The Ministry of Health of the Republic of Uzbekistan Tashkent Medical Academy The department of internal diseases №3 of medical and pedagogical faculty

              Treatment of the underlying disease, which led to the HNK, can significantly reduce its appearance, improve the efficiency of therapeutic interventions.A rational therapeutic regimen.

Health food. When the Tax tables are assigned number 10 or 10 ^a. Limited water and table salt, food should be 5-6 times a day (to use at one time a small amount of food), food should be easily digestible, fortified, calorie diet 1900-2500 calories a day .

Gain decreased myocardial contractility is conducted through the use of cardiac glycosides and neglikozidnyh inotropic agents.

Diuretics, ACE inhibitors, angiotensin  receptors, peripheral vasodilators, angiotensin receptor antagonists II, anti-arrhythmic drugs.

Drug-free treatment of patients with HNS.  Among the non-drug therapies for HNS often use isolated ultrafiltration of blood. 

Intra-aortic balloon kontripulsatsiya used in clinical practice as a method of temporary mechanical support of the pumping function of the left ventricle. kontripulsatsiyu balloon is most often used in acute heart failure. however, this method is also used in patients with TC. It is indicated for patients with end-stage heart failure who are preparing for a heart transplant and surgery to support the work of the heart after the transplantation, the development of patients with ventricular arrhythmias refractory to medical therapy.

In addition to the intra-aortic balloon kontripulsatsii in patients with end-NC as a method of "bridge to transplant" is also used mechanical devices to support ventricular gemopompy and sometimes artificial heart.

              Surgical treatment of chronic heart failure.Heart transplantation is the only effective treatment for most patients with end-stage heart failure. In many cases, a heart transplant can not only extend the life of the patient, but also partially and sometimes completely restore disabled patients.

 

Theoretical survey can be carried out using the "Brainstorm"

 

The method of "Brainstorm"

 

Purpose: This method is used to stimulate the exchange of ideas, increases the degree of involvement of the participants, teaches argue and defend their own point of view, to find the best solution in this situation.

The teacher asks students questions about classes:

1. Define the term syndrome, wheezing and asthma.

2. Tell classification nedostatotochnost krovoobrasheniya and pulmonary insufficiency.

3. List the diagnostic criteria for cardiac and pulmonary insufficiency.

4. List the laboratory and instrumental methods for the diagnosis of heart and lung failure.

5. Give a predisposing factor to the development of cardiac and pulmonary insufficiency.

6 ..Tell the wording of the diagnosis of heart and lung failure.

 

Number	Evaluation	excellent	good	Satisfactory	Unsatisfactory	fair
	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
1	Theoretical part	20-17,2 Grade	17-14,2 score	14-11 points	10,8-7,4 score	7.2 score

 

4.2. The analytical part of

Case Studies:

 

1. The patient was 42 years old, due to frequent inflammations of the airways complaining of hard phlegm and coughing fits, shortness of breath on slight exertion and fatigue. From history: ill for 12 years BA. To prevent the disease took a day to 10-15 mg of prednisone and did Ventolin inhalation. OBJECTIVE: expiratory dyspnea, cyanosis, ChD-30/min. Heart rate of 120 beats / min, blood pressure 150/90 mm Hg Percussion over the light box sound. Auscultation of the lungs common wheezing. FEV1 <60%.

              1.Your preliminary diagnosis

              2.What type of respiratory failure observed in a patient

              3.Plan Survey

4.Specify the groups bronchodilator

              5.Tactics GP

 

2. Patient P. complained of shortness of breath, palpitations, heart pain, asthma attacks at night, disruption of the heart, edema. Objectively: general condition is serious. Skin pale, cyanotic, dense swelling to the waist. Over easy: in the lower unvoiced finely wheezing. Heart borders: right + 1.5 cm down the left anterior axillary line at 6 m / d.The tones are muted, arrhythmias, systolic murmur at the apex and base of the xiphoid process, emphasis on the 2 tone of pulmonary artery. Heart rate and heart rate - 100 beats / min. Blood pressure 110/80 mm Hg Liver + 5 cm, painful.

              1.5 List of diseases involving the above listed symptoms.

              2.Your complete a preliminary diagnosis

              3.Plan Survey.

4.Tactics GP

              5.Treatment and mechanism of action of at least one group of drugs in this complication

 

3. A patient 54 years. Complaints of cough with purulent sputum difficult to separate, fiz.nagruzki shortness of breath, asthma, pain and heaviness in the right hypochondrium, swelling in the legs. Of pain for several years, with the aggravation of the fall and spring. Objective: diffuse cyanosis, neck veins bulging, clubbing. BH 28 min., T body 38.8 ⁰ C. Percussion over the light box sound.Auscultation against a weakened vesicular breathing, wheezing and scattered dry rales. Heart sounds, rhythmic. Heart rate of 90 beats / min. Blood pressure 120/70 mm Hg Liver +5 cm FEV1 ratio Tifno reduced residual lung volume increased.

              1.5 List of diseases involving the above listed symptoms.

              2.Your complete a preliminary diagnosis

              3.Plan Survey.

4.What ECG changes typical of this condition

              Tactics GP

 

4. A patient 70 years there has been the home of congestive heart failure due to myocardial infarction. He is constantly taking digoxin (2m a day), hydrochlorothiazide and furosemide daily 2 times a week, nitrosorbit (4t. Per day). His wife complains that he became irritable and angry. In addition he has diarrhea, severe weakness and nausea. OBJECTIVE: over easy in the lower wet finely wheezing. Heart sounds, arrhythmias, accent 2 tone of the aorta. HR 100, the pulse was 96 beats / min. BP 180/100 mm Hg 4 + 3 cm liver, spleen not palpable.On the lower leg edema and trophic skin changes.

              1.Your complete a preliminary diagnosis

              2.Specify the appearance of the above complaints

3. Plan Survey

4.Tactics GP

 

5. Patient 18 years. Complaints of choking, wheezing and shortness of breath on exertion. No history of disease does not hurt. Warm cyanosis, BH 28 minutes. Auscultation in the lungs of hard breathing, wheezing. Heart - Tonya clear, rhythmical.

              1.Your preliminary diagnosis.

              2.There is a complication in this patient

              3.Information research methods

4.Tactics GP

 

6. The patient in 58 years during the five year history of coronary artery disease and 2 GB, there were shortness of breath, a dry cough at night, swelling in the legs. OBJECTIVE: over easy in the lower rales. Heart sounds are muffled, accent 2 tone of the aorta. Heart rate and heart rate 90 beats / min, rhythmic. Blood pressure 150/90 mm Hg Liver + 2cm.Swelling in the lower leg.

1. Your preliminary diagnosis.

              2.What complication in this patient

              3.Information research methods

4.Tactics GP

 

Number	Evaluation	excellent	good	Satisfactory	Unsatisfactory	fair
	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
2	Case study	50-43 points	42.5 - 35.5 points	35 - 27.5 points	27-18,5 Grade	18 points

 

Tests:

1. Which of the following lead to chronic pulmonary heart:

a) respiratory diseases and alveoli

b) the disease resulting in limitation of motion of the chest

c) myocarditis

g) ischemic heart disease

e) pericarditis

e) pulmonary vascular disease

 

2. The following lead to acute pulmonary heart:

a) cystic lung

b) a valve pneumothorax

c) bronchiectasis

d) pulmonary embolism

e) nodular periartereit

 

3. The typical ECG changes of chronic pulmonary heart disease:

a) axis deviation to the right

b) P pulmonale

c) axis deviation to the left

g) evidence of hypertrophy of the left atrium

d) the signs of left ventricular hypertrophy

 

4. Is not the cause of chronic pulmonary heart disease:

a) chronic obstructive bronchitis

b) acute catarrhal bronchitis

c) acute pneumonia

d) pulmonary emphysema

e) bronchiectasis

 

5. Which symptom is not typical of pulmonary hypertension:

a) jugular veins

b) bradycardia

c) "Dance carotid"

d) tachycardia

d) cyanosis

 

6. Changes in the blood in patients with chronic pulmonary heart disease:

a) high ESR

b) leukocytosis

c) anemia   

d) increase in hemoglobin

e) polycythemia

 

7. Early clinical signs of central lung cancer are:

a) a dry hacking cough

b) loss of body weight

c) shortness of breath 

d) cough with mucous expectoration, sometimes streaked with blood

e) unmotivated weakness, fatigue

e) all of the above

 

8. The combination of what is necessary for the diagnosis of symptoms of asthma:

a) asthma, cough, shortness of breath, wheezing

b) persistent fever

c) the presence of reversible airflow obstruction

d) the presence of irreversible airflow obstruction

d) inspiratory dyspnea attacks

e) Sputum eosinophilia,

 

9. By the formation of chronic pulmonary heart disease can cause:

a) chronic obstructive bronchitis

b) tricuspid stenosis

a) primary pulmonary hypertension

d) pulmonary artery stenosis

e) The Pickwick syndrome

e) acute pneumonia

g) polycystic lung

h) aortic parkas

 

10. The causes of acute pulmonary heart disease are:              

a) severe bilateral pneumonia

b) open pneumothorax   

c) lung cancer

g) status asthmaticus in bronchial asthma

e) pulmonary embolism

e) valve pneumothorax

g) chronic pneumonia

h) pulmonary stenosis

 

11. For the treatment of patients with decompensated pulmonary heart on the basis of obstructive lung disease should be applied:              

a) β-blockers             

b) nitrate             

c) calcium antagonists

g) anticholinergics             

d) corticosteroids

 

12. List the clinical signs of sudden cardiac arrest:

a) loss of consciousness

b) a sharp rise in blood pressure

c) the absence of pulsations
g) pulse deficit

e) normal blood pressure

e) tonic and clonic convulsions

 

Number	Evaluation	excellent	good	Satisfactory	Unsatisfactory	fair
	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
3	test	15-12,9 score	12,7-10,6 score	10,5-8,25 score	8,1-5,5 score	5.4 score

 

4.2.2. Graphic Organizer Venn diagram.

        used for comparison or matching iliprotivopostavleniya 2-3x aspects and show them both traits.

        Develops systems thinking, the ability to compare, compare, analyze and synthesis.

Acquainted with the rules of construction of a Venn diagram. Individually / in pairs construct a Venn diagram and fill part of the non-overlapping circles (X)

Are paired, compare and complete their charts.

The intersection of circles make a list of those features that, in their opinion, are common to information 2 to 3 laps (xx / xxx).

Dyspnea. ABP 105/65.

 4.3. Practical part

The list of skills that GPs should possess after completing training on the subject

1. Perform a visual inspection of patients with diseases soprovozhdayushihsya breathlessness and suffocation.

2. Interpretation of the analyzes, the data of laboratory and instrumental studies, radiographs of patients with diseases breathlessness and suffocation (clinical and biochemical blood tests, coagulation tests, sputum, , x-ray pictures of the chest, the results of lung function, knowledge of the technology in the removal of foreign bodies upper respiratory tract).

3. Prescription of drugs depending on the etiology of shortness of breath and asthma.

 

Number	Evaluation	excellent	good	Satisfactory	Unsatisfactory	fair
1	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
2	Practical part	15 - 12.9 points	12,75-10,6 score	10,5-8,25 score	8,1-5,5 - score	5.4 score

 

5. TYPES OF ASSESSMENT OF KNOWLEDGE, SKILLS AND ABILITIES

        Orally

        Writing

        The solution case studies

        Demonstration of practical skills mastered

 

5.1. Criteria for evaluation of knowledge and skill to practical skills of students.

 

Number	Evaluation	excellent	good	Satisfactory	Unsatisfactory	fair
	Assimilation in%	100% -86%	85% -71%	70-55%	54% -37%	36% or less
1	Theoretical part	20-17,2 Grade	17-14,2 score	14-11 points	10,8-7,4 score	7.2 score
2	Case Studies	50-43 points	42.5 - 35.5 points	35 - 27.5 points	27-18,5 Grade	18 points
3	test	15-12,9 score	12,7-10,6 score	10,5-8,25 score	8,1-5,5 score	5.4 score
4	Practical part	15 - 12.9 points	12,75-10,6 score	10,5-8,25 score	8,1-5,5 - score	5.4 score

 

 

6. The evaluation criteria of the current control

 

Levels of estimates	Rating Point	Characteristics of the student
	2	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 the clinical signs of dyspnea in heart and lung disease.         Do not know the pathogenetic treatment of dyspnea in heart and lung disease.         Do not know the groups of drugs used in treatment of heart failure         Do not know the groups of drugs used in treatment of pulmonary insufficiency         Can not point to differentiate performance of dyspnea in heart and lung disease         Unable to collect the rational history during the Supervision of patients with shortness of breath on a background of heart or lung disease         During Supervision is not able to objectively assess the condition of patients with shortness of breath on a background of heart or lung disease         Not be able to rationally plan for investigation of patients with shortness of breath against cardiac or pulmonary pathology in the SVP or joint venture.
Providing basic knowledge and skills
Satisfactory   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 allow serious errors.
	61-65,9	Moderately satisfactory answer. The student has basic knowledge and skills (see below), but when replying or performing skills make mistakes (subject to certain margin of error)
	66-70,9	Satisfactory answer quality. The student is wholly owned by the basic levels of knowledge and skills:         Knows the clinical signs of shortness of breath against cardiac or pulmonary disease         Can differentiate dyspnea against heart disease from shortness of breath against lung disease for subjective, objective and laboratory-instrumental data         Knows differentiated pathogenetic treatment of shortness of breath against cardiac or pulmonary disease         Knows groups of drugs used in treatment of apnea in the background of heart or lung disease         May indicate a peak flow data and analyze the presence of obstruction         Able according to spirometry differentiate obstructive process of restrictive         Able to build a rational history during the Supervision of patients with shortness of breath on a background of heart or lung disease         During Supervision able to objectively assess the condition of patients with shortness of breath on a background of heart or lung disease         Able to efficiently make a plan of examination of patients with shortness of breath against cardiac or pulmonary pathology in the SVP or joint venture.        May interpret the results of laboratory and instrumental methods of research - may indicate the presence of leukocytosis, leykoformuly shift to the right or to the left, elevated ESR.        May specify according to laboratory and instrumental tests for the presence of ECG changes, changes in blood coagulability.        Can show the technique of taking blood count        Can show the technique of ECG recording        Can show the technique of taking the overall analysis of sputum        Able to correctly fill in the patient diary.
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 classification of respiratory failure         Knows the clinical symptoms and morphological changes characteristic of each group of heart failure         Knows the classification of heart failure         Know the mechanism of action of medicinal drug used in heart failure and pulmonary insufficiency         Rationally choose the drugs used in the treatment of heart failure and pulmonary insufficiency
	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 pathogenesis of heart failure and failure of lung function, and can also be called morphology          Knows the principles of primary, secondary and tertiary prevention of heart failure and respiratory failure
	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:       May indicate localization of pneumonia on X-ray image.       Principles of management, supervision and monitoring of patients with pneumonia, pulmonary tuberculosis and pulmonary infarction in a hovercraft or a joint venture.       Is able to advise you on the boards of non-drug and drug-using skills of IPC.       The principles of clinical examination and rehabilitation of patients with pneumonia, pulmonary tuberculosis and pulmonary infarction in a hovercraft or joint venture
Excellent     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 infiltrative pulmonary tuberculosis and lung infarction         Knows the indications and contraindications for X-ray examination         Able to provide reliable information about pneumonia and infiltrative pulmonary tuberculosis based on 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:         Knows radiographic pulmonary infarction and infiltrative pulmonary tuberculosis         Is able to identify hearth pneumonia methods of objective examination.
	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:         Provided the scientific evidence from the literature (articles and Internet)         Knows the stages of rehabilitation and clinical examination in patients with pneumonia, infiltrative pulmonary tuberculosis and pulmonary infarction.

Note: The basic level of knowledge and skills - a minimum of knowledge that provides the principle of "security" for the patient.

 

7. Quiz

 

1. Differential diagnosis of asthma and shortness of breath.

2. Determination of breathlessness and suffocation

3. Differences between cardiac and bronchial asthma.

5.Emergency and differentiated treatment of diseases involving suffocation.

6. Tactics GPs in asthma and shortness of breath.

7. Indications for hospitalization.

8. Prevention.

 

8. References.

The main

1)       Kasalliklar testes, Sharapov UF T: Ibn Sina, 2003

2)       Kasalliklar testes, Bobozhanov S. T: Yangi Asr avlod 2008

3)       Internal Medicine, Volume 1 Mukhin, NA M. GEOTAR - Media 2009

4)       Internal Medicine, Volume 2 Mukhin, NAM. GEOTAR - Media 2009

5)       Textbook of Internal Medicine Editor-in-Chief William N. Kelley 1997

Additional

1)       Umumy amaliet vrachlar Uchun maruzalar tuples, Gad, A., T., 2012

2)       General practice, Ed.F. G.Nazirova, A.G.Gadaeva.M. GEOTAR Media, 2009.

3)       Collection of practical skills for general practitioners.Gadaev A. Akhmedov Kh.S. T., 2010.

4)       Umumy amaliet vrachlar Uchun Amal kunikmalar tuplyu Gadaev AG, Akhmedov, HS, 2010.

5)       Diagnosis of diseases of the internal organs.AN hams All tomy.2005.

6)       Treatment of diseases of the internal organs.AN hams All tomy.2005.

7)       Differential diagnosis of internal diseases. AV Vinogradov Moscow: Medical News Agency, 2009.

8)       Internal medicine: a textbook. - A 2-ton (2 volumes)Ed. Martynov, etc. M.: GEOTAR - Media, 2005:

 

Internet resurslar:

Internet medicine saytlari:

Med.-site.narod.ru

www.medlook.ru

9. Chronological content classes

Time	Events	Contents	Materials	Duration of training
8.30-9.30	Morning conference	The report of the doctor on duty and duty subordinators on duty.	Medical history, ECG, overhead projector.	1 hour
9.15-10.00	Clinical audit to prescribe patients.	A detailed report on the students' prescription patients.		45 minutes
10.05-10.45	Theoretical analysis of the topic	Checking the initial level of ninety-prepared students.Student survey on employment-forward method first name "round one la."Students heard situ Discount tasks on the topic, they need to analyze and give an opinion.	Case studies, tables, corresponding to a subject class.	40 minutes
10.45 -11.05.	Study of practical skills.	Student under the supervision of a teacher must complete at least two practical skill.	The patient or volunteer.	20 minutes
11.05-11.45	Curation of patients in the department	Each student is supervised by a particular patient wards.	The patient, stethoscope, sphygmomanometer, medical history (with data of clinical and laboratory findings).	40 minutes
11.45-12.15	Break			30 min
12.20-13.20	Analysis of case-patients	At the choice of the teacher conducted a full examination of the patient on the theme of employment or patients preparing for discharge, data analysis, laboratory and instrumental studies, the rationale for the preliminary and final clinical diagnoses REFLECTION.Ed determined treatment plan with the doses of drugs.	The patient, stethoscope, sphygmomanometer, medical history (data of clinical and laboratory findings).	1 hour