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1. /OCULAR DISEASES for medical F. students/Guidance self-study additional curriculum .doc
2. /OCULAR DISEASES for medical F. students/OCULAR DISEASES manual.doc
Ministry of health of ukraine
Ministry of health of ukraine



MINISTRY OF HEALTH OF UKRAINE

DONETSK M.GORKY NATIONAL MEDICAL UNIVERSITY


Department of Ocular Diseases


Guidance

for the 4-year medical university students

to

self-study additional curriculum of ocular diseases


Donetsk – 2008



UDC: 617.7(075.8)

ББК: 56.7

.

Ocular Diseases: Manual. Pavlyuchenko K.P. et al. – Donetsk, 2008.- 85pp.

According to Higher Education Law of Ukraine, the priority of the state policy is to facilitate integration of Ukrainian higher school into the world educational system still preserving and developing national academic achievements and traditions.

The program to implement Bologna Declaration requirements has been approved by the Ministry of Education and Science resolution No 49 of 23.01.2004.

The Guidance has been made according to ECTS conversion plan for medical students. It is an instructive textbook on ocular diseases for students of III-IV accreditation level medical universities. The Supplement shows the plan of workshop topics for a four-year medical students majoring in ocular diseases with Donetsk National Medical University for 2008-2009 and includes 3 conceptual modules. The Guidance is intended to help medical students in self-studying extracurricular topics during first 7 workshops. After the 8th workshop, the students make revision to get ready for an all-topic modular final test.

The Guidance was approved for publishing by the Academic Board of Donetsk Medical University named after M. Gorky on…5..05……., 2008, which is recorded in the minutes No 4….

Reviewers:

1.  Sukhina L.A., Dr Sci (Medicine), Professor, Head of ocular diseases department, advanced medical faculty with Donetsk Medical University.

2. Basiy R.B., Associate Professor of human anatomy department, Head of education and instruction center, Donetsk Medical University.


:

Pavlyuchenko K.P.


Zykov I.G.

Oleynik Т.V.

Mogilevski S.Yu.

Ivashchenko S. Ye.

Belousova Z.F.

Gavrilenko I.N.

Chernyayeva S.N.

DNMU (Donetsk National Medical University) named after M. Gorky

CONTENT




Introduction …………………………………………………………………………3

1.Visual analyzer, its role in perceiving the outside. The background of ophthalmology. Pioneers of domestic ophthalmology….4

2. Anatomy of lacrimal organs. Examination techniques………12

3. Binocular vision. Conditions of binocular vision. The role of binocular vision for professional occupation. ………………..19

4. Dystrophic diseases of cornea……………………………….26

5. Indications for cataract surgical treatment. Development of cataract surgery..34.


6. Eyeball blood supply. Disorders of blood circulation………41


7. Ocular disability examination. Test methods for assessing visual acuity. Ascertaining degrees of disability caused by disordered visual functions. …….49

Reference answers……………………………………………57


References……………………………………………………58


Theme 1. The visual analyzer its value in cognition of world around. A history of development of ophthalmology. Founders of domestic ophthalmology.

Urgency of a theme. The body of sight is the major instrument of knowledge of an external world. The basic information from world around acts in a brain through this analyzer. Its functions underlie all labour and creative activity of the person.

Eye are the distant analyzer of the supreme order. That’s it’s nature the spatial perception of depth, movement of subjects is peculiar, to their remoteness. Development of ophthalmology as sciences has a centuries-old history. The first descriptions of illnesses of eyes and ways of their treatment are found out in Egypt. They are dated 5 millenium B.C. The significant contribution to development of ophthalmology was brought by the Ukrainian scientists. Works of professors S.S.Golovin (Odessa), I.I.Kazas (Dnepropetrovsk), A.V.Hodin Kiev), N.E.Braunshtejn (Kharkov), N.S.Azarova (Simferopol) are widely known. The Odessa’s school of academician V.P.Filatov has given the whole galaxy of known scientists: acad. N.A.Puchkovskaja, prof. S.F.Kalfa, V.E.Shevalev, T.V.Shlopak and many others. The investigated theme is actual for understanding of the important role of sight in ability to live of the person, and the knowledge of a history of occurrence of the Ukrainian ophthalmology allows to see step by step developments of this science in historical aspect.


The purposes of training:

General objective:to be able to estimate importance of the visual analyzer for ability to live of the person.

Specific objectives of learning

Specific objectives of basic level of knowledge and skills

TO BE ABLE

1.to explain the process photochemical

Reactions in photoreceptors mesh

1.to use knowledge on anatomy and physiology mesh for understanding of photoreception process (Normal Physiology Dep.).


2.to now a course of fibres of an optic nerve up to optic chiasm, in limits of it and in structure of visual pathes.

2.to use knowledge on anatomy and physiology of peripheral visual neuron for explanation of process of transfer of the caused potential on central visual neuron (Normal Physiology Dep.).

. 3.to explain a course central visual neuron to cortex visual center

Reconstruct the physiology of central visual neuron for understanding of process of transfer of the information in the visual centers of a cortex of a brain (Normal Physiology Dep.).

4. Interpret the leading part of the visual analyzer among sense organs


To use a knowledge on anatomy and physiology of sense organs (Normal Physiology Dep.).


5.to Interpret the basic historical stages of development of ophthalmology and the scientific contribution of founders of the Ukrainian ophthalmology

To use a knowledge on development of medicine in historical aspect (a rate of a history of medicine)





For finding-out of conformity of an initial level of your knowledge - skills necessary, carry out a tasks. Correctness of the decision check up, having compared them with standards of answers.

Task 1

The patient after a strong blunt trauma had break of an optic nerve within the limits of the same channel . Axons what neurons have suffered?

A.Rods

B.Cones

C.Bipolar

D.Ganglionar

E. Central

Task 2

By archeologists have been found in tombs of pharaons 6 books with the description of illnesses of eyes and methods of their treatment. When these books have approximately been written?

А. I millenium up to AD.

B. II millenium up to AD.

C. III millenium up to AD.

D. IY a millenium up to AD.

E. Y a millenium up to AD.

Standards of answers: 1-D, 2-E.


The literature for updating an initial level of knowledge:The basic:

1. Eroshevskij T.I., Botchkarev A.A. eye deseases-M.: Medicine, 1977.-with 5-12.

2. Smirnov V.M. human physiology:-M.: Medicine, 2002.-With. 469-477.

3. Prives M.G., Lysenkov N.K., Bushkovitch V.I.human anatomy.-SPb: 1998.-With. 565-670.

Additional:

1. Afanasjev J.I., Jurina N.A., Kotovskij E.F., etc. Histology.-M.: Medicine, 2002.-With. 333-354.

The maintenance of training:Theoretical questions on the basis of which performance of target kinds of activity is possible.

1. A role of the visual analyzer among sense organs and its value in ability to live of the person.

2. A structure of photoreceptors mesh and physiological features of photochemical reaction..

3. Anatomo-physiological features of interaction central and peripheral visual neurons.

4. The visual center of a bark of a brain. Features of localization in relation to anothers cortex centers.

5. The basic historical stages of development of ophthalmology since the most ancient times.

6. Founders of the Ukrainian ophthalmology, their contribution to a science.


The basic terms and their designations:

1 Rods - rod photoreceptors

2. Cones - cone photoreceptors

3. Parafoveolar - near to foveolar area


Logical structure graph




Sources of the information


Afanasjev J.I., Jurina N.A., Kotovskij E.F., etc. Histology:.-M.: Medicine, 2002.-With. 333-354.

Vitt V.V.structure of visual system of the person.-Odessa: the Astroprint, 2003.-655 with.

Zhaboyedov G.D., Sergiyenko M.M. eye deseases -Київ: "Здоров'я", 1999.-309 with.

Prives M.G., Lysenkov N.K., Bushkovitch V.I.human anatomy.-SPb: 1998.-With. 565-670.

Smirnov V.M. human physiology:-M.: Medicine, 2002.-With. 469-477.

Focused basis of activity.

The focused basis of activity at the decision of tasks, and also at work with sources of the information is made in the column of logic structure of employment and in diagnostical algorithm where consecutive steps of activity of students are stated at studying a structure of the visual analyzer.


Diagnostic algorithm of defeat of departments of a visual conducting way depending on a pathology of a field of vision.





The tasks below help you check your knowlege.


Task №1

It is known, that cone and rod photoreceptors are located in retina non-uniformly. In what retinal departments practically there are no first of them?

А. A yellow stain

B. fovea centralis

C.Near of a disk of an optic nerve

D. Near to an ora serrata

E. in parafoveolar area

Task №2


It is known, that cone and rod photoreceptors are located in retina non-uniformly. In what retinal departments practically there are no second of them?

А. A yellow stain

B. fovea centralis

C.Near of a disk of an optic nerve

D. Near to an ora serrata

E. in parafoveolar area


Task №3

The optic nerve concerns to cranial nerves. To what pair is it concern?

А. 1 pair

B. 2 pair

C. 3 pair

D. 4 pair

E. 5 pair

Task №4

The optic tract, as is known, begins from chiasm. Axons what neurons enter into its structure?


A.rods

B.cones

C.Bipolar

D.Ganglionar

E.central


Task №5

Optic radiation, as is known, begins from an internal capsule. Axons what neurons enter into its structure?


A.rods

B.cones

C.Bipolar

D.Ganglionar

E.central

Task №6


Optic radiation comes to an end in optical cortex field (fissura calcarina). Where is this field settle down?

А. A medial surface of an occipital share

B. A Lateral surface of a parietal share

C.A Medial surface of a parietal share

D.A Lateral surface of a frontal share

Е. A medial surface of a frontal share


Task №7


Wells and Shakespeare believed, that death the least misfortune than (?).

They meant what defect?

A.Deafness

B. Dumbness

C.Blindness

D. Absence of sense of smell

E.Ataxia


Task №8

It is considered, that the body of sight gives us the greatest quantity{amount} of the information on world around in comparison with other sense organs. How you think, how many it will be in percentage terms to the information?

А. 40 %

B. 50 %

C. 60 %

D. 70 %

E. 80 %


Task №9

One of the major opening in ophthalmology -ophthalmoscope, allowed to inspect an eye bottom. Who is the author?

A.Avitsenna

B. Archimed

C.Gippokrat

D. Helmgolts

E.Galilej

Task №10


One of founders of the Ukrainian ophthalmology has offered a round stalk for plastic operations. Who is the author?

A.Golovin S.S.

B.Filatov V.P.

C.Braunshtejn N.E..

D.Azarova N.S.

E.Kalfa I.G.


Theme 2


Anatomy of a lacrimal apparatus. Methods of research of a lacrimal apparatus .

Urgency of a theme. It is difficult to overestimate a role of a lacrimal liquid for body of sight. It protects a forward department of an eyeball from fine foreign bodies, a smoke, aggressive liquids; interferes with drying of a cornea and conjunctiva; possesses antibacterial properties; takes part in a metabolism of a cornea and conjunctiva. Infringements of development of a lacrimal liquid can lead to such serious diseases as conjunctivites, keratitis, an corneal ulcer , and another. Infringements of lacrimal drainage can be caused by the various reasons of the congenital and got character and in turn can lead to inflammatory complications on the part of an eye and its appendages. The urgency of an investigated theme does not cause doubts.

General objective: to estimate a condition tear production and lacrimal drainage at patients, to reveal a pathology, to put the preliminary diagnosis and to recommend the circuit of treatment


Specific objectives

Specific objectives of basic level of knowledge and skills

TO BE ABLE

1.to examine a lacrimal gland, lacrimal points, a zone of a projection of a lacrimal sac..

1.to use knowledge on anatomy and physiology of a lacrimal gland, lacrimal points, a lacrimal sac for revealing pathological changes (Pathologic Physiology Dep).

2. to assess a tear production (Schirmer test).

2. to use knowledge on anatomy and physiology of a lacrimal gland for understanding of process a tear production (Normal Physiology Dep.).

3.to assess lacrimal canaliculi test and to take into account its results

3. to use knowledge on anatomy and physiology of a lacrimal gland, lacrimal points, a lacrimal sac for revealing pathological changes (Pathologic Physiology Dep).

4.  to assess nazolacrimal test and to take into account its results

4. . to use knowledge on anatomy and physiology of a lacrimal gland, lacrimal points, a lacrimal sac for revealing pathological changes (Pathologic Physiology Dep).

5.make a preliminary diagnozis and to recommend treatment

5.make a differential diagnozis (Prop. Ther. Dep.).



For finding-out of conformity of an initial level of your knowledge - skills necessary, carry out a tasks. Correctness of the decision check up, having compared them with standards of answers.

Tasks for self-checking an initial level of knowledge - skills

Task 1

The doctor is going to examine a palpebral part of a lacrimal gland. Where it is located?

А supra-temporal part of an orbit

B. infra-temporal part of an orbit

C. supra-nazal part of an orbit

D. infra-nazal part of an orbit

Е. In the nazal part of an orbit

Task 2

The doctor is going to examine lacrimal points. Where they are located?

А. The top fornix of conjunctiva

B. The bottom fornix of conjunctiva

С. In caruncula

D. near caruncula’s area

Е. At supra-temporal part of an orbit


Standards of answers: 1-A, 2-D.


The literature for updating an initial level of knowledge:

The basic:

Eroshevskij T.I., Botchkarev A.A.eye desease -M.: Medicine, 1977.-with 5-12.

Smirnov V.M. human physiology: .-M.: Medicine, 2002.-With. 469-477.

Prives M.G., Lysenkov N.K., Bushkovitch V.I. human.anatomy.-SPb: 1998.-With. 565-670.

Additional:Afanasjev J.I., Jurina N.A., Kotovskij E.F., etc. Histology:-M.: Medicine, 2002.-With. 333-354.

Learning content:

Theory used as a basis for target activities.

1. A structure and anatomo-physiological features of lacrimal gland.

2 anatomo -physiological features ways of lacrimal drenage.

3.Schirmer’s test.

4. lacrimal canaliculi test

5. nazolacrimal test.

6. Anomalies of an arrangement and the sizes of lacrimal points.

7. Dacrioadenitis.

8. Dacriocystitis.

9. Canaliculitis.

10. The general principles of treatments of diseases lacrimal apparatus


The basic terms and their designations:

1. Dacrioadenitis - an inflammation of lacrimal gland

2. Dacriocystitis- an inflammation of a lacrimal sac

3. Lagophthalm- incomplete closing the eyelids, caused by the various reasons

4. Ptosis- prolapsus of an upper eyelid

5. Endophthalmitis- an inflammation of all environments of an eye with development of an abscess vitreous body


Logical structure graph





Diagnostic algorithm . Pathology of lacrimal drenage





.


Sources of the information:


1. Zhaboyedov G.D., Sergienko N.M. eye deseases-Київ: , 1999.-309 with.

2.Prives M.G., Lysenkov N.K., Bushkovitch V.I. human anatomy -SPb: 1998.-With. 565-670.

3.Smirnov V.M.human physiology:.-M.: Medicine, 2002.-With. 469-477.

Focused basis of activity.

The focused basis of activity at the decision of tasks, and also at work with patients is made in the graph of logic structure of employment and in diagnostic algorithm where consecutive steps of activity of students are stated at studying a structure of the theme.

Task №1

At survey of the patient the doctor has revealed narrowing the inferior lacrimal point. What is minimal diameter of the given aperture in norm?

А. 0.2мм

B. 0.4мм

С. 0.9мм

D. 1.5мм

Е. 2мм


Task №2

At survey the doctor has revealed at the patient sharp dacrioadenitis. What symptom is more characteristic for the given disease?

А. ptosis

В. The S-shaped form of a palpebral fissure

C. Eksophthalm

D. Lagophthalm

Е. Enophthalm


Task №3

The doctor has has carried out Schirmer’s test at the patient. What is breakdown checked by this?

А. A level of lacrimal production

B. A level of outflow of a lacrimal liquid

C. Drainage ability of lacrimal points

D. Passableness of a lacrimal liquid from lacrimal lake up to a cavity of a nose

Е. Diameter of lacrimal points


Task №4

The doctor has carried out Schirmer’s test at the patient. Through what time this test is taken into account?

А. 1min.

В. 2min..

С. 3min..

D. 4min.

Е. 5min.


Task №5

The doctor has carried out lacrimal canaliculi test

at the patient. What is breakdown checked by this?

А. A level of lacrimal production

B. A level of outflow of a lacrimal liquid

C. Drainage ability of lacrimal canaliculi

D. Passableness of a lacrimal liquid from lacrimal lake up to a cavity of a nose

Е. Diameter of lacrimal points


Task №6

The doctor has carried out lacrimal canaliculi test

at the patient. Through what time this test is taken into account?

А. 1min.

В. 2min..

С. 3min..

D. 4min.

Е. 5min.

Task №7

The doctor has carried out nazolacrimal test

at the patient. What is breakdown checked by this?

А. A level of lacrimal production

B. A level of outflow of a lacrimal liquid

C. Drainage ability of lacrimal canaliculi

D. Passableness of a lacrimal liquid from lacrimal lake up to a cavity of a nose

Е. Diameter of lacrimal points


Task №8

The doctor has carried out nazolacrimal test

at the patient. Through what time this test is taken into account?

А. 1min.

В. 2min..

С. 3min..

D. 4min.

Е. 5min.


Task №9

The patient with congenital narrowing of lacrimal points, disturbs constant watering. What treatment is necessary for appointing?

А. Sounding lacrimal points

B. Antibiotics in drops

C.Adrenolytics in drops

D.Adrenergic in drops

Е. Surgical


Task №10

The patient’s got acute dacrioadenitis. What treatment is necessary for appointing?

А. Sounding lacrimal points

B. Antibiotics in drops

C.Adrenolytics in drops

D.Adrenergic in drops

Е. Surgical

  1   2

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