5. Methods of educational process in the practice.

5.1. The starting phase.

To reveal the theme sessions for medical profession to develop the motivation for focused learning activities. To acquaint students with specific goals and plan activities.

In class, students solve a specific problem, learn to make diagnosis, conduct differential diagnosis of diseases, prescribe appropriate treatment regimens and prevention.

5.2. The main stage

At this stage the student will continue to build professional skills. Particularly at the bedside student demonstrates the ability to collect complaints, history of disease and life, to make an objective examination of the patient by different systems and organs and on the basis of the data to the differential diagnosis to establish a preliminary diagnosis. To support his opinion, the student makes the plan an additional examination of the patient. Synthesizing all the data obtained during examination of the patient, the student formulates a final clinical diagnosis according to modern classification and diagnostic criteria. Analysis of the results allows the student to prescribe appropriate treatment of the patient depending on clinical variant and degree of activity, complications, comorbidities and give recommendations for further treatment and lifestyle.

5.3. The final stage

Assessment of action of each student during class and standardized end control. It conducted the analysis of student achievement, announced rating of each student and put in the book of visits and student achievement. Parish groups simultaneously puts rating in accounting performance and attendance of students. The teacher assures them his signature.

Brief information for students on the theme of the next lesson and instructional techniques to prepare for it.

Task №1.

Patient L. 54, smokes 20 years, complained of shortness of breathing that progresses over several years, increasing during exacerbations of bronchitis, after exercise, inhalation of cold, moist air, sharp odor. Condition worsened after hypothermia 3 days ago. There was marked general weakness, fever to 38.50C, not enough effect of NSAIDs. Increased cough with yellow-green sputum, palpitation.

Examination: The skin, mucous membranes pale, gray color. Chest is emphysematous, additional muscles takes part in breathing. The RR 20/min. Heart rate 100/min, BP 135/80 mmHg. Resistance of the chest is enlarged, vocal fremitus is weakened, percussion sound is tympanicus, during auscultation - weakened vesicular breathing, diffused dry rales and wheezing.

The ECG: diffuse changes in the myocardium. overload of right heart. CBC: Er - 4,0 ∙ 10¹² / l, Hb - 135 g / l, CI - 1,0, Leuk. - 12,0 ∙ 10⁹ / L, eosinophils - 2%, segm. – 75%, lymph. - 12%, mon. - 11%, platelets - 210 ∙ 10⁹ / l, ESR - 25 mm/h. Total sputum analysis: sputum purulent, yellow-green liquid; leukocytes: 52 in visual field, neutrophils: 45 in visual field Chest X-ray: increased transparency of lung fields, enhanced pulmonary picture, the lower border of the lungs are shifted down. Spirometry: FEV1 - 63%, daily fluctuations -5%, test Tyffno - 65%, a negative test with bronchodilators.

1.Make the diagnosis.

2.What is the treatment should be prescribed for patient?