The module 2: Surgical infection.

Bases of clinical oncology. Curation of surgical patients.

Thematic module 4

Conduct of surgical patients

Practical employment №32

Theme: Method of examination surgical patients: head, neck, thorax

І. Actuality of theme

All is know the winged expression: "Qui bene diagnostit – bene curant" – " Who diagnoses – treats".

Modern methods of treatment can not be effective, if unknown, for what purpose to apply them. Last years possibilities for diagnostics broadened considerably, but also today the major component of diagnostic search is careful collection of anamnesis, systematic and skilled physical inspection and accomplished study of local status. Every future doctor must master the algorithm of inspection, which organically passes to the construction of medical tactic.

ІІ. Aims of employment:

1. To know governed and principles of anamnesis examination of surgical patient (α=ІІ).

2. To know pathological symptoms, which it can find out at the objective inspection of head, neck, thorax (α=ІІ).

3. To know the method of objective examination of head, neck, thorax (α=ІІ).

4. To lay hands on the method of anamnesis collection for surgical patients (α=ІІІ).

5. To lay hands on the methods of palpation, percussion and auscultation at the objective examination of head, neck, thorax (α=ІІІ).

6. Able to conduct examinations of mental, mandibular, parotid, back of head, front and back of neck, supraclavicular and arm-pits lymphatic nodules (α=ІІІ).

ІІІ. Providing of initial level of knowledges-abilities

Literature:

Basic:

1. Butyrsky A. General surgery. – Simferopol. 2004.

2. Shevchenko S.I. and others. Surgery. – Kharkov. 2004.

Additional:

1. Kushnir R.Lectures of General surgery. – 2005.

2. Methodological recommendations. – Vinnitsa National Pirogov Memorial medical university. 2007.

Tests for verification of initial level of knowledges

1. What is it trismus?

а) asymmetry of mouth crack

b) strong clench of mouth (+)

c) salivation

d) tonic cramps of masticatory muscles (+)

e) inflammation of trifacial

2. Sardonic smile – it is a sign:

а) wrong introduction of tetanic anatoxin

b) abbreviation of muscles of face at patients with a tetanus (+)

c) beginning of descending form of tetanus(+)

d) beginning of ascending form of tetanus

д) improvement of mood of patient

3. What facies Hyppocratica?

а) abbreviation of muscles of face at patients with a tetanus

b) falling back of the back of nose after carried Syphilis

c) puffy, pale face at chronic kidney insufficiency

d) typical face which is observed at peritonitis (+)

e) face with sharply sharp lines, deeply by hollow full of suffering eyes (+)

4. What is it exophthalmus?

а) goggle-eyed, thrusting of eyeballs out (+)

b) falling back of eyes

c) symptom characteristic for hyperfunction of thyroid (+)

d) one-sided falling back of eye

e) absence of reaction of pupil on light

5. What is it goitre?

а) the increase of front surface of neck is below than thyroid cartilage (+)

b) additional formation of trachea

c) increase of front-neck lymphatic nodes

d) destruction of thyroid cartilage

e) increase of thyroid (+)

6. What sectors (quadrants) a milk gland is divided on de bene esse

а) upper-external, upper -internal (+)

b) upper-areolar, lower-areolar

c) upper -mammarial, lower-mammarial

d) lower-external, lower-internal (+)

e) upper, lower

7. Characteristic for the malignant tumours of milk gland by signs are:

а) retraction nipple or skin (+)

b) the rounded form of education

c) soft-elastic consistency of tumour

d) mobility

e) «woody closeness» of a new formation (+)

8. What topographical lines on a thorax are used as reference points?

а) middle-clavicular (+)

b) front axillar (+)

c) thoracal

d) intercostal

e) phrenic

9. What basic signs of hyperstenic stature?

а) wide trunk, short neck (+)

b) prolate thorax, long neck

c) acute epigastral angle

d) obtuse epigastral angle (+)

e) common increase of stomach

10. How to define the vocal shaking?

а) to suggest to the patient to repeat words the «cup of tea»

b) by means stethophonendoscope

c) to suggest to the patient to repeat words «thirty three» (+)

d) close to attach hands to both halves of thorax (+)

e) to lean an ear to the thorax of patient

11. How to conduct punction of pleura cavity

а) on a middle-clavicular line in ІV intercostal space

b) on a back axillar line in VІІ intercostal space (+)

c) on an parasternal line in ІІІ intercostal space

d) on the upper edge of the below located rib (+)

e) on the lower edge of the higher located rib

12. To the basic complaints characteristic for the diseases of organs of breathing belong:

а) nose-bleed

b) shortness of breath (+)

c) hiccup

d) cold

e) haemoptysis (+)

13. What topographical departments a neck is divided into?

а) front (+)

b) middle

c) tracheal

d) back (+)

e) vertebral

14. At palpation of thyroid in a norm:

а) a gland palpated easily

b) an isthmus palpated (+)

c) stakes not palpated (+)

d) a gland palpated at swallowing

e) a gland palpated above a thyroid cartilage

15. What departments a thyroid consists of?

а) head

b) body

c) stakes (+)

d) tail

e) isthmus (+)