Ministry of Public Health in Ukraine Donetsk M. Gorky National Medical University icon

Ministry of Public Health in Ukraine Donetsk M. Gorky National Medical University




НазваMinistry of Public Health in Ukraine Donetsk M. Gorky National Medical University
Дата29.08.2012
Розмір54.6 Kb.
ТипДокументи

Ministry of Public Health in Ukraine

Donetsk M. Gorky National Medical University.


Approved

on methodological meeting of

The Pathomorphology Department

Head of the Pathomorphology Department

Ph.D., MD, Professor Vasilenko I.V.

______________________________


Guidelines

for the 5th year students of medical faculties and the 3rd year students of stomatological faculty on self-preparation for the practical lesson on biopsy-sectional course

Module 1.

Structure of pathologicoanatomic service. Orders. The procedure of postmortem examination of deaths in hospitals. Principles of postmortem diagnosis formation. Medical death certificate


Executor: Assistant Professor

of the Pathomorphology department, MD

Polyakov K.V.


Structure of pathologicoanatomic service. Orders. The procedure of postmortem examination of deaths in hospitals. Principles of postmortem diagnosis formation. Medical death certificate. (Practical training for biopsy-sectional course for the 5th year students of medical faculties and the 3rd year students of stomatological faculty).

Relevance of topic (topicality): in contemporary socio-economic conditions, there was the need to reform the old system of health care while maintaining and developing the best traditions of national health care. In this regard, and given the clinical-anatomical orientation of modern medicine, the role of pathologicoanatomic service increased, which seeks to ensure the quality of diagnostics and treatment and diagnostic work. The most difficult section in the any specialty doctor’s activity is the diagnosis – recognition of disease and assessment of the patient’s state. The diagnosis in clinical medicine is a brief conclusion about the nature of the disease and the patient's condition. For the making and formulation of a diagnosis requires clinical judgment, which is implemented through such methods of knowledge as analysis and synthesis using elements of formal logic. Final clinical and final (postmortem) diagnoses, differing by some specific features, which are compiled on similar rules and have a similar structure with standardized headings.

The purpose (total): to be able (to know) the structure, aims and tasks of the pathologicoanatomic service, procedure and rules for performance of autopsies of deaths in hospitals, to issue the relevant documentation, to know the structure and principles of postmortem diagnosis formation, to be able to formulate the postmortem diagnosis, issue the medical death certificate.


Specific purposes: The purposes of the initial level:

To be able to

  1. To know the structure of pathologicoanatomic service.

  2. To know aims and tasks of the pathologicoanatomic service.

  3. To perform rules of the procedure of autopsy (postmortem examination) of patients died in hospitals.

  4. To perform rules of the procedure of autopsy (postmortem examination) of patients died at home.

  5. To know the structure and function of post-mortem diagnosis.

  6. To know the principles of postmortem diagnosis formation.

  7. To formulate postmortem diagnosis.

  8. To issue the medical death certificate.




  1. To know the concept of a symptom, syndrome, disease (nosological unit), the structure of the clinical diagnosis (Departments of propaedeutics internal and childhood diseases, general surgery).

  2. To know the morphological manifestations of the basic diseases and pathological processes (Department of Pathomorphology).





For you to be able to understand whether the initial level of your knowledge corresponds to required level of knowledge-skills, we offer you to answer the following tasks.


^ TASKS FOR SELF-TESTING OF INITIAL LEVEL OF KNOWLEDGE-SKILLS.


Assignment №1. During examination of the patient in internal medicine clinic the following changes were revealed: yellowness of the skin and visible mucous membranes, dark urine, in blood tests – increasing level of the total bilirubin up to 150 mmol/l (unconjugated – 90, conjugated 60 mmol/l). Jaundice was diagnosed, which is:

  1. The main symptom.

  2. Symptom in the syndrome of liver damage.

  3. Syndrome.

  4. Clinical diagnosis.

  5. Nosological entity.


Assignment №2. At an autopsy the patient's body the following changes were revealed: pale skin, subcortical hemorrhage in the frontal lobe of the right brain hemisphere, moderate increase in weight and size of the liver and spleen, moderate increase in size of all groups of lymph nodes, bone marrow of the right thigh diaphysis had puruloid appearance; on histological examination in organs described above an erasure of the normal structure of organs due to severe diffuse infiltration with immature white blood cells with polymorphic nuclei and a moderate amount of cytoplasm, severe fatty dystrophy of hepatocytes in the liver were revealed. What disease caused the death of the patient?

  1. Viral hepatitis.

  2. Sepsis.

  3. Hypertensive heart disease.

  4. Acute leukemia.

  5. Fatty hepatosis.


Answers’ etalons for the self-testing of initial level of knowledge-skills: 1.-C, 2.-D.


Information necessary for filling in the gaps in the necessary knowledge-skills can be found in the following literature:

  1. Lectures of The Pathomorphology Department.

  2. Lectures of The Departments of propaedeutics internal and childhood diseases, general surgery.


The basic theoretical questions on the basis of which you can do the purpose task activities:

  1. Structure of pathologicoanatomic service.

  2. Aims and tasks of the pathologicoanatomic service.

  3. Rules of the procedure of autopsy (postmortem examination) of patients died in hospitals.

  4. Rules of the procedure of autopsy (postmortem examination) of patients died at home.

  5. Structure and function of post-mortem diagnosis.

  6. Principles of postmortem diagnosis formation.

  7. Formulation of postmortem diagnosis.

  8. Rules of filling in the medical death certificate.


The sources of educational information:

  1. Order of the Ministry of Health of Ukraine №81 "About the development and improvement of pathologicoanatomіc Service in Ukraine" issued on the 12th of May, 1992, Supplements 2, 3, 5, 6 and 13.

  2. Order of the Ministry of Health of Ukraine №545 issued on the 8th of August, 2006.

  3. A graph of the logical structure "Pathologicoanatomic service in Ukraine." (Suppl. 1)

  4. A graph of the logical structure "Rules of the procedure of autopsy (postmortem examination) of died patients." (Suppl. 2)

  5. A graph of the logical structure "Postmortem Diagnosis." (Suppl. 3)

  6. A graph of the logical structure "Order of filling in the medical death certificate". (Suppl. 4)


After studying of above-listed assignments for self-testing of material learning on the topic it is proposed to solve the following assignments.


Assignment №1. A 56-year-old patient with inoperable lung cancer (small cell lung cancer according to histological conclusion) was under the constant supervision of the district physician and died at home. Who in this case issue of medical death certificate?

  1. The district physician.

  2. Oncologist.

  3. Pathologist.

  4. Expert in forensic medicine.

  5. Head of the outpatient department.


Assignment №2. The corpse of the dead patient along with the case history delivered from the neurological department of the city hospital in the pathologicoanatomic bureau. The pathologicoanatomic bureau in the structure of pathologicoanatomic service in Ukraine is:

  1. Structural division of the city hospital.

  2. Structural unit of the regional hospital.

  3. Independent structural unit.

  4. A branch of pathology department of the city hospital.

  5. A branch of the Central pathology department.


Assignment №3. At the regional hospital for a day died: the patient with myocardial infarction in the cardiology department, a patient with the flu in the infectious department, a child aged 3 days, an unidentified person with suspected carbon monoxide poisoning. The corpses of who from these patients are subject to autopsy?

  1. Children aged 3 days.

  2. Patient with the flu in the infectious department.

  3. Patients with myocardial infarction in the cardiology department.

  4. An unidentified person with suspected carbon monoxide poisoning.

  5. All deaths in the regional hospital.


Assignment №4. A 63-year-old patient with suspected acute pneumonia was under the supervision of a district doctor, died suddenly. After the inspection staff of Ministry of the Interior a corps was taken to the pathomorphology department and sectioned. Who in this case has the right to issue a "medical death certificate"?

  1. A district doctor.

  2. Head of the outpatient department.

  3. The head of pathomorphology department.

  4. The pathologist, who made the autopsy.

  5. Expert in forensic medicine who made the autopsy.


Assignment №5. The 48-year-old patient died in the surgical ward on the 4th day after the appendectomy. Histological examination confirmed phlegmonous appendicitis. Relatives insist on the delivery of the body without an autopsy. Is it allowed to deliver the body without an autopsy in this case?

  1. Yes, because the relatives insist.

  2. Yes, because the diagnosis is clear.

  3. Yes, because the death occurred in hospital.

  4. No, because the death occurred 4 days after surgery.

  5. No, because the death occurred after surgery.


Assignment №6. At autopsy of male 62 years old, who had been suffering from type 2 diabetes melitus for a long time and died of sepsis, the following changes were found: kidney increased in size, the capsule is removed with a little work, their surface with a yellow-green, rounded areas of 0.1-0.4 cm, located primarily in the cortical layer, in the pelvis - the yellow-green opaque contents. Renal pathology and diabetes melitus in the postmortem diagnosis in this case are:

  1. Concomitant diseases.

  2. Concurrent diseases.

  3. The basic and background diseases.

  4. Complication and basic disease.

  5. Basic and concomitant diseases.


Assignment №7. The 63-year-old patient died of cardiopulmonary failure. At autopsy the lower lobe of the right lung is dense, on the cut its surface is dull, matt, with roundish dry yellowish areas the size of 0,3-5 cm in diameter, sometimes coalescing with each other. In the upper lobe the whitish color node without clear boundaries connected with the wall of the upper bronchus is determined. Microscopically, the node has the structure of keratinizing squamous cell cancer in the other fields of view in the lung tissue areas of caseous necrosis. In this case the revealed diseases in the structure postmortem diagnosis would relate as:

  1. Combined basic diagnosis: comorbidities.

  2. Combined basic diagnosis: concurrent diseases.

  3. The basic and background diseases.

  4. Basic disease and complications.

  5. Basic disease and concomitant disease.


Assignment №8. The 53-year-old patient was in the cardiology department for chronic ischemic heart disease, died suddenly of acute anemia due to bleeding from esophageal varices. At autopsy: myocardial postinfarction cardiosclerosis in the heart, liver reduced in size, thick, pale gray, with fine-grained uneven surface. What disease is the basic in this case?

  1. Cirrhosis of the liver.

  2. Chronic ischemic heart disease.

  3. Acute coronary artery disease.

  4. Toxic degeneration of the liver.

  5. Acute hepatitis.


The methodology of the study.

Classes are held in the form of a seminar; at the beginning a initial level of knowledge is determined (tests for monitoring the initial level of knowledge). After the unassisted work the current test control and writing survey are carried out, evaluation of each of them is final in study.


^ Technological chart of study.


Ordinal number

Stages

Time

(min)

Textbooks, learning tools

Equipment

Place

1.

Checking and correction of initial level

20

Test tasks

Test tasks

Classroom

2.

Independent work.

150

Study of the material

Order of the Ministry of Health of Ukraine №81, the Department’s guidelines.

Classroom, registry of the pathomorphology department

3.

Analysis and correction of independent work

15

Discussion




Classroom

3.

The final test control

20

Tests

Tests

Classroom

4.

Summarizing the results of study

10







Classroom



Supplement 1.

Department of Pathomorphology.

A graph of the logical structure:

"Pathologicoanatomic service in Ukraine."





Supplement 2.

Department of Pathomorphology.

A graph of the logical structure:

"
Rules of the autopsy procedure (postmortem examination) of died patients."



Supplement 3.

Department of Pathomorphology.

A graph of the logical structure:

"
Postmortem Diagnosis."



Supplement 4.

Department of Pathomorphology.

A graph of the logical structure:

"
Order of filling in the medical death certificate"

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