Vіі. Method of conducting and organizational structure of employment

Distributing of marks which can be got by a student:

At mastering of theme № 32 a thematic module 4 for educational activity to the student the estimation for 4th is proposed to the traditional scale which is then converted in marks as follows:

Estimation	Balls
“5” (perfectly)	6
“4” (well)	4
“3” (satisfactorily)	2
“2” (unsatisfactorily)	0

Methodical pointing for work of students on practical employment Thematic module 4

Conduct of surgical patients

Practical employment №32

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

Theoretical questions for an independent study and discussion on practical employment №32:

1. To know governed and principles of anamnesis examination of surgical patient.

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

3. To know the method of objective examination of head, neck, thorax.

4. To lay hands on the method of anamnesis collection for surgical patients.

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

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

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. Methodical developments for audience and independent work of students. – Vinnitsa National Pirogov Memorial medical university. 2007.

Distributing of marks which can be got by a student:

At mastering of theme №32 a thematic module 4 for educational activity to the student the estimation for 4th is proposed to the traditional scale which is then converted in marks as follows:

Estimation	Balls
“5” (perfectly)	6
“4” (well)	4
“3” (satisfactorily)	2
“2” (unsatisfactorily)	0

Tests for verification of initial level of knowledges 32

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

Situation tasks for verification of eventual level of knowledges

1. In the induction centre of hospital the sick is delivered with the sword-cut of left forearm. At examination pays attention on itself square form of head, oblate from above, with salient frontal hillocks.

What does such form of head testify to?

2. To the surgeon of policlinic youth appealed 17 years, which was 1 hour ago beaten by unknown. At examination the mouth of patient is widely opened, a patient can not close a jaw, a lower jaw is pulled out ahead, swallowing and speech is laboured, mastication is impossible, a salivation is marked.

Formulate a diagnosis. Does treatment consist in what?

3. The woman of 63 years of 4 days ago felt acute pain in a right iliac area. Since then accepted anaesthetic facilities. The state was worsened. At a review a district doctor paid a regard to characteristic for inflammation of peritoneum (peritonitis) signs: the face of patient is pale with a cyanotic tint, sharply sharp lines, deeply by hollow full of suffering eyes, with the large drops of death-damp on a forehead.

What name is carried by this characteristic face?

4. A hunter by chance fired off and got in other hunter, in a interscapular area. To suffering conducted the rest room of wound, imposed an aseptic bandage and sent home. In 1 days the injured felt the strong compression of mouth, caused the tonic cramps of masticatory muscles.

How is the described symptom named? What disease does he accompany and is it possible it was to warn him?

5. In a hospital a boy is delivered 6 years, which 15 minutes back hammered together a car. At examination he has disproportion of pupils.

How is this symptom named? About what does testify one expansion of pupils?

6. A young man with a friend during a journey on a motor scooter did not manage with a management and rode into in a concrete fence. The doctor of first-aid in place of incident of visible vital sparks did not discover at none of victims. Then a doctor paid a regard to the state pupils which a man had extended, and for a woman – narrowed.

Why did a doctor pay a regard to the state pupils and what their expansion testifies to?

7. A surgeon examined a patient, directed for the planned operative treatment concerning inguinal hernia and paid a regard to thrusting out eyes at patient.

How is this symptom named? What pathological state does he accompany?

8. Describe changes in a thyroid at ІІ degrees of its increase.

9. For a patient 38 years in the upper-external quadrant of right mammary gland a surgeon noticed involvement of skin as a «lemon crust», there tumular new formation palpate to 2,5 sm in a diameter, dense, uneven, soldered with surrounding tissues. The lymphatic nodules of arm-pits are megascopic to 1,5 sm.

About what disease is it possible to talk at the exposure of such pathological changes? What research is it necessary to conduct for verification of diagnosis?

10. For a woman which suckles 4-monthly child, on the border of overhead quadrants of right mammary gland a surgeon noticed hyperemia of skin without clear scopes, at palpation is infiltrate to 3 sm in a diameter, local increase of temperature, pain, in a center area of softening influence.

What disease does speech go about? Am I in this situation of testimony to operative interference?

11. At sick, 68 years, operated concerning stone cholecystitis, stagnant pneumonia developed in an early postoperative period.

How to conduct determination of the vocal shaking for this patient? What changes here will be observed?

12. A fitter at implementation of height works broke away from a height ІІІ floor. Hospitalized in the thoracal surgery department with a diagnosis: closed break of the IV rib on the right, right-side hemothorax.

What changes of the vocal shaking will be observed in the projection of accumulation of blood?

13. A boy 8 years fell off a tree and got in the induction centre of hospital with suspicion on the break of ribs. Show the special diagnostic receptions which use for the break of ribs.

14. Describe the method of implementation of puncture of pleura cavity at presence of in the last liquid.

15. Describe the method of implementation of puncture of pleura cavity at presence of in the last air.