VII. Method of leadthrough of employment and organizational structure of employment

Distributing of marks which are appropriated students:

At mastering those # 33 thematic modules # 4 an estimation is proposed a student ball (traditional) scale which is then converted in marks as follows:

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

The methodical pointing for work of students on practical employment

Semantic module 4.

TRAUMATISM AND DAMAGE

Practical employment # 33

Theme: methods of examination of surgical patients: abdomen and locomotor apparatus.

Theoretical questions are for a study and discussion:

1. Basic and additional complaints of patient with the disease of gastrointestinal tract.

2. Anatomical zones and topographic lines of front abdomen wall.

3. Main causes of ascites and main methods of examination of patients with ascites.

4. General examination of patient, its clinical interpretation.

5. Examination of abdomen, palpation of abdomen.

6. Symptoms of irritation of peritoneum.

7. Finding symtoms of abdominal hernias (umbilical, hernias of white line).

8. Complaints of patients with deseases of joints, anamneses.

9. Testing of active and passive movements of joints.

Literature:

1.Butursky A. “General surgery”. (Simferopol 2004)

2.S. I. Shevchenko; A. A. Tolkoglas and etc. “Surgery” (Kharkov 2004)

3.Methodological Instruction.

Distributing of marks which are appropriated students:

At mastering of theme 33 from rich in content the module # 4 for educational activity an estimation is proposed a student for traditional scale which converted to points as follows:

Estimation	Points
“5”(fine)	7 points
“4” (well)	5 points
“3”(satisfactorily)	3 points
“2” (unsatisfactorily)	0 points

Tests and tasks for verification of initial level of knowledges tema 33

1.Decline of appetite is:

A аnоrехіа

B hурогехіа

C сіtоfоbіа

D eruсtаtіоn

E геguгgіtаtіоn

2. The symptom of fluctuation is characteristic for:

A flatulence

B ascites

C obesities

D edema of front wall of stomach

E pyloristenosis

3. Heartburn is:

A аnогехіа

B сіtоfobіа

C eruсtаtіоn

D ругоsіs

E nаusеа

4. Belch air is:

A аnогехіа

B hурогехіа

C сіtоfobіа

D eruсtаtіоn

E геguгgіtаtіоn

5. Pain in an epigastrium, which has girdle character and irradiats to the back, testifies to:

A gastritis or ulcerous illness of stomach

B duodenitis or ulcerous illness of duodenum

C pancreatitis

D cholecystitis

D irritations of abdominal interlacement as a result of disease of stomach, duodenum, gall-bladder, pancreas

6. Tarry color of excrement the masses testifies to:

A gastric bleeding

B pulmonary bleeding

C enterorrhagia

D bleeding from haemorrhoidal veins

7. The symptom of muscle defence is characteristic for:

A inflammation of organs of abdominal region

B inflammation of peritoneum

C ulcerous illness of stomach

D ulcerous illness of duodenum

E pyloristenosis

8. Absence of appetite

A аnогехіа

B hурогехіа

C сіtоfobіа

D eruсtаtіоn

E геguгgіtаtіоn

1. Patient A. (52 y. old) a hepatocirrhosis is diagnosed. During examination of patient, you determine the increase of stomach, that can be related to flatulence or presence in the abdominal region of free liquid. 1. What methods of inspection is it necessary to utillize for differentiation of the indicated states? 2. Tell characteristic for a ascites signs. 3. Tell characteristic for flatulence signs.

2. Patient T. grumbles about periodic pain and swelling of abdomen, that is localized in a counter-clockwise iliac area. During palpation of sigmoid bowel the dense is determined, uneven, immobile, a few sickly education, by sizes 3x4 sm you diagnose the tumour of sigmoid bowel. 1. What complication did arise up at patient as a result of tumour of sigmoid bowel? 2. What signs can it find out during examination of stomach? 3. At what yet pathosiss, except for a tumour can there be the complication indicated by you?

3. Patients during superficial palpation of abdomen feels a sickliness and resistance of abdominal wall is determined in right subcostal near-by the external edge of direct muscle of stomach. 1. About pathology of what organs is it possible to think? 2. Name the palpation signs of resistance of abdominal wall. 3. What diagnostic value does have resistance?

4. At patient the ulcer of duodenum suddenly was a «whinger» pain in abdomen. During palpation the sharp poured out sickliness and tension of muscles of abdominal wall is determined. 1. What complication did arise up at patient? 2. What can be marked during examination of abdomen? 3. What diagnostic value does have resistance?

5. A patient grumbles about that when he swallows bread, meat, a meal passes laboured. 1. What symptoms of dyspepsia does speech go about? 2. What can the complaint of patient be conditioned? 3. What the additional methods have of research be appointed ?

6. Patient K (34 years old) during 12 years is ill the ulcer of duodenum. In the morning felt a strong weakness, broke into perspiration, pale. In 10 minutes vomit appeared with the admixtures of blood. Objectively: pallor of skin covers, pulse 110 in a minute, an arteriotony 90/50 мм of рт. item A stomach takes part in the act of breathing, soft, painless. 1. How is this complication of ulcerous illness named? 2. What yet is a symptom characteristic for this complication? 3. What additional methods of inspection are needed above all things?

7. A patient grumbles about inconstant pain in right subcostal area, nausea, bitter taste in to the mouth, belch, decline of appetite. 1. About the disease of what organs is it possible to think? 2. On what yet can a patient complain in the case of pathology of these organs? 3. What reason of origin of pain?

8. A patient is delivered in a clinic with complaints about sharp pain in right subcostal and vomit. Pain arose up after the use of rich and sharp food. During palpation of abdomen tension and sickliness is marked in right subcostal. 1. About what pathosis is it possible to think? 2. What additional signs can be exposed during the physical inspection of patient? 3. Ground the mechanism of formation of pain in the case of the pathology indicated by you?