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

.: 118 g Hb / l, Ar 4 0h10/12 l, L-10,8 x10 / l 9. ESR - 22 mm / h OAM: 100 ml, color - s / w, y / - 1019, protein - abs, leukocytes 3-4/1;

Chest X-ray: in the basal segments of the lower lobe of the right notes blackout homogeneous character.  

The patient's problem:

1) cough with "rusty sputum" pain in the right side of the chest

2) a high body temperature.

The tactics of GPs:

1) The psychological contact with the patient.

2) Find out the history (chronic tonsillitis, otitis media, etc.).

3) Causes of irregular treatment.

4) Set: complete blood count, urinalysis, chest X-ray, sputum analysis and

         With a group to discuss the actions of the student performing the role of a "sick". Then discuss what surveys to do this sick. Answer must first student, a performing th extending the role of "doctor", then complete the answers to the students of the group.At the end of the game it is necessary to evaluate the analytical abilities of each student st.

The practical part of the training - Supervision of sick students - performed under the supervision of a teacher in the department of pulmonology

For topical bypass preparing 2-3 patients with lung pathology, with the presence of a history of sufficient minimum surveys: the common blood and urine tests, blood tests for rheumatoid factor, CRP, seromucoid, sialic, sublimate test, ASO, ASK, ASG, uric acid , rent genography chest.During bypass the fixed attention on the characteristics of complaints of patients, depending on the nature of cough, dry or with sputum, phlegm what character (purulent, with an admixture of blood) 

Attention is focused on the sequence of history-taking, depending on the nature of cough.

Physical examinations aimed at identifying pain, palpation, percussion and auscultation of the chest.

 

USE OF THE "TOUR GALLERY."

Objective: To teach students critically evaluate information and identify the completeness of knowledge on the subject.

     Each small group is invited one problem they solve for 10 minutes in writing and then exchange tasks. Revealing mistakes of the previous group, and additions made to the answers discussed by all members of the adoption of the final version of the responses. Methodology tour gallery requires students to maximum concentration and a good theoretical background for this section.

  Example: subject classes "Cough with expectoration." Three small groups are given on a question: A variant of issues.

1.     Characteristics of cough in lung diseases.

2.     Features of the course of infiltrative pulmonary tuberculosis

3.     Features of lobar pneumonia

So for 30 minutes, the teacher gets an idea of ​​the level of training of students on various sections of topics and their ability to defend their views.

 

Answers:

1.  For the duration of cough is: constant - continues throughout the day - occurs in chronic bronchial, laryngeal some clinical variants of TBZ lungs, lung cancer, periodic coughing - occurs with smoking, the early stages of TBZ lungs, asthma and pneumonia, morning cough - BAB, lung abscess, gastroesophageal reflux, smoking, night cough-TBZ lungs, lymphoma, lung cancer, stasis in the pulmonary circulation, silent cough occurs in frail patients, or before death.

 

By the nature of sputum:

      Serous

      Mucous - meets at tracheitis, acute bronchitis; lab. - Leukemia.5.6.1

      Contaminated with fetid odor - BAB, abscess and gangrene - leukemia. in great numbers

      Mixed (mucopurulent) - pneumonia, lobar pneumonia - "rusty"

      Coughing up blood - lung cancer, ehinokkokoz, pulmonary infarction, mitral stenosis, bronchiectasis, TBZ lung lobar pneumonia, pulmonary embolism

      Vitreous - BA

      "Raspberry jelly" - Article IV lung cancer.

      Pinkish, frothy - pulmonary edema

 

1.     An infectious disease characterized by the formation of lesions in the affected tissues of specific inflammation and expressed the general reaction of the organism. In many developed countries, particularly in Russia, have significantly decreased the incidence of tuberculosis and mortality. The most pronounced of these epidemiological shifts among children, adolescents and women, to a lesser extent - in men, particularly the elderly. Nevertheless, tuberculosis remains a common disease.

The main symptoms of pulmonary tuberculosis symptoms - is:

1.     the presence of persistent pain in the area of the lesion, pain in the lungs can not be pronounced and appear after physical exertion;

2.     long, not passing a cough with sputum streaked with blood;

3.     shortness of breath;

4.     weakness;

5.     episodic increase in body temperature to 37.5.

Specified diagnosis by fluoroscopy and tuberculin skin test. Regular, annual fluoroscopy - quite an effective tool for the detection of tuberculosis in the early stages.

Fractional (lobar) pneumonia is more common in the most serious and rapidly developing forms of pneumococcal (lobar) and klebsielleznoy P. Lobar (lobar fibrinous) PA is characterized by severe exudative reaction with a high content of fibrin in the alveolar exudate, involving in the process of adjacent pleura (pleuropneumonia); inflammation can capture lobe or more of its segments.

 

 

Number	Conformity Assesssment	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

 

4.2.1. Case Studies:

1) Case