Download Metoduchka_III_kyrs._Modul_2

Danylo Halytsky Lviv National Medical University
Faculty of Medicine
Department of Propedeutics of Internal Medicine №1
Discipline: Propedeutics of Internal Medicine
Methodological Guidelines for English-speaking Students of Medical Faculty
(3-d Year of Study)
“Symptoms and syndromes of patients with diseases of internal organs” – Module
№2
Lviv-2014
CONTENT
1. The syndrome of cardiovascular failure. Diagnostic value. Heart valve disease:
Mitral and Aortic valvular disease………………………………..…………4
2. Syndrome of arterial hypertension. Essential hypertension and symptomatic
hypertension. Hypertensive crises. Syndrome of myocarditis. Syndrome of
pericarditis………………………………………………………………..…..12
3. Ischemic (coronary) heart disease: major symptoms and syndromes for angina
and myocardial infarction. Sudden coronary death…………………….……17
4. The main symptoms and syndromes respiratory system: pulmonary tissue
consolidation, increased airiness of the pulmonary tissue, bronchium
obstruction, fluid accumulation in pleural cavity, air accumulation in pleural
cavity, cavity in the lungs………………………………………………..…..22
5. The main clinical manifestations of bronchitis, bronchial asthma and
Bronchiectatic disease. Emphysema of the lungs……………………..……28
6. Pneumonia: symptoms and syndromes on the basis of clinical, instrumental and
laboratory methods. The main symptoms and syndromes of dry and exudative
pleurisy………………………………………………………………….……32
7. The main symptoms and syndromes in patients with disorders of the digestive
system: jaundice syndrome, syndrome of bile ducts dyskinesia (dysfunctional
bile truct disorders), syndrome of gastrointestinal bleeding, syndrome of portal
hypertension, syndrome of functional dyspepsia……………………………...35
8. Chronic gastritis and duodenitis. Peptic ulcer (ulcer disease).
Calculus
cholecystitis (cholelitiasis)…………………………………………………….41
9. Chronic hepatitis, chronic virus hepatitis, liver cirrhosis. Main clinical and
laboratory manifestations of chronic hepatitis and liver cirrhosis……….……45
10.The main syndromes of urinary system: nephritic syndrome, the urinary
syndrome, the syndrome of acute renal failure, the syndrome of chronic renal
failure. Glomerulonephritis and pyelonephritis…………………………….…48
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11.The main symptoms and syndromes of blood system: the syndrome of anemia,
myeloproliferative syndrome, syndrome of bleeding disorders.
Laboratory
diagnosis…………………………………………………………………...…..53
12.Major syndromes in systemic diseases.…………………………………..……59
13.The final module………………………………………………………………62
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Topic 1
THE SYNDROME OF CARDIOVASCULAR FAILURE. DIAGNOSTIC
VALUE. HEART VALVE DISEASE: MITRAL AND AORTIC VALVULAR
DISEASE
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Give the definition of “Heart failure”.
2. Into what 2 groups is divided “Syndrome of cardiovascular failure”?
3. What common causes of heart failure you know?
4. What compensatory mechanisms in heart failure you know?
5. Indicate basic symptoms and signs of heart failure.
6. Indicate additional methods of examination for establishing heart failure.
7. Give the definition of “Acute left ventricular failure”.
8. What causes of acute left ventricular failure you know?
9. What two clinical forms of acute left ventricular failure you know?
10.Give the definition of “Cardiac asthma”.
11.Indicate clinical features of cardiac asthma.
12.What signs of cardiac asthma can be observed during objective examination
of patient.
13.Give the definition of “Pulmonary edema”
14.Indicate clinical features of pulmonary edema.
15.What signs of pulmonary edema can be observed during objective
examination of patient.
16.Indicate additional methods of examination for establishing pulmonary
edema.
17.Give the definition of “Acute left atrial failure”.
18.Give the definition of “Acute right ventricular heart failure”.
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19.What causes of acute right ventricular heart failure you know?
20.Indicate basic symptoms and signs of acute right ventricular heart failure.
21.What signs of acute right ventricular heart failure can be observed during
objective examination of patient.
22.Indicate additional methods of examination for establishing acute right
ventricular heart failure.
23.Give the definition of “Chronic left ventricular heart failure”.
24.What causes of chronic left ventricular heart failure you know?
25.Indicate basic patient complaints with chronic left ventricular heart failure.
26.What signs of chronic left ventricular heart failure can be observed during
objective examination of patient.
27.Indicate additional methods of examination for establishing chronic left
ventricular heart failure.
28.Give the definition of “Chronic left atrial heart failure”.
29.Give the definition of “Chronic right ventricular heart failure”.
30.What causes of chronic right ventricular heart failure you know?
31.Indicate basic patient complaints with chronic right ventricular heart failure.
32.What signs of chronic right ventricular heart failure can be observed during
objective examination of patient.
33.Indicate additional methods of examination for establishing chronic right
ventricular heart failure.
34.List all classification of heart failure.
35.Describe Classification of heart failure according to New York Heart
Association.
36.Give the definition of “Vascular failure”.
37.What includes the concept of vascular failure?
38.Give the definition of “Syncope”
39.Indicate classification of syncope.
40.What signs of syncope can be observed during objective examination of
patient.
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41.Give the definition of “Collapse”
42.What causes of collapse you know?
43.What signs of collapse can be observed during objective examination of
patient.
44.Give the definition of “Shock”
45.Indicate classification of shock according to pathophisiological picture.
46.Indicate classification of shock according to etiology.
47.What clinical features of shock can be observed during examination of
patient?
48.What complications of shock you know?
49.Indicate additional methods of examination for establishing shock.
50.Give the definition of “Mitral regurgitation”.
51.What causes of mitral regurgitation you know?
52.Indicate main disorders of hemodynamics which may occur under
appearance of mitral regurgitation.
53.What clinical features of mitral regurgitation can be observed during
examination of patient?
54.What signs of mitral regurgitation can be observed during objective
examination of patient.
55.Indicate additional methods of examination for establishing mitral
regurgitation.
56.Give the definition of “Mitral stenosis”.
57.What causes of mitral stenosis you know?
58.Indicate main disorders of hemodynamics which may occur under
appearance of mitral stenosis.
59.What clinical features of mitral stenosis can be observed during examination
of patient?
60.What signs of mitral stenosis can be observed during objective examination
of patient.
61.Indicate additional methods of examination for establishing mitral stenosis.
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62.Give the definition of “Aortic regurgitation”.
63.What causes of aortic regurgitation you know?
64.Indicate main disorders of hemodynamics which may occur under
appearance of aortic regurgitation.
65.What clinical features of aortic regurgitation can be observed during
examination of patient?
66.What signs of aortic regurgitation can be observed during objective
examination of patient?
67.Indicate additional methods of examination for establishing aortic
regurgitation.
68.Give the definition of “Aortic stenosis”.
69.What causes of aortic stenosis you know?
70.Indicate main disorders of hemodynamics which may occur under
appearance of aortic stenosis.
71.What clinical features of aortic stenosis can be observed during examination
of patient?
72.What signs of aortic stenosis can be observed during objective examination
of patient.
73.Indicate additional methods of examination for establishing aortic stenosis.
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct physical examination of the patient with heart failure. Identify the
main symptoms and syndromes, establish functional class of the patient.
2. Conduct physical examination of a patient with mitral valve disease. Identify
major symptoms and syndromes.
3. Conduct physical examination of a patient with aortic valve disease. Identify
major symptoms and syndromes.
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4. Conduct questioning of patients with disorders of the cardiovascular system.
Identify the main (specific) complaints.
5. Conduct questioning of patients with disorders of the cardiovascular system.
Identify the nonspecific complaints.
6. Conduct inspection of the heart region. Determine examination plan, specify
the clinical symptoms.
7. Conduct palpation of the heart region. Determine examination plan, show
the technique of palpation the apex beat. Specify the basic signs of
pathological changes of the heart region.
8. Percussion of the heart: specify examination plan of percussion. Show the
percussion technique to determine the relative cardiac dullness of the heart.
Identify normal borders of the relative cardiac dullness.
9. Percussion of the heart: specify examination plan of percussion. Show the
percussion technique to determine the absolute cardiac dullness of the heart.
Identify normal borders of the absolute cardiac dullness.
10.Determine by percussion the vascular bundle, evaluate findings.
11.Determine by percussion configuration of the heart. Identify normal
configuration of the heart.
12.Conduct auscultation of arteries to determine the diagnostic value of
symptoms.
13.Auscultation of the heart: specify examination plan of auscultation. Show
the technique of auscultation (five standard listening points of the heart).
Tell about the normal heart sounds (heart tones) and their changes.
14.Auscultation of the heart: specify examination plan of auscultation. Show
the technique of auscultation (five standard listening points of the heart).
Tell about the three-sound rhythms (additional heart sounds).
15.Auscultation of the heart: specify examination plan of auscultation. Show
the technique of auscultation (five standard listening points of the heart).
Tell about the heart murmurs.
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III.
Control Test of theoretical knowledge.
1. II stage of heart failure by Classification according to N.D. Strazhesko and V.H.
Vasilenko is characterized by:
a) symptoms during physical exercises: dyspnea, palpitation only at rest;
b) symptoms and signs of heart failure not only durin physical exercises, but at
rest;
c) at rest pronounced cyanosis, swollen jugular veins, edema and ascites are
revealed;
d) hemodynamic disorders, irreversible morphological changes of all organs,
functional and metabolic disorders.
2. Acute left ventricular failure may be caused by:
a) lobar pneumonia;
b) bronchial asthma (status asthmaticus);
c) myocarditis;
d) cardiomyopathy.
3. Forced position of patient with cardiac asthma is:
a) sitting with legs hanging down from the bed or he stands up;
b) sitting with trunk slightly bent forward;
c) there is no forced position;
d) lying on the abdomen.
4. Clinical picture of congestion in lesser circulation is characterized by all listed,
except:
a) breathlessness;
b) sometimes hemoptysis;
c) enlarged liver;
d) orthopnea;
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e) crepitation over the lung.
5. Aortic”heart configuration is the sign of:
a) aortic stenosis;
b) aortic regurgitation;
c) mitral stenosis;
d) mitral regurgitation.
6. Asymmetrical (p. differens) pulse on the radial arteries is a sign of:
a) aortic stenosis;
b) aortic regurgitation;
c) mitral stenosis;
d) mitral regurgitation.
7. Signs of aortic regurgitation:
a) patient feels fatigue, exhaustion, palpitations of the heart, cough, exertional
and nocturnal dyspnea;
b) exertional and nocturnal dyspnea, cough, palpitation, pain in the heart;
c) dizziness, headaches, syncope, cardiac asthma, low diastolic pressure in the
aorta;
d) pain in the heart (angina type pain), cardiac asthma and even pulmonary
edema.
8. Complications of mitral regurgitation:
a) chronic left ventricular and atrial failure, chronic right ventricular heart
failure and chronic total ventricular heart failure;
b) arterial or venous emboli with massive pulmonary, cerebral, peripheral
thromboembolism, chronic left atrial heart failure, right ventricle heart
failure;
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c) cardiac asthma, chronic heart failure due to the “mitralization" of aortic
regurgitation;
d) sudden cardiac death, cardiac asthma, pulmonary edema, heart failure due to
“mitralization” of aortic stenosis.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
11
Topic 2
SYNDROME OF ARTERIAL HYPERTENSION
ESSENTIAL HYPERTENSION AND SYMPTOMATIC HYPERTENSION
HYPERTENSIVE CRISES
SYNDROME OF MYOCARDITIS
SYNDROME OF PERICARDITIS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “syndrome of arterial hypertension”.
2. Define the concept of “Symptomatic arterial hypertension”.
3. What renal diseases can cause second hypertension?
4. What endocrine diseases can cause second hypertension?
5. What hemodynamic diseases can cause second hypertension?
6. What neurogenic diseases can cause second hypertension?
7. What special forms o f second hypertension you know?
8. List diagnostic criteria of the renoparenhimal hypertension?
9. List diagnostic criteria of the renovascular hypertension?
10.List diagnostic criteria of the phaeochromocytoma?
11.List diagnostic criteria of the primary hyperaldosteronism (Conn’s
syndrome)?
12.List diagnostic criteria of the Cushing’s syndrome?
13.List diagnostic criteria of the Hemodynamic arterial hypertension?
14.Define the concept of “Essential hypertension”.
15.What predisposing factors of essential hypertension you know?
16.Please write Classification of hypertension according to blood pressure
level.
17.Please write Classification of hypertension according to organ damage.
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18.What sings of hypertension can be found during objective examination of
patients?
19.Please list Protocol of diagnostic procedures for patients with hypertension
I-II stages.
20.Please list Protocol of diagnostic procedures for patients with hypertension
III stages.
21.What additional methods of examination of hypertension you know?
22.Give the definition of “Myocarditis”.
23.Please write Classification of myocarditis according to etiology.
24.Please write Classification of myocarditis according to cours of disease.
25.Please write Classification of myocarditis according to severity of cours.
26.List complaints of patients and sights during objective examination of mild
course myocarditis.
27.Indicate additional methods of examination for establishing mild course
myocarditis. What signs of mild course myocarditis can be detected during
additional methods of examination?
28.List complaints of patients and sights during objective examination of
moderate course myocarditis.
29.Indicate additional methods of examination for establishing moderate course
myocarditis. What signs of moderate course myocarditis can be detected
during additional methods of examination?
30.List complaints of patients and sights during objective examination of sever
course myocarditis.
31.Indicate additional methods of examination for establishing sever course
myocarditis. What signs of sever course myocarditis can be detected during
additional methods of examination?
32.Give the definition of “Pericarditis”.
33.Please write Classification of pericarditis according to etiology.
34.Please write clinical Classification of pericarditis.
35.Describe the pathogenesis of pericarditis.
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36.List clinical features and sights of dry pericarditis during additional methods
of examination.
37.List clinical features and sights of exudative pericarditis during objective
examination.
38.Indicate additional methods of examination for exudative pericarditis. What
signs of exudative pericarditis can be detected during additional methods of
examination?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct physical examination of the patient with arterial hypertension.
Identify major symptoms and syndromes.
2. Conduct physical examination of a patient with myocarditis. Identify major
symptoms and syndromes.
3. Conduct physical examination of a patient with dry pericarditis. Identify
major symptoms and syndromes.
4. Conduct physical examination of a patient with exudative pericarditis.
Identify major symptoms and syndromes.
5. Palpation of the pulse. Show the technique of palpation. Identify the main
characteristics of pulse and their normal manifestations.
6. Blood pressure measurements. Specify examination plan of blood pressure
measurement. Identify normal findings of blood pressure.
7. Blood pressure measurements. Specify examination plan of blood pressure
measurement. Identify common abnormalities of blood pressure.
III.
Control Test of theoretical knowledge.
1. Grade I hypertension established at the level:
a) 120-129 SBP (mm Hg) and/or 80-84 DBP (mm Hg);
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b) 130-139 SBP (mm Hg) and/or 85-89 DBP (mm Hg);
c) 140-159 SBP (mm Hg) and/or 90-99 DBP (mm Hg);
d) 160-179 SBP (mm Hg) and/or 100-109 DBP (mm Hg);
e) 180 SBP (mm Hg) and/or > 110 DBP (mm Hg).
2. On what level should be diastolic arterial blood pressure (DBP) for
establishing arterial hypertension?
a) to 70 mmHg and higher;
b) to 90 mmHg and higher;
c) to 120 mmHg and higher;
d) to 140 mmHg and higher.
3. Sings of Stage III hypertension:
a) no objective signs of organic changes;
b) at least one of the following signs of organ involvement without
symptoms or dysfunction;
c) both symptoms and signs have appeared as result of organ damage;
d) signs of a absence of consciousness and / or failure of organs.
4. Increase level of what laboratory index is typical for Conn’s syndrome
a) cortisol and 17-OKS is in blood;
b) aldosteron in blood and urine;
c) adrenalin, noradrenalin;
d) renin in plasma of blood.
5. Dyspnea at rest is typical for:
a) mild cours of myocarditis;
b) moderate cours of myocarditis;
c) sever cours of myocarditis;
d) not typical for myocarditis.
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6. Pericardial friction of scraping character is typical for:
a) myocarditis;
b) dry pericarditis;
c) exudative pericarditis;
d) hypertension.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
16
Topic 3
ISCHEMIC (CORONARY) HEART DISEASE: MAJOR SYMPTOMS AND
SYNDROMES FOR ANGINA AND MYOCARDIAL INFARCTION.
SUDDEN CORONARY DEATH
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “Ischemic (coronary) heart disease”.
2. Please write Classification of Ischemic (coronary) heart disease.
3. Please write Classification of Angina pectoris.
4. Please write Classification of Myocardial infarction (MI).
5. What are the main etiological factors of Ischemic (coronary) heart disease?
6. Describe the pathogenesis of Ischemic (coronary) heart disease.
7. Define the concept of “Stable angina”.
8. What clinical features of stable angina you know?
9. Please write Canadian Cardiovascular Society Classification of stable
angina.
10.What main sights of stable angina can be detected during objective
examination?
11.What sights of stable angina can be detected during additional methods of
examination?
12.Exercise ECG for stable angina: describe the method and explain its
importance.
13.Pharmacological stress testing with imaging techniques: describe the method
and explain its importance.
14.Define the concept of “Acute coronary syndrome”.
15.What clinical features of acute coronary syndrome you know?
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16.What main sights of acute coronary syndrome can be detected during
objective examination?
17.What sights of acute coronary syndrome can be detected during additional
(laboratory) methods of examination?
18.What instrumental examinations are used for establishing acute coronary
syndrome and explain why?
19.Please write Braunwald Classification system for unstable angina.
20.Define the concept of “Myocardial infarction”.
21.Indicate clinical features of myocardial infarction.
22.What main sights of myocardial infarction can be detected during objective
examination?
23.List atypical forms of myocardial infarction and their sights.
24.List complications of myocardial infarction.
25.Please write Classification of acute heart falure by Killip.
26.What additional (laboratory) methods of examination can be used for
establishing of myocardial infarction?
27.What additional (instrumental) methods of examination can be used for
establishing of myocardial infarction?
28.List markers of myocardial infarction.
29.ECG sights of myocardial infarction.
30.Define the concept of “Sudden cardiac death”.
31.List the causes of “Sudden cardiac death”.
32.What clinical signs of sudden cardiac death you know?
33.What main sights of sudden cardiac death can be detected during objective
examination?
34.What additional methods of examination can be used for establishing sudden
cardiac death?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
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1. Conduct questioning of patients with Ischemic heart disease. Install
dominant disease. Identify the main (specific) complaints.
2. Conduct physical examination of the patient with stable angina. Identify
major symptoms and syndromes, Define functional class.
3. Conduct physical examination of the patient with мyocardial infarction.
Identify major symptoms and syndromes.
4. Analyze the ECG of patient with мyocardial infarction. Determine character
and localization of heart muscle affection.
5. Analyze the ECG by the following scheme: Determination of the Cardiac
Rhythm Regularity, Calculation of the Heart Rate, Measurements of the
ECG Amplitude, Determination of the Cardiac Rhythm Pacemaker Site,
Estimation of the conductivity, Determination of the Electrical Axis of the
Heart, Measurements of the duration and amplitude of the ECG waves and
intervals and make the following ECG conclusion:
a) The cardiac rhythm pacemaker (sinus or nonsinus rhythm)
b) Regularity of cardiac rhythm (regular or irregular)
c) The heart rate
d) Position of electrical axis of the heart
e) Presence of the four ECG syndromes: arrhythmias, conduction
disturbances, atrial or ventricular hypertrophy, myocardial injury
(ischemia, injury, necrosis, scar)
III.
Control Test of theoretical knowledge.
1. The main cause of coronary heart disease is:
a) atheroma and its complications;
b) hypoxia of the brain of any origin;
c) congenital heart disease;
d) arterial hypertension.
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2. In what period of myocardial infarction is formed myocardial scar?
a) very acute;
b) acute;
c) subacute;
d) recovery.
3. What type of myocardial infarction can pass unrecognized and may
reveal afterwards during ECG recording or Echo-CG examination?
a) abdominal type of myocardial infarction;
b) asthmatic type of myocardial infarction;
c) arrhythmic type of myocardial infarction;
d) “silent” type of myocardial infarction.
4. In subacute period of myocardial infarction may be observe all
complications except:
a) ulcers of gastrointestinal tract;
b) Dressler’s syndrome;
c) post-infarction remodeling;
d) post-infarction angina.
5. Optimal time for estimation of myocardial marker of necrosis – troponin
I is:
a) in 1-2 hours after chest pain;
b) every 12 hours 3 time;
c) in 60-90 minutes after chest pain, every 12 hours 3 time;
d) in 12 hours after chest pain, one time.
6. Sudden cardiac death (SCD) is characterized by all except:
a) apnea;
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b) difficulty in breathing, cough with a foamy pink sputum;
c) absence of heart sounds;
d) appearance of pale-grey tint of skin.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
21
Topic 4
THE MAIN SYMPTOMS AND SYNDROMES RESPIRATORY SYSTEM:
PULMONARY TISSUE CONSOLIDATION, INCREASED AIRINESS OF
THE PULMONARY TISSUE, BRONCHIUM OBSTRUCTION, FLUID
ACCUMULATION IN PLEURAL CAVITY, AIR ACCUMULATION IN
PLEURAL CAVITY, CAVITY IN THE LUNGS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. What the main syndromes of the diseases of respiratory system you know?
2. Syndrome of the pulmonary tissue consolidation, give the definition.
3. What are the main etiological factors of syndrome of the pulmonary tissue
consolidation?
4. Name mechanisms of pulmonary tissue consolidation.
5. List all forms of pulmonary tissue consolidation.
6. List the main complaints of patients and their characteristics in the presence
of syndrome of the pulmonary tissue consolidation.
7. What the main features of the syndrome of the pulmonary tissue
consolidation can be detected during objective examination?
8. What additional methods of examination can be used to identify the
syndrome of the pulmonary tissue consolidation and what signs of this
syndrome can be detected?
9. Syndrome o f increased airiness of the pulmonary tissue, give the definition.
10.What are the main etiological factors of syndrome of increased airiness of
the pulmonary tissue?
11.Describe the pathogenesis of increased airiness of the pulmonary tissue.
12.List all forms of increased airiness of the pulmonary tissue.
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13.List the main complaints of patients and their characteristics in the presence
of syndrome of increased airiness of the pulmonary tissue.
14.What the main features of the syndrome of increased airiness of the
pulmonary tissue can be detected during objective examination?
15.What additional methods of examination can be used to identify the
syndrome of increased airiness of the pulmonary tissue and what signs of
this syndrome can be detected?
16.Syndrome of bronchium obstruction (bronchospastic syndrome), give the
definition.
17.What are the main etiological factors of syndrome of bronchium obstruction
(bronchospastic syndrome)?
18.Describe the pathogenesis of bronchium obstruction.
19.List the main complaints of patients and their characteristics in the presence
of syndrome of bronchium obstruction (bronchospastic syndrome).
20.What the main features of the syndrome of bronchium obstruction
(bronchospastic syndrome) can be detected during objective examination?
21.What additional methods of examination can be used to identify the
syndrome of bronchium obstruction (bronchospastic syndrome) and what
signs of this syndrome can be detected?
22.Syndrome of fluid accumulation in pleural cavity (hydrothorax), give the
definition.
23.What are the main etiological factors of syndrome of fluid accumulation in
pleural cavity (hydrothorax)?
24.Describe the pathogenesis of fluid accumulation in pleural cavity.
25.List all forms of fluid accumulation in pleural cavity.
26.List the main complaints of patients and their characteristics in the presence
of syndrome of fluid accumulation in pleural cavity (hydrothorax).
27.What the main features of the syndrome of fluid accumulation in pleural
cavity (hydrothorax) can be detected during objective inspection?
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28.Describe particularities of objective examination depending on the stage of
pleural syndrome development.
29.What signs can be detected in the presence of exudate?
30.List the clinical and diagnostic zones that occur in the presence of exudate.
31.What auscultative records are observed according to distinguish zones?
32.What signs can be detected in the presence of transudate?
33.What additional methods of examination can be used to identify hydrothorax
and what signs of this syndrome can be detected?
34.Syndrome of air accumulation in pleural cavity (pneumothorax), give the
definition.
35.Describe the pathogenesis of pneumothorax.
36.List all forms of pneumothorax.
37.List the main complaints of patients and their characteristics in the presence
of syndrome of air accumulation in pleural cavity (pneumothorax).
38.What the main features of the syndrome of air accumulation in pleural cavity
(pneumothorax) can be detected during objective examination?
39.What additional methods of examination can be used to identify
pneumothorax and what signs of this syndrome can be detected?
40.Syndrome o f the cavity in the lungs, give the definition.
41.What are the main etiological factors of syndrome o f the cavity in the
lungs?
42.Describe the pathogenesis of cavity in the lungs.
43.List the main complaints of patients and their characteristics in the presence
of syndrome o f the cavity in the lungs.
44.What the main features of the syndrome o f the cavity in the lungs can be
detected during objective examination?
45.What additional methods of examination can be used to identify the
syndrome of the cavity in the lungs and what signs of this syndrome can be
detected?
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II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning, inspection and objective examination of the patient
with Syndrome of the pulmonary tissue consolidation and set the typical
complaints and symptoms.
2. Conduct questioning, inspection and objective examination of the patient
with Syndrome o f increased airiness of the pulmonary tissue and set the
typical complaints and symptoms.
3. Conduct questioning, inspection and objective examination of the patient
with syndrome of bronchium obstruction (bronchospastic syndrome) and set
the typical complaints and symptoms.
4. Conduct questioning, inspection and objective examination of the patient
with syndrome of fluid accumulation in pleural cavity (hydrothorax) and set
the typical complaints and symptoms.
5. Conduct questioning, inspection and objective examination of the patient
with syndrome of air accumulation in pleural cavity (pneumothorax) and set
the typical complaints and symptoms.
6. Conduct questioning, inspection and objective examination of the patient
with syndrome of the cavity in the lungs and set the typical complaints and
symptoms.
7. Conduct questioning of patients with disorders of respiratory system.
Identify the main complaints.
8. Conduct inspection of the chest of patient with pathology of the respiratory
system. Identify the main symptoms and signs that are established during
static inspection.
9. Conduct inspection of the chest of a patient with pathology of the respiratory
system, Identify the main symptoms and signs that are established during
dynamic inspection.
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10.Palpation of the chest. Indicate three basic key points that are established by
palpation of the chest, and the method of their determination.
11.Comparative percussion of the lungs. Indicate main tasks of this method and
show the technique of its performance.
12.Topographic percussion of the lungs. Indicate main tasks of this method and
show the technique of its performance.
13. Determine the active mobility of the lower edge of the lungs, evaluate
diagnostic value of symptoms.
14.Auscultation of the lungs. Show the technique of auscultation (anterior view,
posterior view, axillary regions). Tell about the main respiratory sounds
(breath sounds).
15.Auscultation of the lungs. Show the technique of auscultation (anterior view,
posterior view, axillary regions). Tell about the main respiratory sounds
(breath sounds) namely about vesicular (alveolar) breath sounds.
16.Auscultation of the lungs. Show the technique of auscultation (anterior view,
posterior view, axillary regions). Tell about the adventitious (added) sounds
namely about bronchial (laryngotraheal) breath sounds.
III.
Control Test of theoretical knowledge.
1. For syndrome of the cavity in the lungs typical character of cough is:
a) may be dry or with sputum discharge;
b) commonly dry and has reflex character;
c) moist with difficult sputum expectoration;
d) commonly dry which turn to the moist with large amount (by “full
mouth”).
2. Air accumulation in pleural cavity also called:
a) hydrothorax;
b) pneumothorax;
26
c) hemothorax;
d) chylothorax.
3. For syndrome of the pulmonary tissue consolidation typical character of
dyspnea is:
a) expiratory or mixed and increased during physical activity;
b) expiratory, gradually increased;
c) inspiratory or mixed;
d) mixed, rapidly increased and transmit to asphyxia.
4. For bronchospastic syndrome typical character of cough is:
a) may be dry or with sputum discharge;
b) commonly dry and has reflex character;
c) moist with difficult sputum expectoration;
d) commonly dry which turn to the moist with large amount (by “full
mouth” ).
5. Bronchial breathing –“metallic” is typical for:
a) hydrothorax;
b) syndrome of increased airiness of the pulmonary tissue;
c) pneumothorax;
d) syndrome of the pulmonary tissue consolidation.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
27
Topic 5
THE MAIN CLINICAL MANIFESTATIONS OF BRONCHITIS
BRONCHIAL ASTHMA AND BRONCHIECTATIC DISEASE
EMPHYSEMA OF THE LUNGS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “bronchitis”. Specify basic forms of bronchitis.
2. Specify etiologic factors and clinical features of acute bronchitis.
3. Describe the signs of acute bronchitis that can be detected during objective
examination and additional methods of study.
4. Indicate etiological factors and pathogenesis of chronic bronchitis.
5. Specify classification of chronic bronchitis by N.P. Paleev.
6. What clinical featurs of chronic bronchitis you know?
7. What sings of chronic broncitis can be found during objective examination?
8. What sings of chronic broncitis can be found during additional methods of
examination?
9. Indicate etiological factors and pathogenesis of bronchiectatic disease.
10.What clinical featurs of bronchiectatic disease you know?
11.What sings of bronchiectatic disease can be found during objective
examination?
12.What sings of bronchiectatic disease can be found during additional methods
of examination?
13.Define the concept of “bronchial asthma”.
14.Indicate etiological factors of bronchial asthma.
15.Specify classification of bronchial asthma according to the complex of
clinical and functional signs of bronchial obstruction.
28
16.Describe the clinical features of bronchial asthma in the prodromal period
and the period of asthma attack reverse.
17.Describe the clinical features of bronchial asthma in the period of clinical
manifestation (bronchial asthma attack).
18.What sings of bronchial asthma can be found during additional methods of
examination?
19.Define the concept of “emphysema of the lungs”. Specify basic forms of
bronchitis.
20.What sings of emphysema of the lungs can be found during objective
examination?
21.What sings of emphysema of the lungs can be found during additional
methods of examination?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning and examination of the patient with obstructive lung
disease. Identify the main symptoms and syndromes, lesion data spirograph
set the stage of the disease.
2. Perform palpation, percussion of the chest and auscultation of the lungs of
patients with obstructive lung disease. Identify the main symptoms and
syndromes.
3. Conduct questioning and objective examination of the patient with
bronchitis. Identify the main symptoms and syndromes.
4. Conduct questioning and objective examination of the patient with
bronchiectatic disease. Identify the main symptoms and syndromes.
5. Conduct questioning and objective examination of the patient with bronchial
asthma. Identify the period of disease, main symptoms and syndromes.
29
6. Conduct questioning and objective examination of the patient with
emphysema of the lungs. Identify the main symptoms and syndromes.
Evaluate radiological signs of emphysema.
III.
Control Test of theoretical knowledge.
1. Inflammatory injury of bronchial tree is also called:
a) emphysema of the lungs;
b) bronchial asthma;
c) bronchitis;
d) pneumonia.
2. Emphysema of the lungs it is:
a) inflammatory injury of bronchial tree;
b) disease accompanied by destructive changes of alveoli;
c) disease that leads to bronchial hyperreactivity;
d) inflammatory disease with obligatory alveoli involvement.
3. Hemoptysis as a sign of disease is more typical for:
a) emphysema of the lungs;
b) bronchial asthma;
c) bronchitis;
d) bronchiectatic disease.
4. Severity of asthmatic status is characterized by all listed, except:
a) degree of respiratory failure;
b) acidosis;
c) degree of renal failure;
d) hypercapnia.
30
5. X-ray sing of lung’s “amputation” is typical for:
a) lungs emphysema;
b) bronchial asthma;
c) chronic bronchitis;
d) bronchiectatic disease.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
31
Topic 6
PNEUMONIA: SYMPTOMS AND SYNDROMES ON THE BASIS OF
CLINICAL, INSTRUMENTAL AND LABORATORY METHODS.
THE MAIN SYMPTOMS AND SYNDROMES OF DRY AND EXUDATIVE
PLEURISY
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “pneumonia”. Specify basic forms of bronchitis.
2. Specify classification of pneumonia according to the particularities of
infection.
3. The category of the patients with nonhospital pneumonia: specify
classification.
4. The groups with intrahospital pneumonia: specify classification.
5. Define the concept of “nonhospital” and “intrahospital” pneumonia.
6. Indicate main risk factors of pneumonia.
7. Indicate main pathogenic links of pneumonia.
8. What clinical featurs of pneumonia you know?
9. What sings of pneumonia can be found during objective examination?
10.What sings of pneumonia can be found during additional methods of
examination?
11.Give the definition for “Pleuritis”.
12.Give the definition for “Dry pleuritis”.
13.Indicate etiological factors and pathogenesis of dry pleuritis.
14.What clinical featurs of dry pleuritis you know?
15.Describe the signs of dry pleuritis that can be detected during objective
examination and additional methods of examination.
16.Give the definition for “Exudative pleuritis”.
32
17.Indicate etiological factors and pathogenesis of exudative pleuritis.
18.What clinical featurs of exudative pleuritis you know?
19.What sings of exudative pleuritis can be found during objective
examination?
20.What sings of exudative pleuritis can be found during additional methods of
examination?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning and physical examination of the patient with
pneumonia. Identify the main symptoms and syndromes.
2. Conduct questioning and physical examination of a patient with pleurisy.
Identify the nature of pleurisy, the main symptoms and syndromes.
III.
Control Test of theoretical knowledge.
1. In auscultation of the lungs of patient with pleurisy can be heard:
a) dry rales;
b) pleural friction;
c) crepitation;
d) nothing is heard.
2. Nonhospital pneumonia means:
a) pneumonia that develops in first 48-72 hours after hospitalization;
b) pneumonia that develops outside from hospital;
c) pneumonia that develops in first 120 hours after hospitalization;
d) pneumonia, that was diagnosed on admission to hospital.
3. Clinical signs of pneumonia as pain in the chest is characterized by:
33
a) pain that irradiates to left shoulder or arm;
b) occurs suddenly, increase during deep inspiration or cough;
c) epigastrium pain during coughing;
d) not a typical sign of pneumonia.
4. The posture o f the patients with pneumonia is:
a) frequently active or may be forced (orthopnea);
b) forced (lie on the affected side in order to relieve the pain);
c) active;
d) forced (lie on the healthy side in order to relieve the pain).
5. X-ray signs of significant darkness with slanting upper border o f the fluid is
typical for:
a) focal pneumonia;
b) lobar pneumonia;
c) emphysema of the lungs;
d) exudative pleurisy.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
34
Topic 7
THE MAIN SYMPTOMS AND SYNDROMES IN PATIENTS WITH
DISORDERS OF THE DIGESTIVE SYSTEM: JAUNDICE SYNDROME,
SYNDROME OF BILE DUCTS DYSKINESIA (DYSFUNCTIONAL BILE
TRUCT DISORDERS), SYNDROME OF GASTROINTESTINAL
BLEEDING, SYNDROME OF PORTAL HYPERTENSION, SYNDROME
OF FUNCTIONAL DYSPEPSIA
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. What the main syndromes of the diseases of dygestive system you know?
2. Syndrome of jaundice, give the definition. What types of jaundice you
know? (please list).
3. What are the main etiological factors of syndrome of jaundice?
(suprahepatic – hemolytic, hepatic – parenhimatous, subhepatic –
mechanical).
4. Indicate pathogenesis of suprahepatic jaundice.
5. Indicate pathogenesis of hepatic jaundice.
6. Indicate pathogenesis of subhepatic jaundice.
7. What clinical featurs of suprahepatic – hemolytic, hepatic – parenhimatous,
subhepatic – mechanical you know?
8. What the main features of the syndrome of jaundice can be detected during
objective examination?
9. What additional methods of examination can be used to identify the
syndrome of jaundice and what signs of this syndrome can be detected?
10.Describe changes in the activity of enzymes that occur in the presence of
cytolisis syndrome, cholestatic syndrome, hepatic-cellular failure syndrome,
immunoinflammatory syndrome.
35
11.Provide interpretation of changes in the levels of total protein in the blood.
12.Provide interpretation of changes in globulins levels and indicate what they
reflect.
13.Syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders), give
the definition. What are the main etiological factors of this syndrom?
14.Indicate pathogenesis of syndrome of bile ducts dyskinesia (dysfunctional
bile tract disorders).
15.Specify classification of syndrome of bile ducts dyskinesia according to the
etiology, localization and functional state.
16.List the main clinical features and their characteristics in the presence of
syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders).
17.What main features of the syndrome of bile ducts dyskinesia (dysfunctional
bile tract disorders) can be detected during objective examination?
18.What additional methods of examination can be used to identify the
syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders) and
what signs of this syndrome can be detected?
19.Syndrome of gastrointerstitial bleeding, give the definition. Specify
classification of syndrome of gastrointerstitial bleeding according to the
etiology, localization, functional state and intensity.
20.Define the concept of “hematomesis”, “melena” and “hematochezia”.
21.What are the main etiological factors of syndrome of gastrointerstitial
bleeding? (Please list the most common causes of upper gastrointestinal
hemorrhage and of lower gastrointestinal bleeding).
22.Indicate pathogenesis of syndrome of gastrointerstitial bleeding.
23.What clinical featurs of syndrome of gastrointerstitial bleeding you know?
24.What additional methods of examination can be used to identify the
syndrome of gastrointerstitial bleeding and what signs of this syndrome can
be detected?
25.Describe all the possible results of Coprological study including bleeding
from different departments of gastrointestinal tract.
36
26.What tests for occult bleeding you know and what they define?
27.Syndrome of portal hypertension, give the definition. Specify classification
of syndrome of portal hypertension depending on the etiology and
mechanism of developing.
28.What clinical featurs of syndrome of portal hypertension you know?
29.Describe the signs of syndrome of portal hypertension that can be detected
during objective examination.
30.Describe the signs of syndrome of portal hypertension that can be detected
during additional methods of examination.
31.Syndrome of functional dyspepsia, give the definition. What are the main
etiological factors of this syndrom?
32.Specify classification of syndrome of functional dyspepsia according to the
type of dyspepsia and stage of dyspepsia. Indicate pathogenesis of syndrome
of functional dyspepsia.
33.What clinical featurs of syndrome of functional dyspepsia you know?
34.What additional methods of examination can be used to identify the
syndrome of functional dyspepsia and what signs of this syndrome can be
detected?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning, inspection and objective examination of the patient
with syndrome of jaundice and set the typical complaints and symptoms.
2. Conduct questioning, inspection and objective examination of the patient
with syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders)
and set the typical complain ts and symptoms.
3. Conduct questioning, inspection and objective examination of the patient
with syndrome of gastrointerstitial bleeding and set the typical complaints
and symptoms.
37
4. Conduct questioning, inspection and objective examination of the patient
with syndrome of portal hypertension and set the typical complaints and
symptoms.
5. Conduct questioning, inspection and objective examination of the patient
with syndrome of functional dyspepsia and set the typical complaints and
symptoms.
6. Conduct questioning of patients with disorders of digestive system. Identify
the main complaints.
7. Conduct inspection of abdomen. Determine examination plan, specify signs
of
abdomen in the normal conditions and pathological causes that lead to
abdomen changes.
8. Superficial palpation of the abdomen. Show the technique of palpation.
Indicate main signs that are defined during superficial palpation of the
abdomen.
9. Penetrative palpation of the abdomen. Indicate main points that are
determined during penetrative palpation of the abdomen.
10.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the sigmoid colon.
11.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the caecum colon.
12.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the ascending colon.
13.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the descending colon.
38
14.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the transverse colon.
15.Deep sliding palpation of the abdomen (by Obraztsov-Strazhesko). Indicate
recommended sequence of the examination. Show the technique of deep
sliding palpation of the stomach.
16.Palpation of the liver. Show the technique of palpation. Identify the main
basic signs that are determined during palpation of the liver.
17.Percussion of the liver (by M.G. Kurlov). Show the percussion technique to
determine the liver borders. Identify normal sizes of the liver. Indicate
pathological causes that lead to liver borders changes.
III.
Control Test of theoretical knowledge.
1. Obstructive jaundice (subhepatic jaundice) - it is characterized by
a) Orange-yellow tint;
b) Lemon-yellow tint;
c) Greenish- yellow tint;
d) Pale tint.
2. Itching of skin is the most typical symptom for:
a) Syndrome of bile ducts dyskinesia;
b) Syndrome of jaundice;
c) Syndrome of gastrointerstitial bleeding;
d) Syndrome of portal hypertension.
3. Beerlike color of urine is typical for:
a) Syndrome of jaundice;
b) Syndrome of gastrointerstitial bleeding;
c) Syndrome of portal hypertension;
39
d) Syndrome of functional dyspepsia.
4. Chronic diseases of the liver, chronic infections, autoimmune hepatitis, liver
cirrhosis, chronic active hepatitis reflect increasing of:
a) α1-globulins;
b) α2-globulins;
c) β-globulins;
d) γ-globulins.
5. Tenderness in Ker`s point is typical for:
a) Syndrome of jaundice;
b) Syndrome of gastrointerstitial bleeding;
c) Syndrome of bile ducts dyskinesia;
d) Syndrome of functional dyspepsia.
6. Causes of syndrome of functional dyspepsia all except:
a) alimentary faults;
b) pancreatitis;
c) reception of medicines;
d) infectious of a stomach mucous by Helicobacter pilory.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
40
Topic 8
CHRONIC GASTRITIS AND DUODENITIS
PEPTIC ULCER (ULCER DISEASE)
CALCULUS CHOLECYSTITIS (CHOLELITIASIS)
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “gastritis and duodenitis”.
2. Indicate etiological
factors
and
pathogenesis
of
chronic gastritis
(Helicobacter pylori).
3. Specify classification of chronic gastritis according to the types of gastritis
and special forms.
4. What clinical featurs of gastroduodenitis you know? What sings of
gastroduodenitis can be found during objective examination?
5. What additional methods of examination can help in the diagnosis of
gastroduodenitis and what changes can be detected?
6. Give the definition for “Ulcer disease or peptic ulcer”. Indicate etiological
factors of ulcer disease.
7. Specify classification of ulcer disease (According to the localization,
According to the etiology, According to the stage of the process, According
to the accompanied morphological changes, According to the complications
development).
8. Describe detailed the nature of pain in patients with ulcer disease.
9. What clinical featurs of ulcer disease you know?
10.What sings of ulcer disease can be found during objective examination?
11.What complications can occur in patients with peptic ulcer?
12.What additional methods of examination can help in the diagnosis of peptic
ulcer and what changes can be detected?
41
13.Define the concept of “calculus cholecistitis”, “cholelitiasis” and
“choledocholitiasis”. Indicate etiological factors of cholecistitis.
14.Indicate pathogenesis and of classification cholecistitis.
15.What clinical featurs of cholecistitis you know?
16.What sings of cholecistitis can be found during objective examination?
17.What additional methods of examination can help in the diagnosis of
cholecistitis and what changes can be detected?
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning of the patient, inspection and palpation of its abdomen
in a patient with chronic gastritis. Identify the major syndromes.
2. Analyze the results of a study of gastric contents in patients with chronic
gastritis. Determine the state of gastric secretion and estimate its acidforming function.
3. Conduct questioning, inspection and palpation of the abdomen in patient
with peptic ulcer disease. Identify the major syndromes, identify possible
localization of ulcers.
4. Conduct questioning, inspection and palpation of the abdomen in a patient
with chronic cholecystitis. Check the main symptoms typical for affection of
gallbladder. Identify the major syndromes.
5. Evaluate the results of duodenal intubation of patients with diseases of the
stone in biliary tract. Identify the main symptoms and localization of lesions.
III.
Control Test of theoretical knowledge.
1. Positive Kerras’, Murphys’, Ortners’ and Mussis’ symptoms typical for:
a) Ulcer disease;
b) Gastroduodenitis;
42
c) Pancreatitis;
d) Cholecistitis.
2. Signs dysbacteriosis in coprology study is typical for:
a) Gastroduodenitis;
b) Chronic virus hepatitis;
c) Ulcer disease;
d) Calculus cholecistitis.
3. Complications of ulcer disease all except:
a) perforation;
b) stenosis;
c) hemorrhoids;
d) malignization.
4. Aching pain that arises in right upper quadrant or upper abdominal, which may
radiate to the right scapular area is typical for:
a) Ulcer disease;
b) Gastroduodenitis;
c) Chronic virus hepatitis;
d) Cholecistitis.
5. Nocturnal, hunger pain, which is abated after taking food is typical for:
a) Gastroduodenitis;
b) Chronic virus hepatitis;
c) Ulcer disease;
d) Cholecistitis.
6. Presence of bilious pigments in clinical urine analysis typical for:
a) Ulcer disease;
43
b) Gastroduodenitis;
c) Liver cirrhosis;
d) Cholecistitis.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
44
Topic 9
CHRONIC HEPATITIS, CHRONIC VIRUS HEPATITIS, LIVER
CIRRHOSIS. MAIN CLINICAL AND LABORATORY MANIFESTATIONS
OF CHRONIC HEPATITIS AND LIVER CIRRHOSIS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Define the concept of “chronic hepatitis”. Indicate etiological factors of chronic
hepatitis.
2. Specify classification of chronic hepatitis (I. According to the etiology and
pathogenesis; II. According to the clinico-biochemical and histological criteria:
a. According to the degree o f activity, b. According to the index o f histologic
activity (IHA) on Knodell in points; III. According to the stage of a chronic
hepatitis (defined by prevalence of fibrosis and development o f liver cirrhosis).
3. Define the concept of “Chronic virus hepatitis (CVH)”. Specify classification of
“Chronic virus hepatitis (CVH)”.
4. What clinical featurs of CVH you know?
5. What sings of CVH can be found during objective examination?
6. What additional methods of examination can help in the diagnosis of CVH and
what changes can be detected?
7. Define the concept of “liver cirrhosis”. Indicate etiological factors of liver
cirrhosis.
8. Indicate pathogenesis of liver cirrhosis.
9. What clinical featurs of liver cirrhosis you know?
10.What sings of liver cirrhosis can be found during objective examination?
11.What complications can occur in patients with liver cirrhosis?
12.What sings of liver cirrhosis can be found during additional methods of
examination?
45
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning and examination of the patient with hepatitis. Identify the
main symptoms and syndromes.
2. Conduct questioning and examination of the patient with liver cirrhosis.
Identify the main symptoms and syndromes.
3. Conduct physical examination of the patient with hepatitis. Identify the major
syndromes based on the results of biochemical blood tests and urinalysis.
4. Conduct physical examination of the patient with cirrhosis. Identify the major
syndromes based on the results of biochemical blood tests and urinalysis.
III.
Control Test of theoretical knowledge.
1. Extra hepatic displays of virus hepatitis include all except:
a) Shegren syndrome;
b) Vasculitis;
c) Reino syndrome;
d) Conn's syndrome.
2. Enlargement or decline of the liver sizes is typical for:
a) Chronic virus hepatitis;
b) Ulcer disease;
c) Gastroduodenitis;
d) Calculus cholecistitis.
3. In palpation of the liver and spleen in the presence of virus hepatitis can be
found:
a) Liver is non-palpable;
46
b) Changes of liver lower edge, surface, consistency;
c) Hepatosplenomegaly;
d) Lower liver border and spleen are not accessible for palpation.
4. Edematous ascitic syndrome even anasarca typical for:
a) Ulcer disease;
b) Liver cirrhosis;
c) Gastroduodenitis;
d) Cholecistitis.
5. Red color blood on the stool surface in coprology study may be detected in case
of:
a) Liver cirrhosis;
b) Ulcer disease;
c) Gastroduodenitis;
d) Cholecistitis.
6. Revealing of varicous expanded veins of an esophagus and stomach can be
detected in the presence of:
a) Gastroduodenitis;
b) Ulcer disease;
c) Cholecistitis;
d) Liver cirrhosis.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
47
Topic 10
THE MAIN SYNDROMES OF URINARY SYSTEM: NEPHRITIC
SYNDROME, THE URINARY SYNDROME, THE SYNDROME OF
ACUTE RENAL FAILURE, THE SYNDROME OF CHRONIC RENAL
FAILURE.
GLOMERULONEPHRITIS AND PYELONEPHRITIS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. List all syndromes typical for the diseases of urinary system.
2. Nephritic syndrome, give the definition.
3. What are the main etiological factors of nephritic syndrome (nephritic
syndrome caused by chronic renal disease, acute renal diseases and fast
advance renal affection)?
4. Indicate pathogenesis of nephritic syndrome.
5. Specify forms of nephritic syndrome (according to the cause, according to
the variants of duration).
6. What the main clinical featurs of nephritic syndrome can be detected during
objective examination?
7. What additional methods of examination can be used to identify the
nephritic syndrome and what signs of this syndrome can be detected?
8. Urinary syndrome, give the definition.
9. Indicate etiological factors of urinary syndrome (urinary syndrome caused
by pathology of the kidney and urinary tract and extrarenal pathology).
10.What clinical featurs of urinary syndrome you know? (Indicate
manifestations depending on the disease).
11.Syndrome of acute renal failure, give the definition.
48
12.Indicate classification of syndrome of acute renal failure depending on the
cause, character of duration and period.
13.What the main clinical featurs of syndrome of acute renal failure can be
detected during objective examination?
14.Please list syndromes associated with syndrome of acute renal failure and
can be detected during objective examination of patient.
15.What additional methods of examination can be used to identify the
syndrome of acute renal failure and what signs of this syndrome can be
detected?
16.Syndrome of chronic renal failure, give the definition.
17.Specify etiological factors of chronic renal failure syndrome (main causes).
18.Describe pathogenesis of chronic renal failure syndrome.
19.Please list syndromes associated with syndrome of chronic renal failure and
can be detected during objective examination of patient.
20.Please list signs of chronic renal failure according to the periods.
21.What additional methods of examination can be used to identify the
syndrome of chronic renal failure and what signs of this syndrome can be
detected?
22.What is glomerulus’s filtration rate? By what formula we calculate
glomerulus’s filtration rate (GFR)?
23.Indicate classification of chronic renal diseases (according to GFR).
24.Please list additional instrumental methods of examination for establishing
syndrome of chronic renal failure.
25.Define glomerulonephritis. What etiologic factors of glomerulonephritis you
know?
26.Provide basic classification of glomerulonephritis.
27.Describe pathogenesis of glomerulonephritis.
28.Describe pathogenesis of arterial hypertension on glomerulonephritis.
29.Define acute glomerulonephritis. Specify the main clinical featurs of acute
glomerulonephritis that can be detected during objective examination.
49
30.What additional methods of examination can be used to identify the acute
glomerulonephritis (indicate changes that can be detected)?
31.List complications of acute glomerulonephritis.
32.Define fast advance glomerulonephritis. Specify the main clinical featurs of
fast advance glomerulonephritis that can be detected during objective
examination.
33.What additional methods of examination can be used to identify the fast
advance glomerulonephritis (indicate changes that can be detected)?
34.List complications of fast advance glomerulonephritis.
35.Lists know to you forms of chronic glomerulonephritis.
36.Specify main clinical featurs of chronic glomerulonephritis (nephritic form)
that can be detected during objective examination and violations that can be
detected by additional methods of examination.
37.Specify main clinical featurs of chronic glomerulonephritis (hypertensive
form) that can be detected during objective examination and violations that
can be detected by additional methods of examination.
38.Specify main clinical featurs of chronic glomerulonephritis (mixed form)
that can be detected during objective examination and violations that can be
detected by additional methods of examination.
39.Specify main clinical featurs of chronic glomerulonephritis (latent form) that
can be detected during objective examination and violations that can be
detected by additional methods of examination.
40.Define pyelonephritis and specify classification of pyelonephritis.
41.Describe the etiology and pathogenesis of pyelonephritis.
42.Specify main clinical featurs of acute pyelonephritis that can be detected
during objective examination and violations that can be detected by
additional
methods
of
examination.
List
complications
of
acute
pyelonephritis.
43.Specify main clinical featurs of chronic pyelonephritis that can be detected
during objective examination and violations that can be detected by
50
additional methods of examination. List complications of chronic
pyelonephritis.
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct questioning of patients with disorders of urinary system. Identify
the main complaints.
2. Palpation (by Obraztsov-Strazhesko) and percussion (Pasternatsky`s
symptom) of the kidneys. Identify the basic signs that are determined during
palpation and percussion of the kidneys.
3. Conduct questioning, inspection and objective examination of the patient
with nephritic syndrome and set the typical complaints and symptoms.
4. Conduct questioning, inspection and objective examination of the patient
with urinary syndrome and set the typical complaints and symptoms.
5. Conduct physical examination of a patient with kidney disease
(glomerulonephritis or pyelonephritis). Identify the major syndromes.
6. Analyse urinalysis of a patient with kidney disease. Identify the main
symptoms and syndromes. Make a conclusion about the nature of kidney
damage.
III.
Control Test of theoretical knowledge.
1. “Facies nephritica” is typical sign of:
a) urinary syndrome;
b) nephritic syndrome;
c) urethrical syndrome;
d) none of the listed.
2. In Clinical urine analysis for nephritic syndrome is typical all except:
51
a) High specific gravity;
b) Proteinuria (≥3g/24h);
c) Macrohematuria;
d) Large amount of cylinders.
3. Renal cause of acute renal failure:
a) Urinary tract obstruction;
b) Inflammatory renal diseases;
c) Diarrhea and vomiting;
d) Overdose of diuretics.
4. Indicate GFR typical for Stage V Chronic Renal Diseases:
a) 60-89 ml/min;
b) 30-59 ml/min;
c) 15-29 ml/min;
d) less than 15 ml/min.
5. Combination of hypoproteinemia and hypercholisterinemia in biochemical
blood analysis is a typical feature for:
a) urinary syndrome;
b) nephritic syndrome;
c) urethrical syndrome;
d) renal failure syndrome.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
52
Topic 11
THE MAIN SYMPTOMS AND SYNDROMES OF BLOOD SYSTEM: THE
SYNDROME OF ANEMIA, MYELOPROLIFERATIVE SYNDROME,
SYNDROME OF BLEEDING DISORDERS. LABORATORY DIAGNOSIS
Type of a lesson – theoretical and practical.
I.
Please answer the following questions (Theoretical knowledge).
1. List the major syndromes in the blood system. Define these syndromes.
2. Indicate known to you types of anemias. Define these anemias.
3. Syndrome of anemia, give the definition.
4. Classification of anemia.
5. Indicate known to you symptoms and signs of anemia.
6. Describe the main clinical features of syndrome of anemia that can be
detected during an objective examination.
7. Describe the main signs features of syndrome of anemia that can be detected
during additional methods of examination.
8. Bone marrow examination: specify the main purpose of this research and
diagnostic value.
9. Specify diagnostic value of biochemical blood analysis in establishing
syndrome of anemia.
10.Evaluation o f hemoglobin structure and biosynthesis. Diagnostic value.
11.Provide additional methods of examination that helps in diagnosing
syndrome of anemia.
12.Classification of syndrome of bleeding disorders.
13.Describe the main clinical features of syndrome of bleeding disorders that
can be detected during an objective examination.
14.Describe the main signs features of syndrome of bleeding disorders that can
be detected during additional methods of examination.
53
15.Tests for plasma factors involved in coagulation and fibrinolisis. Diagnostic
value.
16.Iron deficiency anemia, give the definition.
17.Provide main etiological factors of Iron deficiency anemia.
18.Describe the main clinical features of Iron deficiency anemia that can be
detected during an objective examination.
19.Provide additional methods of examination that helps in diagnosing Iron
deficiency anemia.
20.Megaloblastic anemia, give the definition.
21.Etiology of vitamin B12-deficiencv anemia.
22.Etiology of folic acid deficiency anemia.
23.Describe the main clinical features of Megaloblastic anemia that can be
detected during an objective examination.
24.Provide additional methods of examination that helps in diagnosing
Megaloblastic anemia.
25.Hemolytic anemias, give the definition.
26.Classification of Hemolytic anemias.
27.Describe the main clinical features of Hemolytic anemias that can be
detected during an objective examination.
28.Describe the main signs features of Hemolytic anemias that can be detected
during additional methods of examination.
29.Hereditary spherocytic anemia, give the definition.
30.Provide three main mechanisms causing hereditary spherocytic anemia.
31.Describe the main clinical features of hereditary spherocytic anemia that can
be detected during an objective examination.
32.Describe the main signs features of hereditary spherocytic anemia that can be
detected during additional methods of examination.
33.Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency anemia, give the
definition.
54
34.Etiology of Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
anemia.
35.Describe the main clinical features of Glucose-6-phosphate dehydrogenase
(G-6-PD) deficiency anemia that can be detected during an objective
examination.
36.Describe the main signs features of Glucose-6-phosphate dehydrogenase (G6-PD) deficiency anemia that can be detected during additional methods of
examination.
37.Thalassemias syndrome, give the definition.
38.Describe the main clinical features of α-thalassemia and β-thalassemia that
can be detected during an objective examination.
39.Describe the main signs features of α-thalassemia and β-thalassemia that can
be detected during additional methods of examination.
40.What special tests to establish α-thalassemia and β-thalassemia you know?
41.Sickle cell anemia - chronic hemolytic anemia give the definition.
42.Indicate the main clinical features of chronic hemolytic anemia that can be
detected during an objective examination.
43.Indicate the main signs features of chronic hemolytic anemia that can be
detected during additional methods of examination.
44.Define the concept of hemoblastosis.
45.Classification of hemoblastosis.
46.Indicate etiology and pathogenesis acute myeloblastic leukemia.
47.Indicate the main clinical features of acute myeloblastic leukemia that can be
detected during an objective examination.
48.Indicate the main signs features of acute myeloblastic leukemia that can be
detected during additional methods of examination.
49.Define the concept of chronic myelocytic leukemia.
50.Indicate etiology and pathogenesis chronic myelocytic leukemia.
51.Indicate the main clinical features of chronic myelocytic leukemia that can be
detected during an objective examination.
55
52.Indicate the main signs features of chronic myelocytic leukemia that can be
detected during additional methods of examination.
53.Define the concept of polycythemia vera.
54.Indicate the main clinical features of polycythemia vera that can be detected
during an objective examination.
55.Indicate the main signs features of polycythemia vera that can be detected
during additional methods of examination.
56.Define the concept of acute lymphoblastic leukemia.
57.Specify etiology and pathogenesis acute lymphoblastic leukemia.
58.FAB-classification.
59.Specify the main clinical features of acute lymphoblastic leukemia that can
be detected during an objective examination.
60.Specify the main signs features of acute lymphoblastic leukemia that can be
detected during additional methods of examination.
61.Specify the main clinical features of chronic lymphoblastic leukemia that can
be detected during an objective examination.
62.Specify the main signs features of chronic lymphoblastic leukemia that can
be detected during additional methods of examination.
63.Hemophilia (hemophilia B, hemophilia C), give the definition.
64.Indicate the main clinical features of hemophilia that can be detected during
an objective examination.
65.Describe the main signs features of hemophilia that can be detected during
additional methods of examination.
66.Define Idiopathic thrombocytopenic purpura (Werlhoff’s disease), and
specify the main features of this disease that can be detected during an
objective examination and additional methods of examination.
67.Define Henoch-Schoenlein syndrome, and specify the main features of this
disease that can be detected during an objective examination and additional
methods of examination.
56
II.
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
1. Conduct physical examination of a patient with anemia. Identify the major
symptoms and syndromes, based on complete blood count to determine the
nature of anemia.
2. Analyze complete blood count of the patient with leukemia. Identify the
main laboratory symptoms and type of chronic leukemia.
3. Palpation of the spleen. Show the technique of palpation. Identify the main
basic signs that are determined during palpation of the spleen.
4. Palpation of lymph nodes. Specify main lymph nodes. Determine signs of
lymph nodes that need to be determined during palpation and pathological
causes leading to enlarged lymph nodes.
III.
1.
Control Test of theoretical knowledge.
Normal values of erythrocytes count in men:
a) 5.5±1.0 x 1012/1;
b) 10,8±1.0 x 1012/1;
c) 15,5±1.0 x 1012/1;
d) 20,0±1.0 x 1012/1.
2.
Normal values of hemoglobin in men:
a) 10.5±2.5 g/dl;
b) 2.5±2.5 g/dl ;
c) 5.5±2.5 g/dl;
d) 15.5±2.5 g/dl.
3.
Normal values of hemoglobin in women:
a) 10.0±2.5 g/dl;
57
b) 12.0±2.5 g/dl;
c) 14.0±2.5 g/dl;
d) 16.0±2.5 g/dl.
4.
What values of color index can be characteristic for vitamin B12
deficiency anemia:
a) less than 0.8;
b) 1.2-1.5;
c) more than 1.1;
d) 0.85-1.1.
5.
Normal number of thrombocytes (platelets) is:
a) 100.0-220.0 x 109/l ( 180000-320000 per 1 µl);
b) 120.0-320.0 x 109/l ( 180000-320000 per 1 µl);
c) 180.0-320.0 x 109/l ( 180000-320000 per 1 µl);
d) 200.0-420.0 x 109/l ( 180000-320000 per 1 µl).
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
58
Topic 12
MAJOR SYNDROMES IN SYSTEMIC DISEASES
Type of a lesson – theoretical and practical.
I.
II.
Please answer the following questions (Theoretical knowledge).
Demonstrate the following methods for objective examination of the
patient (Рractical skills).
III.
Control Test of theoretical knowledge.
Suggested Reading: Propaedeutics to Internal Medicine: Syndromes and diseases;
textbook for English learning Students of higher medical schools; Part 2; Ed. 2 /
O.N. Kovalyova, S. Shapovalova, O.O. Nizhegorodtseva
– Vinnytsya: Nova
Knyha publishers, 2011. – 264 p.
59
Topic 13
EVALUATION OF STUDENT KNOWLEDGE
ON FINAL MODULE
The final module control includes two situational tasks, practical skills and
control test of theoretical knowledge that are added.
Maximum points that can be earned for the module is 100 points:
- control test of theoretical knowledge – 50 points;
- 2 situational tasks – each task is rated at 20 points;
- practical skill – 10 points.
Minimum points that can be earned for the module is 50 points:
Module consists of two parts:
- First part of the module involves writing control test of theoretical
knowledge. Maximum – 50 points, minimum – 25 points. *
- Second part of the module consists of two situational tasks (each task is
rated at 20 points) and practical skill (10 points). Maximum – 50 points,
minimum – 25 points.
The final score of the module
Evaluation of a four-system
100……….85
"Excellent" – 5
84…….…70
"Good" – 4
69…….…50
"Satisfactory" – 3
49…….….0
"Unsatisfactory" – 2
* If student received less than 25 points on first part of the module this involves
re-writing of the first part (control test of theoretical knowledge). In this situation
student not permitted to the second part of the module and in convenient for
teacher and for student time again writes test control of theoretical knowledge. In
60
case of receiving 25 or more points for test control student is admitted to the
second part of the module.
Approved at the department meeting Propaedeutics of Internal Medicine №1
“
“ of ____________ 20___ year
Head of the chair ______________ Prof. MD Dutka R.J.
61