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Методички онкология / 5 курс / Преподавателям / 7уМетодПреп-РШ,ЛГМ,Mbs.doc
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5.2.1. Preparation stage:

At the beginning of class, the instructor introduces students to the basic tasks of occupation plan. To control the output level of knowledge of students each proposed to solve typical issues in diagnosis - you can use situational clinical problem.

5.2.2. Main stage:

Materials for the methods of the main stage sessions

N Abir radiographs, tables, owner of anticancer chemotherapy, hospital records and medical history of patients with precancerous diseases and skin cancer, findings of morphological studies of biopsies of skin tumors (if possible micropreparations)

Polls and physical examination performed with the patient turns the students, under the supervision of the teacher. To evaluate the accuracy of surveys consistently attracted other students.

When patients surveyed students' attention is drawn to the medical history of the disease, the presence of chronic inflammation and precancerous oryuvan illnesses, occupational hazard.

When patients surveyed students' attention is drawn to the medical history of the disease, the study of factors that cause of skin cancer, melanoblastoma.

5.4. Final stage:

Control and correction of professional skills and knowledge held by solving situational and clinical tasks, tests for self-control. Assesses knowledge and skills students study each assessment.

The teacher has homework, recommended literature on the subject next class basic and additional.

VI. Materials for methods of classes

6.1.Materialy control baseline (baseline) of students:

Task 1.

The patient complains of '65 appearing on the face sores, to about May does not heal, formed thick bundles in place. On examination, the skin of the right cheek determined rounded liykovydni ulcers covered with yellow in cotton gray crust with valykopodibnymy edges. Also marked infiltration of underlying tissues. What is the likely diagnosis?

A. Melanoma skin.

B. Bazalnoklitynnyy skin cancer.

C. Squamous cell skin cancer neorohoviyuchyy face.

D. Squamous cell skin cancer orohoviyuchyy face.

E. Keratopapiloma skin.


Task 2.

Patient S., 21, turned in oncologic dispensary about the increased "mole", which gradually increased from 3 mm to 1 cm in diameter. The skin of the chest is the formation of soft consistency browned on w and Rocky stem diameter of 1 cm, the skin around is not changed. Previous e iahnoz?

A. Melanoma skin.

B. Bazalnoklitynnyy skin cancer.

C. Squamous cell skin cancer neorohoviyuchyy.

D. Squamous cell skin cancer orohoviyuchyy.

E. Keratopapiloma skin.


Problem 3.

Patient 70 years complains formation appearing on the skin and ear p kovyny. The skin of the ear is defined by two tenacious, Bumpy, Oct. color at first nodule on a broad basis, 5 and 7 mm in diameter, which merge together. Peripheral lymph nodes were not enlarged. What additional research is crucial to clarify the diagnosis?

A. Common blood and urine;

B. Biochemical analysis of blood;

C. Urine for Bence Jones protein;

D. Cytological verification by fine needle biopsy;

E. Cytological verification by zskribka surface formations.


Problem 4.

Patient M., '31 complaining about the presence of the formation of the skin of the nose, which is rapidly increasing in size. On examination of the skin and nasal defined etsya dense tumor with rough, crusty, size and rum to 0.5 cm. Peripheral lymph nodes were not enlarged. In cytological d at slidzhenni zskribka of formation obtained conclusion - orohoviyuchyy flat at cell carcinoma. What is your tactic?

A. Clear formation of crusts mazove treatment.

B. Hospitalize patients in the surgical ward.

C. Refer the patient to an oncologist.

D. Run dermatoscopy.

E. Refer to the beautician.


Task 5

Patient 29 years old, complained of the presence of pigment formation with mo k Nuti center in transitional folds right breast, but I have deposited 1.5 months. Mammary glands are the same size, not deformed. If n and lpatsiyi tumors in the breast parenchyma is not defined. Peripheral Lee MF in ouzl and not enlarged. What is the most specific method of examination in railway and nomu case?

A. mammography;

B. duktohrafiya breast;

C. smear-imprint cytology of the tumor;

D. computed tomography of the chest and its organs;

E. axillary lymphography collector.


Problem 6

Patient M., 76 years old, complained of the presence of a smooth seal in the left parotid, found that 5 years ago. Addressed through collection and lshennya formation in size and sores last. She studied samolikuva Mr. tion - handles ulcer infusion of herbs. When the smears dia g noz set cytologically - rodent ulcer. The doctor decided VIC at Nata excision of the tumor. How should the cuts be made?

A. top to bottom;

B. upwards;

C. along the lines of tension of skin;

D. along the branches of "crow's feet";

E. right to left


Problem 7

Patient K., 68 years old, turned to the doctor complaining of feeling drive at mfortu and pain in the back of the neck, weakness, sensitivity is smite Noah area. Described symptoms noted for several months. On examination means pitting under a crust of pidrytymy edges and sanious from at kremlyuvanym. Which methods of examination do you recommend to verify the diagnosis?

A. Ultrasound;

B. trepan-biopsy;

C. ekstsyzi and on biopsy;

D. complete blood count;

E. zskrebok.


Task 8

Patient 55 years old, suffers from diabetes for 10 years, calls Mr. nulasya complaining of increasing pigment formation of the skin lateral behavior p Their neck left. Surgeon for UTO h tion began ekstsyzi diagnosis and biopsy well. Where can ekstsyzi and lead to biopsy or moderate form of height and tion in melanoma?

A. postoperative wound.

B. lymphostasis.

C. massive hematogenous metastasis

D. Mr. limfohe no metastasis

E. low immunity.


Problem 9

Patient, 28 years old, male, asthenic constitution addressed Derm and toloha complaining of itchy skin, weight loss, fever up to 38 0 C in the evening. The patient was prescribed desensybilizu yu chu and hepatotropic therapy for 20 days. The effect of treatment was not, began to disturb night sweats, skin rash pustular back appeared. after treatment in the patient surgeon was appointed antybakteri and lnu and Immunotropic therapy. Objectively, besides the aforementioned changes proved collection and lshennya 2 lymph nodes right axillary area; lymph nodes up to 2.5 cm, soft flexible, mobile, not soldered between themselves and others and TC nynamy

A. Staph hroniosepsis

B. Limfohranulem and TOZ

C. Pyoderma skin

D. lymphosarcoma nodes right accessories and polar plots

E. Retykulosa p coma right axillary area


Problem 10

The boy 9 years revealed conglomerate lymph nodes in the neck on the left. Lymph nodes with a diameter of 1.5 cm, painless, not interconnected and environ at some extra and we tissues. The liver and spleen were not enlarged. Symptoms of intoxication percent in the TNI. In the blood: erythrocyte sedimentation rate 30 mm / h, 68% neutrophils, 18% lymphocytes, cells of Sternberg. The most probable diameter d noz?

A. Nonspecific lymphadenitis

B. Acute Leukemia

C. Infectious mononu k leoz

D. Toxoplasmosis

E. Lymphogranulomatosis


Problem 11

Patient '38 complains of weakness, fever up to 38 0, night sweating. Sick almost 3 weeks. Asked the doctor, treated over HIVZ - no improvement. 3 days ago I noticed increased limfov in fusion neck with law. Asked the oncologist was made ​​puncture lymph nodes. B and revealed Sternberg cells. What is the preliminary diagnosis?

A. Non-Hodgkin's lymphoma

B. Limphadenitis

C. Lymphoma Berkita

D. Lymphogranulomatosis

E Metastases at PLN quality tumors of the head and neck



Task 12

Patient in '38 was a doctor with complaints of shortness of breath, and odutlov dence at least lychchya. On examination - a doctor noticed an increase nezluchenyh interconnected nodes neck subcutaneous veins of the face and neck sharply expanded. Shadows among the wall at very advanced. Permissible your dia g noz?

A. Limfohranule matoz

B. Lung Cancer

C. Esophageal cancer

D. Cancer of stomach

E Colon w ki ki


Standards of answers: 1 - B, 2 - A, 3 - E, 4 - C, 5 - C, 6 - D, 7 - E, 8 - C, 9 - B, 10 - E, 11 - D, 12 - A.


6.2. Materials for the methods of the main stage classes H Abir radiographs, tables, owner of anticancer chemotherapy, hospital records and medical history of patients, findings of morphological studies of biopsies (if possible micropreparations) medicines.

6.3. Materials for the final stage of the study: clinical case studies

Test number 1

A patient 52 years complains of appearing on the skin of the glans penis formation, which is growing rapidly. During the inspection determined at k ruhle limited, bright red, flat, agonizing with velvety surface formation about 1 cm in diameter. What is the likely diagnosis?

A. Erytroplaziya Kairi;

B. Squamous cell carcinoma;

C. Papilloma;

D. Rodent ulcer;

E. Chancre.


Test number 2.

The patient in '28 revealed tumor of skin left leg flesh to about loru with ulcers in the center with a diameter of 3 cm, which does not heal 2 months, Zoom b tween complete inguinal lymph nodes on the affected side for 1 to 2 cm in diameter. Expose f ing diagnosis - melanoblastoma skin left leg with metastases to inguinal l and mfovuzly. What signs indicate disease?

A. The presence of tumors on the skin of the lower leg.

B. The presence of tumor, covered with sores on the skin of the shin, lumps in n and hu.

C. The presence of tumor that does not heal, the skin of the shin, lumps in n and hu.

D. Only the presence of enlarged lymph nodes in the groin.

E. Size of the tumor and lymph nodes.


Test number 3.

Patient 55 years, suffering from diabetes for 10 years. Vick at Nana left thigh amputation 6 months ago. Troubled sores in the area after I operational scar that appeared 1.5 months ago, shortness of breath. Ikuvannya L maz I we no effect. In the groin area of dense, elastic, painless knot to 2 cm in diameter. In the area of postoperative scar crater ulcer 2x4 cm flabby granulation and necrotic bottom. Cytological conclusion would zskri ka with expression of ki - squamous cell carcinoma. What research should be done to stand in ing stage of the process in the first place?

A. Radiography of the chest;

B. Computed tomography of the chest;

C. Angiography;

D. Scanning;

E. Ultrasound retroperitoneum.


Test number 4

The patient in '82 on the skin of the trunk multiple dense pu's tench from 0.3 to 1 cm in diameter. Peripheral lymph nodes were not enlarged. When cytology - elements undifferentiated carcinoma, but in ne - squamous cell carcinoma. What further and rolled teak?

A. Cryodestruction formations.

B. Removing tumors.

C. Additional examination of the patient by the organs and systems of the sighting and sentenced hoyu the esophagus and lungs.

D. Deleting entities after chemotherapy.

E. Observing the patient.


Test number 5

Patient 65 years. is onkohirurhichnomu department with a diagnosis of squamous cell skin cancer cheek. What should be the treatment strategy in state and nomu case?

A. Radiation therapy - hormone therapy.

B. surgery - postoperative radiotherapy + complex medi tion n.

C. neadyuvantna vnutriarterialna chemotherapy + radiotherapy + tion and operas

D. preoperative radiotherapy + surgery + complex medi tion n.

E. operation + hormone therapy.


Test number 6

Patient B. '31 at preventive examinations on the left half of December Dr. Noah cells detected elastic, rounded, smooth, rolling swell n junction, purple-bluish color to 1.5 cm in diameter, spadayetsya when pressed. Lymph nodes were not enlarged. Your preliminary diagnosis?

A. Cancer left breast.

B. Mastopatia left breast.

C. Pigmented nevus.

D. Hemanhyoma.

E. Melanoma.


Test number 7

Patient N., 21 years appealed to the doctor complaining of increasing li m fovuzliv neck and left inguinal area. Examination: R-graphy WGC - p and tolohiyi found. Zag and lnyy blood - red cells-4, 1x10 12 / l, Hb-122 / L, L-9, 4x10 9 / l, f-4%, b-0%, 2% p-, p-64% l-22% m 8% ESR-12 mm / h. When needle biopsy found Sternberg cells. Your Doctor and ahnoz?


A. Limfohranule matoz

B. lymphosarcoma

C. Metastatic lymph nodes

D. Leukemia

E Limphadenitis


Test number 8

Patient N., 21 years appealed to the doctor complaining of increasing that m perature t and la to 37.2 0 C-37, 3 0 C for 3 weeks, lumps in the neck and left axillary region and hone to 1.5 cm . In laboratory examinations in blood: erythrocyte sedimentation rate 35 mm / h, white blood cell count 8.8 x 10 9 / L, lymphocyte Penny at 8%, increased fibrinogen to 7.7 g / l. In the X-ray shadow of mediastinal enlargement. What preliminary diagnosis can put patients at th?

A. Chronic les and Cossack

B. lymphosarcoma

C. Hodgkin's disease.

D. Infectious m at nonukleoz

E Limphadenitis.


Test number 9

Patient '17 complains of general weakness, night sweats pronounced, generalized itching, pi t d raising the body over the past 15 days to 38.5 0. Palpable determined increased to 2-cm, painless neck l and mfovuzly left. Tot. blood: Hb - 90 g / l; Lake. - 9h109 / l, ESR - 40 mm / h. Diagnosis?

A. Limfohranul e matoz

B. AD onichnyy lymphocytic leukemia

C. Tuberculosis

D. lymphadenopathy

E lymphosarcoma.


Test number 10

The patient in '23 limfohranul e matoz / disease Hodzhkina / second stage of the lesion cervical-supraclavicular lymph nodes and lymph nodes left with is redostinnya. Histologically, mixed-cell variant. Select the best method of treatment bath?

A. 3 courses of chemotherapy / TSOPP /.

B. 3 courses of chemotherapy / TSOPP / + radiotherapy for radical b Noah apps and my above diaphragm

C. Radiotherapy for radical program on all nodes above diafra g we

D. Radiation therapy for all groups of lymph nodes on both sides diafra g we

E Radiation te rapiya the left cervical-supraclavicular area


Standards of answers: 1 - B, 2 - C, 3 - E, 4 - C, 5 - B, 6 - D, 7 - A, 8 - C,

9 - A, 10 - B.


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