good
|
Satis.
|
Unsatis.,
|
bad
|
|
Assimilation in%
|
100%-86%
|
85%-71%
|
70-55%
|
54%-37%
|
36% and less
|
1
|
The theoretical part
|
20-17,2
point
|
17-14,2 point
|
14-11 point
|
10,8-7,4 point
|
7,2 point
|
2
|
Case Studies
|
50-43 point
|
42,5- 35,5 point
|
35- 27,5 point
|
27-18,5
балл
|
18 point
|
3
|
test
|
15-12,9 point
|
12,7-10,6 point
|
10,5-8,25 point
|
8,1-5,5 point
|
5,4 point
|
4
|
The practical part
|
15-12,9 point
|
12,75-10,6 point
|
10,5-8,25 point
|
8,1-5,5- point
|
5,4 point
|
6. The evaluation criteria of the current control
levels of estimates
|
rating
points
|
Characteristics of the student
|
|
20
|
Point of presence on the practical session. Complete lack of knowledge and ability to perform a skill - The student is not ready for practical employment.
|
not satisfactory
|
20 - 54,9
|
The student answers unsatisfactory.
Students do not know the fundamentals of knowledge and skills, at least one of the following:
• Do not know what does the term "postcholecystectomical syndrome" and a "disease of the operated stomach"
• Do not know the cause of dyspepsia in "postcholecystectomy syndrome" and "operated stomach illness'
• Do not know the etiology of "postcholecystectomy syndrome" and the "disease of the operated stomach."
• Can not tell the main clinical signs of "postcholecystectomy syndrome" and "operated stomach illness'
• Can not list the main methods of diagnosis "postcholecystectomy syndrome" and "operated stomach illness'
• Do not know the group of drugs for the treatment of "postcholecystectomy syndrome" and "operated stomach illness'
• Not able to assemble a rational history during outpatient appointment for patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
• During the outpatient appointment is not able to objectively assess the condition of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
• Not able to make a differential diagnosis of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
-
• Do not know which category of services includes patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
|
Providing basic knowledge and skills
|
satisfactorily
55-70,9%
|
55-60,9
|
Satisfactory answer of poor quality.
The student tries to hold the basic levels of knowledge and skills (see below), but when replying or performing skills makes serious mistakes.
|
61-65,9
|
Moderately satisfactory answer.
The student has basic knowledge and skills (see below), but when replying or performing skills makes mistakes (subject to some error)
|
66-70,9
|
Satisfactory answer quality.
The student is wholly owned by the basic levels of knowledge and skills:
• Knows that includes the concept of "postcholecystectomical syndrome" and a "disease of the operated stomach"
• Know the causes of dyspepsia in the "postcholecystectomy syndrome" and "operated stomach illness'
• Knows the etiology "postcholecystectomy syndrome" and the "disease of the operated stomach."
• Can tell the main clinical signs of "postcholecystectomy syndrome" and "operated stomach illness'
• Can list the main methods of diagnosis "postcholecystectomy syndrome" and "operated stomach illness'
• Knows the group of drugs for the treatment of "postcholecystectomy syndrome" and "operated stomach illness'
• Able to build a rational history during outpatient appointment for patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
• During the outpatient appointment is able to objectively assess the condition of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach
• Able to make a differential diagnosis of patients with "postcholecystectomical syndrome" and a "disease of the operated stomach"
-
• Knows how to categorize services include patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
|
Advanced level of knowledge
|
good
71-85,9%
|
71-75,9
|
The student is wholly owned by the basic levels of knowledge and skills (listed under "66-70,9") + has the following knowledge and skills:
• Knows the etiology and pathogenesis of "postcholecystectomy syndrome" and a "disease of the operated stomach"
• Can list the diagnostic techniques necessary to establish the diagnosis "postcholecystectomical syndrome" and "operated stomach illness'
• Knows the basic standards of care "postcholecystectomy syndrome" and "operated stomach illness'
• Knows the mechanism of action of drugs used to treat the "postcholecystectomy syndrome" and "operated stomach illness'
• Can be rationally choose the medication and non-drug therapy to the patient with the "postcholecystectomy syndrome" and a "disease of the operated stomach")
|
76-80
|
The student is wholly owned by the basic levels of knowledge and skills (see above) + knowledge referred to in paragraph "71-75,9", and also owns the following knowledge and skills:
• Knows the etiology and pathogenesis of "postcholecystectomy syndrome" and a "disease of the operated stomach"
-
• Knows the principles of tertiary prevention "postcholecystectomy syndrome" and "operated stomach illness'
|
81-85,9
|
The student is wholly owned by the basic levels of knowledge and skills (see above) + knowledge referred to in paragraph "71-75,9" and "76-80", and also owns the following knowledge and skills:
• Can tell the basic principles of management, supervision and monitoring of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach" in a hovercraft or a joint venture.
• Is able to advise you on the boards of non-drug and drug-using skills of IPC.
-
• Know the principles of clinical examination and rehabilitation of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach" under MRA or joint venture
|
perfect
86-100%
|
86-90
|
The student is wholly owned by the basic levels of knowledge and skills (see above) + knowledge referred to in paragraph "81-85,9", and also owns the following knowledge and skills:
• Knows the principles of treatment of patients with "postcholecystectomy syndrome" and a "disease of the operated stomach"
• Know the indications and contraindications of drugs used in the "postcholecystectomy syndrome" and "operated stomach illness'
• Is able to provide reliable information about dyspepsia based Internet data
|
91-95
|
The student is wholly owned by the basic levels of knowledge and skills (see above) + knowledge referred to in paragraph "86-90", and also owns the following knowledge and skills:
|
96-100
|
The student is wholly owned by the basic levels of knowledge and skills (see above) + knowledge referred to in paragraph "91-95", and also owns the following knowledge and skills:
• to provide scientific data on the basis of additional literature (articles and Internet)
• Know the indications and contraindications for surgical treatment of the re-
• Know the indications for referral to a specialist and special profile (surgical) separating
• Can tell in detail how to carry out laboratory and instrumental methods of diagnosis in "postcholecystectomy syndrome" and the "disease of the operated stomach", is able to interpret them
• Can be in English ask complaints, gather medical history and talk briefly about the disease to the patient with the "postcholecystectomy syndrome" and a "disease of the operated stomach"
-
• Has a pedagogical skill - good lucidly present the topic audience using educational technology
|
-
Note: The basic level of knowledge and skills - a minimum of knowledge that provides the principle of "security" for the patient.
-
7. Test questions.
-
1.Etiologiya postcholecystectomical syndrome, a disease of the operated stomach.
-
2.Klinika postcholecystectomical syndrome, a disease of the operated stomach
-
3.Diagnostika postcholecystectomical syndrome, a disease of the operated stomach
-
4.Differentsialnaya postcholecystectomical syndrome diagnosis, disease operated stomach
-
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