Vіі. The method of conducting of practical lesson and the organizational structure of the lesson

Distribution of the marks appropriated to the students:

At learning of the theme №4 of the module №1 for educational activity to the student mark is proposed after 4th to the ball (traditional) scale which is then converted in marks as follows:

Mark	Balls
“5”(excellent)	7
“4” (good)	5
“3”(satisfactory)	3
“2” (unsatisfactory)	0

Flowsheet of the lesson

№ p/p	Basic stages of the lesson, their functions and content	Level of maste-ring	Methods of control and teaching	Materials of the methodical providing	Distribu-ting of the time (min)
1. 2. 3.	Preparatory stage Organizational measures Raising of educational purposes is that motivation Control of initial level of knowledge, skills, abilities 1. Features of the surgical anatomy of fingers and a hand which matter for the flow, diagnostic, treatment of the panaritium and phlegmon of the hand. 2. The classification of a panaritium and phlegmon of a hand. 3. An etiology, a pathogenesis, the clinical signs and features of the flow of solitary forms of the panaritium and phlegmons of the hand, methods of the diagnostic of the panaritium and phlegmons of the hand. 4. Indication to the conservative and operative treatment of the panaritium and phlegmon of the hand. 5. Methods of an anesthesia and surgical attacks at different forms of the panaritium and phlegmons of the hand.	II ІІ ІІ ІІ ІІ	Individual questioning Tests of the ІІ level Tasks of the II level	П.1 "Actuality of the theme" П.2 "Educational purposes" Questions of the II level Tests of the ІІ level Tasks of the II level Table: Anatomy of fingers and a hand Table: Forms of a panaritium. Table: Areas of sickliness at different forms of a panaritium	1-3 5 20
4.	Basic stage 1. To master the technique of the implementation of research by the bulbous-end bougie allowing to differentiate different forms of the panaritium and phlegmon of the hand. (α=ІІ). 2. To conduct differential diagnostics of panaritium and phlegmons of the hand| with other purulent-inflammatory processes of soft tissues which can be localized on a finger or hand (α=ІІ). 3. To choose the method of an anaesthetizing and method of surgical attack at different forms of panaritium and phlegmon of a hand (α=ІІ	ІІІ ІІІ ІІІ	Professional training in the decision of untypical clinical tasks Practical training	Patients with a panaritium Tasks of the ІІІ level Tasks of the ІІІ level	19 18 15
5. 6. 7.	Final stage Control and correction of level of professional abilities and skills Work out the totals of the lesson Domestic task (basic and additional literature to theme)	ІІІ	Individual control of skills Tests of the ІІІ level	Tests ІІІ of Tasks ІІІ of "Short" methodical pointing to work on practical lesson.	10

Tests for verification of the initial level of knowledge TEMA 23

1. A paronychia is an inflammation of:

A. All tissues of a finger

B. A periungual roller

C. A nail bed

D. An interphalangeal joint

E. A tendinous vagina of a finger

2. It doesn't the form of the panaritium:

A. Cartilaginous

B. Hypodermic

C. Bone

D. Arthral

Д. Dermic

3. Pandactylitis is purulent inflammation of:

A. A nail plate

B. Hypoderm

C. A periungual roller

D. A tendinous vagina of a finger

E. All tissues of a finger

4. It is the panaritium in form cuff-link:

A. A hypodermic panaritium with a breach leaving of the pus under an epidermis

B. A tendinous panaritium

C. A paronychia

D. A bone panaritium

E. A purulent melting of all tissues of the finger

5. It isn't the complication of hypodermic panaritium of the ІІІ finger of the hand:

A. A tendinous panaritium

B. A bone panaritium

C. An arthral panaritium

D. A miner's elbow

Д. A phlegmon of forearm

6. The panaritium of the І finger can be complicated:

A. By the phlegmon of tenor

B. By the phlegmon of hypotenor

C. By the V-like phlegmon of the hand

D. By the phlegmon of the middle space of the hand

E. By the phlegmon of the shoulder

7. There are the following clinical forms of a panaritium:

A. Gangrenous

B. Fatty

C. Phlegmon

D. Bone

E. Dermic

8. There are the following clinical forms of a panaritium:

A. Tubercular

B. Osteoarticular

C. Septic

D. Arthral

E. Posttraumatic

9. The symptom of a bony crepitus at palpation of the finger can specify on:

A. Presence of the osteoarticular form of the panaritium

B. Presence of hypodermic form of the panaritium

C. Presence of the tendinous panaritium

D. Presence of the lymphatic panaritium

E. Presence of the arthral form of the panaritium

10. The differential diagnostics of the panaritium is conducted with:

A. A phlegmon

B. An erysipelatous inflammation

C. A polyarthritis

D. A lymphadenitis

E. A fracture

11. It is used for diagnostics of a panaritium:

A. Determination of a crepitation at the palpation

B. Determination of a local increase of the temperature

C. Determination of the relative and absolute length of finger

D. Determination of areas of sickliness by the bulbous-end probe

E. Determination of sensitiveness of the skin on a finger

12. It is possible to apply in the postoperative period at the treatment of osseous form of the panaritium:

A. The multicomponent method

B. The open-end method

C. The method of a skeletal extraction

D. The closed method

E. The half-open method

13. The phlegmon of Pirogov-Paron's space can develop as a result:

А. The tendinous panaritium of the І finger

B. The agnail of the ІІІ finger

C. The tendinous panaritium of the ІІ finger

D. The subcutaneous panaritium of the І finger

E. The purulent tenosynovitis of the V finger

14. A phlegmon of a hand can be:

A. Catarrhal phlegmon

B. Commissural phlegmon

C. Phlegmon of tenor

D. Basal phlegmon

E. Phlegmon of the lateral space

15. A phlegmon of the hand can be:

A. Phlegmon of the deep space

B. Phlegmon of the antithenar

C. Basal phlegmon

D. Subaponeurosis phlegmon of the rear of the hand

E. Phlegmon of the medial space

16. A phlegmon of a hand can be:

A. Phlegmon of rise of the ІІІ finger

B. Phlegmon of the middle space

C. Phlegmon of the lateral space

D. Catarrhal phlegmon

E. V-like phlegmon

17. It is the site of entry for a development of a commissural phlegmon of the hand:

A. The erysipelas of the palm surface of the hand

B. The callosity of the skin with the presence of chaps on palm's surface of the hand

C. The furuncle of the palm's surface of the hand

D. The carbuncle of the palm's surface of the hand

E. The aquatic callus of the palm's surface of the hand

18. What do tendon vaginas of the fingers of the hand end blindly on the level of the palm's corrugation?

A. Tendon vaginas of the ІІ finger

B. Tendon vaginas of the І and ІІ fingers

C. Tendon vaginas of the V finger

D. Tendon vaginas of the ІІІ finger

E. Tendon vaginas of the IV and V fingers

19. It is the anatomical pre-condition for the fast development of a defeat of the bone at a panaritium in the area of nail phalanx:

A. The bone of nail phalanx hasn't a separate nourishing artery

B. The bone of nail phalanx has a slender endosteal channel

C. The bone of nail phalanx has a thick periosteum

D. The bone of nail phalanx is spongy

E. The bone of nail phalanx has bad innervation

Situation tasks

1. Patient has 26 years ago and grumbles on a pain in a right hand which is marked 4 days. The pain at the beginning appeared at foundation ІІ and ІІІ fingers. Then an edema and intumescence of the dorsal surface of the hand became quickly to increase. ІІ and ІІІ fingers are half-bent in interphalangeal joints, unbended and divorced in metacarpal-finger joints, the hand has the appearance of “rakes”. What will be your diagnosis and tactic of the treatment of this patient?

2. On a reception to the surgeon a 53-years-old woman with complaints about an itch and burning of skin came on ІІІ finger of left hand. It is known from anamnesis, that 3 days ago the patient at home cut fish and pricked the finger by bone of the fish. The edema and| hyperemia of the finger appeared in a day. The spot of hyperemia with a cyanotic tint is marked at examination on the back-lateral surface of the finger. The edges of the hyperemia are scalloped. The finger is hydropic; motions in interphalangeal joints are limited and painful. What disease is it needed to think about? What pathology is it necessary to conduct differential diagnostics with? What method of treatment will be applied for this patient?

3. A patient grumbles about the throe pulsating pain in ІІ finger of the right hand. Four days ago she pricked the finger at cutting of fish. Last two nights she could not sleep from th pain. The nail-bone of the finger has swollen, the swelling and sharp sickliness is marked on its palm's surface. Motions in interphalangeal joints are gently limited. Inguinal lymph-nodes are not increased. What is your diagnosis? What help must be rendered this patient.

4. The patient K. has 36 years ago, pricked by a rope deeply the І finger of the right hand. After days an edema and pulsating pain appeared in the finger. He did not apply for medical help and only two sleepless nights compelled him to come on reception to the surgeon. The nail-bone of the finger is incrassate like a mace; sickliness is marked at palpation by the probe of practically all of palm's surface of distal phalange. Limitation of motions takes a place in the interphalangeal joint. What will your diagnosis and possible operative incision cut be?

5. The sick came on a reception with a purulent hypodermic panaritium of ІІ finger of the right hand. Indications to the operation are absolute. The consent of the patient to surgical attack is got. But the effective draining of blood of the finger is needed before dissection carefully to delete all nonviable tissues. How will you create it?

6. A mother brought to a reception to the surgeon a boy 9 years ago which is disturbed by pain in the І finger of right hand. He is ill for 3 days. The area of the swelling of turbidly-white color with diameter to 0,8 cm which is surrounded the thin strip of hyperemia is determined at the examination on palm's surface of the nail phalanx of finger. What help must be rendered a child?

7. The patient O., 44 years ago, appealed with complaints about pain in the І finger of left hand. She is ill about week from the moment of deleting of a splinter (fish bone) from under a nail. At once pain was insignificant. She applied baths with a salt solution, with potassium permanganate, put compresses with Vishnevsky's ointment, baked onion. An improvement did not come. The sleepless night the day on the eve compelled to come to the doctor. The dimness as a triangle in the center of nail plate is determined at examination. Pressure on the nail plate causes sharp pain. Motions in the interphalangeal joint are full. What will your diagnosis and medical tactic?

8. A man, 35 years ago, with complaints about moderate pain in the area of nail phalanx of the ІІ finger of right hand appealed to the policlinic. Pain disturbs for two weeks. The secretion of a purulent content appeared from an appearing fistula on the nail phalanx of the finger in 5 days from the beginning of disease, after it pain diminished. Pain and edema of the finger were periodically increased then, but a facilitation came after the output of pus. For the last days intensity of pain increased again, and the edema of finger began to grow in the area of nail phalanx, the pus did not depart. It is discovered at an objective inspection: it was swollen hyperemia (the color of skin was cyanotic with a purple tint) of the nail phalanx of the ІІ finger of right hand spreading on distal part of the middle phalanx. There is fistula by a diameter to 2 mm from which at pressure the trace of purulent exudate is selected on palm's surface of the phalanx. Research by the bellied bougie discovered the area of the expressed sickliness for all of nail phalanx of the ІІ finger of the right hand. The focuses of destruction of the distal phalanx are exposed on the sciagram of this finger. What will diagnosis be to this patient? What will the tactic of treatment?

9. The patient, 35 years ago, has entered to the clinic with the diagnosis tendinous panaritium of the І finger of the right hand. What order must it be executed him operation, and what method of anaesthetizing here must be applied?

10. The patient, 9 years ago, has entered to the clinic. The diagnosis is set for her. It is the hypodermic panaritium of the ІІІ finger of the left hand. The purulent-necrotizing process is localized on the nail phalanx. Last time the child ate and drank 1 hour ago. What must tactic of a surgeon be in this case?

11. The patient, 73 years ago, has entered to the surgical department in 15 days from the beginning of the disease. She complains about moderate permanent pain in the V finger of the right hand, on pain and slight swelling of the hand in the area of the antithenar, on a hyperemia to 39^oС, on general weakness and thirst. It is known from anamnesis she for 25 years has diabetes mellitus ІІ type, for some time past for the correction of the level of sugar| she used Maninil. It is discovered at examination of the right hand: the V finger is incrassate with the areas of necrotic skin; there are purulent fistulas by the diameter 2 and 3 mm on the nail and the middle phalanxes, purulent content is exuded from these fistulas. At palpation of the finger a crepitation and pathological mobility is determined in the proximal interphalangeal joint. The area of the antithenar is infiltrated, a hyperemia of the skin here is unexpressed, the symptom of fluctuation is not determined. The sickliness is exposed on space of tendon vagina at the research by the bellied bougie. What will you determinate preliminary diagnosis? What additional methods of research must be applied for this patient? Will tactic of treatment consist in what?

12. The sick, 34 years ago is hospitalized in the surgical department with complaints about pain in the index finger of the right hand on 22 days from the beginning of the disease. It is known that he was operated concerning a hypodermic panaritium in a policlinic on 8th days from the moment of the disease. After the operation he applied baths with salt solution, bandages with Vishnevsky's ointment. UHF-therapy was used. In two weeks such treatment an improvement did not come. The nail phalanx of the finger is incrassate, sickly. On a radial surface it's the linear wound is with surplus granulations and scanty seropurulent exudate. What complication did develop at this patient? What additional researches are needed to be executed with the purpose of verification of the diagnosis?

13. The patient G., 23 years ago, has entered in the surgical department with complaints about pain in the ІІ finger of the left hand. Two a week ago he pricked his finger a metallic scobs. During the last week he was treated in a policlinic: a puncture, antibiotics and an immobilization. An improvement did not come. He was directed on the stationary treatment. The finger in the proximal interphalangeal joint is half-bent, fusiform incrassate, hydropic, the skin is with hyperemia, palpation in the area of joint sharply sickly, motions in the joint are practically absent. What is your diagnosis? What additional researches must be executed? What will your medical tactic?