Vіі. Method of conducting and organizational structure of employment

Distributing of marks which can be got by a student:

At mastering of theme № 24 a thematic module 1 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 The thematic module 1

Surgical infection. Necrosis

Practical employment № 24

Theme: Purulent diseases of bones

Theoretical questions for the independent study and discussion on practical employment №24:

1. To know anatomical and physiological features of structure of long tubular bone and feature of its blood supply.

2. To know classification of osteomyelitis.

3. To know etiology, pathologic anatomy, pathogeny (thromboembolic theory of Lekser and infectiously-allergic theory of Derizhanov), clinical signs and features of flow of different forms of osteomyelitis.

4. To know the methods of rehabilitation at osteomyelitis.

5. To capture the technique of methodical dosed percussion of bone at acute hematogenous osteomyelitis (AHO).

6. Able to interpret sciagrams at the different forms of osteomyelitis.

7. Able to conduct differential diagnostics AHO with rheumatism, intermuscular phlegmon, fracture, erysipelas.

8. To capture the technique of interosseal punction with the purpose of diagnostics and treatment.

Literature:

Basic:

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

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

3. Gostishchev V.K. General surgery / The manual. – M.: GEOTAR-MED, 2003. – P. 164-170.

Additional:

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

2. Methodological recommendations on surgical patients care. – Vinnitsa National Pirogov Memorial medical university.

Distributing of marks which can be got by a student:

At mastering of theme № 24 a thematic module № 1 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 №24

1. In what age more frequent acute hematogenous osteomyelitis develops?

а) 1-10 years;

b) 11-20;

c) 21-30;

d) 31-40;

e) 41-50.

2. What bones more frequent are struck at hematogenous osteomyelitis?

а) femoral;

b) sciatic;

c) vertebrae;

d) tibial;

e) humeral.

3. The characteristic sign of what types of osteomyelitis sequestration of bone is?

а) abscess Brodie;

b) posttraumatic osteomyelitis;

c) Ollje osteomyelitis;

d) Garre osteomyelitis;

e) hematogenous osteomyelitis.

4. Name the distinctive signs of abscess Brodie:

а) cavity with sequestra;

b) cavity without sequestra;

c) mucous exudatum;

d) purulent exudatum;

e) diffuse osteosclerosis.

5. Name the distinctive signs of Garre osteomyelitis:

а) cavity in metaphysis;

b) bulge of bone;

c) presence of sequestra;

d) albumen exudatum;

e) osteosclerosis.

6. When the roentgenologic signs of acute hematogenous osteomyelitis appear?

а) in 3 days;

b) in 3 months;

c) in 10-15 days;

d) in 20-30 days;

e) in 30-40 days.

7. What basic signs of chronic hematogenous osteomyelitis?

а) atrophy of muscles;

b) osteoporosis;

c) presence of purulent fistula;

d) presence of sequestral box and sequestrum in her;

e) presence of cavity without sequestra.

8. For chronic hematogenous osteomyelitis are not characteristic:

а) frequent defeat of metaphysis and epiphysis tubular bones;

b) frequent defeat of diaphysis tubular bones;

c) rarely meeting atrophy of muscles;

d) the constantly observed atrophy of muscles;

e) rare defeat of the nearest joints.

9. What pathological changes are not observed at acute hematogenous osteomyelitis:

а) phlegmon of marrow;

b) subperiosteum abscess;

c) formation of cavity without sequestra;

d) paraossal and intermuscular phlegmon;

e) albumen exudatum.

10. What from the transferred microorganisms can not become the etiologic factor of origin of osteomyelitis?

а) intestinal stick;

b) staphylococcus;

c) stick of tetanus;

d) the diphtherial stick of Leffler;

e) protey.

11. What local clinical displays testify to the neglected cases of acute hematogenous osteomyelitis?

а) going of skin pale;

b) deformation of bone;

c) appearance of symptom of fluctuation;

d) formation of skin necrosis area;

e) formation of purulent fistula

12. What surgical receptions are most expedient at medical treatment of patient with acute hematogenous osteomyelitis?

а) only dissection of phlegmon;

b) dissection of phlegmon and section of periosteum;

c) resection of the staggered bone;

d) decompressive drainage of bone channel;

e) amputation of extremity.

13. What methods are most effective during sanation of bone cavity after radical sequestrectomy?

а) seal integrity by a gypsum;

b) myoplastic;

c) tamping;

d) the plastic arts by a collagen sponge with antiseptics;

e) seal integrity by a hypodermic fatty cellulose.

14. What medical measures are contra-indicated in the early stage of acute hematogenous osteomyelitis?

а) massage (+);

b) medical physical education;

c) creation of functional rest of the staggered region;

d) introduction of antibiotics;

e) setting of bacteriophage.

15. The most frequent complications at protractedly current chronic osteomyelitis:

а) cirrhosis of liver;

b) amiloidosis of buds;

c) endocarditis;

d) dystrophy of myocardium;

e) chronic anaemia.

Situation tasks for verification of eventual level of knowledges

1. The doctor of first-aid was caused in the evening to the 7-years-old boy in connection with worsening of his state. Approximately 1,5 days back a child with complaints about head pain was released from lessons home. On to the house he was examined by a district paediatrician and concerning a "acute respiratory viral infection" appointed anti-inflammatory and antibacterial preparations.

At examination the state of child is heavy, put on the brakes. Temperature of body 40 °C. According to a mother, before arrival of "first-aid" there were hallucinations. A face is pale, аcrоcyanosis. A pulse is 128 shots in a minute. Breathing — 28 in a minute, superficial. In the lower departments of lights hearkened to the dissipated dry and moist wheezes. A stomach is soft, painless. Liver, spleen not increased. Marked sickliness at palpation in lower third of right thigh, edema of him.

About what disease is it necessary to think? As far as will roentgenologic research be informing?

2. In the admission department of hospital a boy is delivered 9 years with complaints on pain in a right foot. It is ill during 2 weeks. Treated oneself on to the house. The state was worsened, therefore directed on stationary treatment.

Temperature of body each evening to 40 °C. In lights hearkened to the single dissipated dry and moist wheezes. A liver and spleen is not increased. An edema and hyperemia of skin is determined in lower third of right thigh, acute sickliness. A knee-joint is increased in a volume, a leg in him is half-bent, motions are sickly. It is additionally set that 3 a week ago struck a right thigh at a school desk.

Your diagnosis? What researches must be executed in an admission department?

3. A mother brought around to a reception to the surgeon of boy 13 years, which during the last year periodically aching pains disturb in overhead third of left shin. As a rule, pains appear at the change of weather and at nights.

Outwardly shin without features. The limited promoted sensitiveness is marked at pressing on on a tibia in the overhead third it. Motions in a knee-joint are carried out in full.

On sciagrams in spongy part of metaphysis of tibia the rounded cavity is determined by a diameter about 1 sm, surrounded well the visible area of sclerosis like a narrow border and tender periostitis impositions on a bone surface.

Your diagnosis?

4. Surgical infection department the sick entered with complaints on pain in a right shin, periodic increase of temperature of body to 38-39 °C. Moves by crutches. 12 months back carried the opened break. Treatment was conducted skeletal extraction and gipseous bandage. However from pains can not move independently.

On the front surface of right shin there is fistula with scanty purulent separated. A shin is an edema, round fistula there is moderate hyperemia of tissues. On sciagrams shins are marked false joint, end osteolisis of debris of tibia, endostal sclerosis, bulge and fringing of periost.

What diagnosis did the sick act with? What must be conducted additional methods of research?

5. On a reception to the surgeon the sick came A., 63 years, with complaints on pain in a left thigh, which appeared about a week ago. Suffers chronic osteomyelitis of left thigh about 40 years after a splinter wound.

According to patient, periodically on a thigh fistulas was opened with purulent separated and pull out of "stone".

Left thigh considerably thicker right. Motions in a left knee-joint are absent. On the outward surface of thigh there is a great number of crateriform of the pulled in and linear scars as a result before opened fistulas and carried operative interferences. The area of hyperemia of skin, slight swelling, sickliness, is here determined, in the center of palpate infiltrate is softening influence. Temperature of body 37,8 °C.

What diagnosis will you put a patient? Your diagnostic tactic?

6. Surgical infection department the sick entered with "infiltrate" of posterior and lateral wall of stomach on the right. To the patients counts itself about 8 days, when each evening began to mark the increase of temperature of body to 38-39 °C.

Three years back treated oneself concerning gun osteomyelitis of front surface of comb of ilium. A process deleted under act of conservative measures. Since considered itself absolutely healthy.

What complication is it necessary to suspect at patient?

7. A hospital of 23-years-old man, suffering chronic hematogenous osteomyelitis of right thigh chart comes into a question at medical conference. What changes in a bone will be observed on a sciagram for this patient?

8. The doctor of first-aid was caused in the evening to the 7-years-old boy in connection with worsening of his state. Approximately 1,5 days back a child with complaints about head pain was released from lessons home. On to the house he was examined by a district paediatrician and concerning a "acute respiratory viral infection" appointed anti-inflammatory and antibacterial preparations.

At examination the state of child is heavy, put on the brakes. Temperature of body 40 °C. According to a mother, before arrival of "first-aid" there were hallucinations. A face is pale, аcrоcyanosis. A pulse is 128 shots in a minute. Breathing — 28 in a minute, superficial. In the lower departments of lights hearkened to the dissipated dry and moist wheezes. A stomach is soft, painless. Liver, spleen not increased. Marked sickliness at palpation in lower third of right thigh, edema of him.

Your medical tactic?

9. In the induction centre of hospital a boy is delivered 9 years with complaints on pain in a right foot. It is ill during 2 weeks. Treated oneself on to the house. The state was worsened, therefore directed on stationary treatment.

Temperature of body each evening to 40 °C. In lights hearkened to the single dissipated dry and moist wheezes. A liver and spleen is not increased. An edema and hyperemia of skin is determined in lower third of right thigh, acute sickliness. A knee-joint is increased in a volume, a leg in him is half-bent, motions are sickly. It is additionally set that 3 a week ago struck a right thigh at a school desk.

Your medical tactic?

10. A mother brought around to a reception to the surgeon of boy 13 years, which during the last year periodically aching pains disturb in overhead third of left shin. As a rule, pains appear at the change of weather and at nights.

Outwardly shin without features. The limited promoted sensitiveness is marked at pressing on on a tibia in the overhead third it. Motions in a knee-joint are carried out in full.

On sciagrams in spongy part of metaphysis of tibia the rounded cavity is determined by a diameter about 1 sm, surrounded well the visible area of sclerosis like a narrow border and tender periostitis impositions on a bone surface.

Your medical tactic?

11. The sick entered into the surgical infection department with complaints on pain in a right shin, periodic increase of temperature of body to 38-39 °C. Moves by crutches. 12 months back carried the opened break. Treatment was conducted skeletal extraction and gipseous bandage. However from pains can not move independently.

On the front surface of right shin there is fistula with scanty purulent separated. A shin is an edema, round fistula there is moderate hyperemia of tissues. On sciagrams shins are marked false joint, end osteolisis of debris of tibia, endostal sclerosis, bulge and fringing of periost.

Your medical tactic?

12. On a reception to the surgeon the sick came A., 63 years, with complaints on pain in a left thigh, which appeared about a week ago. Suffers chronic osteomyelitis of left thigh about 40 years after a splinter wound.

According to patient, periodically on a thigh fistulas was opened with purulent separated and pull out of "stone".

Left thigh considerably thicker right. Motions in a left knee-joint are absent. On the outward surface of thigh there is a great number of crateriform of the pulled in and linear scars as a result before opened fistulas and carried operative interferences. The area of hyperemia of skin, slight swelling, sickliness, is here determined, in the center of palpate infiltrate is softening influence. Temperature of body 37,8 °C.

Your medical tactic?

13. On the sciagrams of sick S. in distal metaphisis of thigh-bone a cavity is determined with a freely lying sequestrum to 1,5 sm in a diameter. Operative treatment is shown a patient.

What did you offer for filling (seal integrity) of sequestral cavity after sequestrectomy and sanation of " sequestral coffin"?