Vііі. The method of conducting of employment is that organizational structure of employment

Distributing of marks that can get students:

At mastering of theme № 3 from rich in content to the module №1 for educational activity to the student the estimation for 4th is proposed by a mark (traditional) scale which are after converted in marks as follows:

Estimation	Marks
“5”(fine)	7 marks
“4” (well)	6 marks
“3”(satisfactorily)	5 marks
“2” (unsatisfactorily)	0 marks

Technological card of employment

№	Basic stages of employment, them functions and maintenance	Level of mastering of know­ledge	Methods of control of teaching	Materials of methodical providing	Distributing of time (min)
1. 2. 3.	Preparatory stage Organizational measures Raising of educational purposes is that motivation Control of initial level of knowledge, skills and abilities: Specificity of exciters of sharp specific surgical infection; Close the origin of sharp specific surgical infection; Determination of sharp specific surgical infection; Clinical symptoms of sharp specific surgical infection; Methods of diagnostics of sharp specific surgical infection; Conservative and operative medical treatment of sharp specific surgical infection; Sanitary-hygienic mode at the care of patients with a sharp specific surgical infection; Specific and unspecific prophylaxis of sharp specific surgical infection.	ІІ ІІ ІІ ІІ ІІ ІІ ІІ ІІ	Individual questioning Tests ІІ of	P.1 Actuality of theme P.2 Educational purposes Tables: Classification of gas gangrene, tetanus, diphtheria, sibiries. Sciagrams. Operative medical treatment of gas gangrene.	1-3 5 15
4.	Basic stage 1) Features of motion of gas gangrene, tetanus, anthrax, diphtheria of wounds; 2) Principles of conduct of patients with a gas gangrene, tetanus, sibiries, by diphtheria of wounds ; 3) Operative medical treatment of gas gangrene; 4) Prophylaxis of gas gangrene, tetanus, sibiries and diphtheria of wounds; 5) Sanitary-hygienic mode in the separations at medical treatment of gas gangrene, tetanus, anthrax, diphtheria of wounds	ІІІ ІІІ ІІІ ІІІ ІІІ	Professional training in the decision of typical clinical tasks Practical training	Employment is conducted in an educational room Employment is conducted in the festering bandaging Tasks of ІІІ level	15 20 15
5. 6. 7.	Final stage Control and correction of level of professional abilities and skills Work out the totals of employment Domestic task (basic and additional literature after a theme)	ІІІ	Individual control of skills Tests of ІІІ level	Tests of ІІІ level Tasks of ІІІ level Short methodical pointing to work on practical employment	12

Theme 25: Tetanus. Anaerobic gas gangrene, etiology, pathogenesis, clinic, diagnostics, medical treatment, prophylaxis.

1. Most favorable for development of tetanus is considered:

a) wounds after the planned operations;

b) wounds after dissection of abscess;

c) deep cut wounds;

d) superficial damages - scratch, which heal over under a scab;

e) wounds with widespread necrosis of fabrics, muddy by earth.

2. The heavy form of tetanus has a latent period by duration:

a) 3-4 weeks;

b) 2-3 weeks;

c) 1-2 weeks;

d) 5-7 days;

e) 2-3 days.

3. To the basic clinical symptoms of tetanus belongs all transferred except for:

a) loss of pain sensitiveness;

b) rigidity masticator muscles and muscles of the back of head;

c) tonic-clonic cramps;

d) dysphagya;

e) rise of temperature.

4. The clinical signs of sibiries to the carbuncle are characterized (right all after the exception):

a) by the presence of hollow ulcer with a necrotic bottom darkly – red color;

b) inflammatory fold with the crown of vesicle, dense basis and widespread edema round;

c) by painlessness to the carbuncle;

d) by the selection of a plenty of thick pus;

e) by the selection of far of serous liquid.

5. Medical treatment of skin forms of sibiries includes all transferred after the exception:

a) introduction of specific against a serum sibiries in a dose to 100ml;

b) introduction of specific against sibiries hamaglobulin to 120ml;

c) antibiotic therapy (penicillin, tetracycline, cephalosporin, phtorchinolon);

d) the extended surgical treatment;

e) bandages with solution of antiseptics, by antibacterial ointments on a hydrophilic basis.

6. Diphtheria of wounds peculiar (right all except for):

a) massive layer of fibrin on a surface;

b) selection of thick pus with a characteristic smell;

c) serous - bloody excretions;

d) edema of surrounding fabrics and skin;

e) regional lymphadenitis.

7. Optimum terms for development of gas gangrene arise up at:

a) the closed breaks;

b) mechanical damages of skin covers;

c) burn II-IV degree;

d) getting of the II-IV degree frost-bitten;

e) bites of insects.

8. The characteristic local signs of gas gangrene are:

a) inflammatory reaction, necrosis, was swollen, intoxication;

b) absence of inflammatory reaction, was swollen, necrosis;

c) it was swollen, lymphangitis;

d) elephant;

e) leucocytosis of bactriemia, subfascial phlegmon.

9. Overwhelming localization of process at a gas gangrene is:

a) head, neck;

b) extremities;

c) trunk;

d) crotch;

e) intestine.

10. At action on the organism of exciters of gas gangrene develop:

a) numerous abscesses;

b) removing of epidermis a layer by a layer with necrosis of hypodermic cellulose;

c) gas formation with necrosis of muscles and connecting fabric;

d) traumatic shock;

e) necrosis of skin, muscles, bone fabric.

11. The following forms of gas gangrene are clinically distinguished:

a) quick as lightning, lifeless flow;

b) sharp, subsharp;

c) sharp, chronic;

d) chronic, recidivate;

e) sharp, recidivate.

12. Pathanatomic is distinguished by the following forms of gas gangrene:

a) erytematous, bulous, phlegmonous, necrotic;

b) metastasis, septic;

c) septic, septicopyemic;

d) emphysematous, necrotic, phlegmonous, edema;

e) catarrhal, septic.

13. After anatomic classification such forms of gas gangrene are selected:

a) epifascial, subfascial;

b) intrajoint;

c) intrabone;

d) epidural, subdural;

e) skin, hypodermic, muscular.

14. Characteristic signs of gas gangrene at the review of wound are:

a) it was swollen, hyperemia, festering excretions;

b) it was swollen, red spots and way on a skin;

c) fetid selection from a wound, pallor of skin;

d) emphysema, rapid growth of edema;

e) pains in a wound, was swollen, convulse of muscles.

15. The unspecific prophylaxis of gas gangrene includes:

a) primary surgical treatment of wound;

b) massive antibiotic therapy;

c) introduction of antigangrenous serum;

d) introduction around wound by antibiotics;

e) determination of sensitiveness of exciter to the antibiotics.

16. The most essential medical measures at a gas gangrene are:

a) antishock therapy;

b) introduction of medical doses of antitetanus serum;

c) desensibilization and antibacterial therapy;

d) opening of hearth of infection with necrectomy and oxybarotherapy;

e) introduction around of hearths of defeat by antibiotics.

17. What minimum dose of antigangrenous serum at medical treatment of gas gangrene:

a) 30 000 IU;

b) 90 000 IU;

c) 150 000 IU;

d) 300 000 IU;

e) 600 000 IU.

18. The characteristic clinical signs of non clostridia infection of soft fabrics are:

a) it was swollen, marble picture of skin covers, gas formation;

b) hyperemia of skin covers with clear scopes;

c) necrosis of muscles and connecting fabric, gasification;

d) abscess with purulent-hemorrhagic fetid excretions;

e) anemia, leucocytosis, convulsion of muscles in the region of inflammation.

19. The exciter of tetanus causes the disease, getting to the organism through:

a) the damaged serous shell of bowel;

b) the damaged skin or mucus;

c) overhead respiratory tracts;

d) by an alimentary way;

e) by a air-dropping way.

20. Leading part in pathogenesis tetanus is acted by exotoxin:

a) streptokinase;

b) tetanohemolizin;

c) gialouronidaza;

d) leucocidin;

e) tetanospazmin.

21. Duration of latent period at to the tetanus makes on the average:

a) 1-3 days;

b) 4-14 days;

c) 15-20 days;

d) 21-30 days;

e) 31-40 days.

22. The early symptoms of tetanus are:

a) it was swollen, which quickly makes to progress;

b) sardonic smile, opistotonus;

c) bradycardia, decline of temperature of body, dryness of skin covers;

d) convulsion of muscles in the area of wound, hyperthermia;

e) loss of consciousness, paralysis.

23. The obvious sign of tetanus is:

a) delirium;

b) decompensate of the cardio-vascular system;

c) anemia;

d) sardonic smile;

e) attacks of fever, which cyclic oneself repeat.

24. The show to the urgent prophylaxis of tetanus is:

a) guardianship and getting And degree frost-bitten;

b) the closed break, break of muscles and tendons;

c) operation on thick bowel;

d) furuncle of person;

e) operation on muscles.

25. The unspecific prophylaxis of tetanus is folded with:

a) imposition of stitches on a wound;

b) hemosorbtion;

c) primary surgical treatment of wound with wide dissection and drainage;

d) barotherapy;

e) massive antibiotic therapy.

26. The specific active-passive prophylaxis of tetanus consists of introduction to the patient:

a) 1 ml tetanus anatoxin and antibiotics;

b) 1 ml tetanus anatoxin and muscular relaxants;

c) 3 000 IU antitetanus serum and muscular relaxants;

d) 1 ml tetanus anatoxin, 3 000 IU antitetanus serum;

e) 3 000 IU antitetanus serum and antibiotics.

27. Extern specific prophylaxis of tetanus is conducted during concentration of tetanus anatoxin in the serum of blood of the patient:

a) more than 0.1 IU/ml;

b) less than 0.1 IU/ml.

c) more than 0.01 IU/ml;

d) more than 0.01 IU/ml;

e) less than 0.01 IU/ml.

1. Patient 30 years, entered clinic concerning pain in extremities, difficulty swallowing, involuntary abbreviation of muscles of person (“sardonic smile”), rigidity of muscles of the back of head. In 3.5 weeks after the wound by glass of forearm in a railway transport there were pain and convulsion in a wound, promoted swelling, still in 6 days – higher determination of change. At once after a trauma the conducted surgical treatment of wound, nacladenni stitches. A wound healed over, suppuration is not present. Antitetanus inoculations over 5 years ago. The common state of patient is satisfactory, temperature of subfebril. Define a diagnosis, form, degree, prognosis of disease, medical measures.

2. At a patient 40 years, the clinical picture of tetanus appeared in 2.5 weeks after the wound. Four days was marked: general illness, head pain, insomnia, swelling. Then appeared: trizm, sardonic smile, rigidity of muscles of the back of head, short clonic and tonic cramps. Temperature of body of 38 ^oC Violations of breathing it is not. Define a clinical form and degree of disease, prognosis.

3. Patient 65 years under time agricultural works got the flesh-wound (scratch) of shin. Concerning a trauma by did not appealed medical for help. Information about the antitetanus inoculations is not present. In 10 days arose up pain in the area of wound, pain at swallowing, swelling. Still rigidity of masticator muscles and muscles of the back of head, swelling appeared in 2 days. Tonic and clonic cramps in 10-20 minutes with a tendency to pochashennya, violation of swallowing, breathing, profuse swelling, temperature 400. Define a diagnosis, form, degree, prognosis, disease, principles of medical treatment.

4. A patient 50 years appealed to the policlinic concerning education on the cheek of ulcer by a diameter 5 sm., with the inflammatory bottom of crimson color, inflammatory hump and painless slight swelling round, considerable serous-blood by the separation. 4 days ago on this city there was a red itch spot, afterwards bubble, and after a breach – ulcer. The state of patient of middle weight, temperature 39.5 ^oC, marks head pain, insomnia and regional inguinal painless lymphadenitis. Define a diagnosis, measures of his confirmation, tactic and medical treatment.

5. A patient 30 years after a profession is the government purveyor of animal, hospitalized in the surgical separation in 5 days from the beginning of illness with a diagnosis: erysipelas. The quickly making to progress widespread, dense, painless edema of forearm, covered by shallow bubbles, takes place, by the areas of necrosis. Part of bubbles are broken, a plenty of serous liquid is selected. The state of patient is heavy, there is great head pain, delirium, a temperature arrives at 40 ^oC. What disease it follows to suspect that it follows to do for his clarification, what measures to cause. Define a prognosis, and medical treatment.

6. At sick 20 years, after dissection of phlegmon of thigh a wound cleared up, granulation was partly carried out, the common state and temperature were normalized. Without obvious reasons the common state again considerably became worse, a temperature rose to 39 ^oC, there was tachycardia, became worse sleep, appetite. A wound took shelter by the dirty very tightly soldered raid of fibrin, serous-hemorrhagic excretions, edema and hyperemia of surrounding fabrics, regional lymphadenitis, appeared. What complication takes place, which it is needed to carry out for his clarification, necessary organizational and medical measures?

7. Man 44 years old tumbled into the opened sewage pit. He got the opened break of right shin. In the surgical separation conducted primary surgical treatment of wound with the use of deaf stitches and skeletal the traction on second day at a patient appeared euphoria, pain in a wound, and feeling of press and stamping of bandage. What complication? What local changes characteristic for such complication?

8. In a district hospital from the place of way-transport accident the three sick are delivered from fractures of bones of shin and considerable contamination by earth and pieces of clothes by the lacerated wounds of lower extremities. Your actions?

9. After introduction to the patient of antigangrenous serum with a prophylactic purpose, the fever, press in an thorax, vomit, falling of arterial pressure, death-damp, cyanosis, appeared, eclipse of consciousness. What complication arose up? What your actions?

10. At a serviceman with the plural wounds of soft fabrics of both lower extremities, buttocks, the backs in the process of medical treatment arose up symptoms of anaerobic clostridia infection. At introduction of antitetatanus serum in 20 minutes on a forearm there was the papule of do1.4 sm. in a diameter. What subsequent tactic in such situation?

11. A patient with the gas gangrene of shin acted in the separation. Taking into account high contagious of anaerobic clostridia infection, it is necessary to organize and control the observance of the sanitary-epidemiology mode in the separation. What does it consist in?

12. Sick C, 24 year old, operated concerning sharp appendicitis. On a fifth day of hyperemia of edges of wound was marked, edema of hypodermic cellulose to right ribs and overhead third of thigh. Previous diagnosis? By what methods it is possible verification?

13. At a patient with a fifth day after the wound of right brush, a temperature to 38 ^oC rose, pains in muscles appeared, difficulty swallowing, impossibility to close a mouth, sardonic smile. What complication arose up at a patient? What are your actions?

14. At a patient wound of right brush, on the surface of wounds grey-yellow fibrin raids are marked, firmly soldered with inferior fabrics, festering excretions are not present What disease it follows to suspect, specific medical treatment?

15. Sick C. concerning the anaerobic gas gangrene of right shin was conducted high amputation of right thigh. What appearance the treatment of the used bandaging material is conducted by?

16. At sick a diagnosis is set anthrax, bullous form of the left forearm. What specific therapy?

17. At sick on a right cyst the ulcer size 20 mm, with a black bottom on an edge daughter's vesicle. What disease, type of local medical treatment on to hospital stage?

18. After the wound there is the sick C. marks pain in the area of wound of right forearm, with convulsive muscles of heavy extremity. Documentary confirmation about the inoculation is not present. What disease can be suspected, urgent prophylaxis?

19. To sick O. concerning the anaerobic gas gangrene of right shoulder was conducted exarticulation right overhead extremity. What appearance the treatment of the used tool is conducted by?