Instructions for the 4 th course students, 8 semester icon

Instructions for the 4 th course students, 8 semester




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Sumy State University

Internal Medicine Department


Methodological Instructions

for the 4th course students, 8 semester

Module 2

Pulmonology, Haematology”


Prepared by Orlovsky A. V., assistant, D.Ph,

Murenets N. A., postgraduate


Sumy - 2009

Methodological Instruction to Lesson № 1.


Propedeutics in pulmonology.

Hours: 5.

Working place: classroom, hospital wards.


Questions.


  1. Structure of the bronchial tree.

  2. Determination of the lungs border.

  3. Structure of the respiratory segment (part) of the lung.

  4. Comparative percussion of the lungs.

  5. Blood supply of the lung.

  6. Cough, its characteristics.

  7. Structure of the bronchial mucous. Concept of bronchial clearance.

  8. Rales and their characteristics.

  9. Physiology of respiration.

  10. What is vocal fremites and method of its indication?

  11. Show the spirogram schematically. What is the purpose of the spirogram?

  12. Name kinds of dispnoea.

  13. What is forced expiration volume in 1 second (FEV1), forced vital capacity (FVC)?

  14. Comparative percussion of the lungs.

  15. What is this pneumotachometry?

  16. Name main symptoms of respiratory diseases.

  17. Name main groups of drugs in patients with respiratory diseases.


References.


  1. Propedeutics to Internal medicine Part 1 Diagnostics/O. M. Kovalyova, T. V. Ashcheulova. – Vinnytsya. – 2006. – P.60 - 138.

  2. Davidson’s Principles and practice of medicine (nineteenth edition)/Christopher Haslett, Edvin R. Chilvers and others. – Edinburgh, 2002.



Prepared by Orlovsky A. V., assistant, D.Ph.,

Murenets N. A., postgraduate


Methodological Instruction to Lesson № 2.


Chronic obstructive pulmonary disease (COPD).

Hours: 5.

Working place: classroom, hospital wards.


Questions.


  1. Give the definition of COPD.

  2. Etyology of COPD. Give external and internal risk factors of COPD.

  3. Pathogenesis of COPD. What reflects airflow limitation.

  4. Pathology of COPD.

  5. Clinical symptoms of COPD.

  6. Name co-morbidities in patients with COPD.

  7. Physical findings of patients with COPD.

  8. X-Ray findings of patients with COPD.

  9. Studing of external respiration functions. Spyrometry.

  10. Clinical and functional monitoring.

  11. Give the classification of COPD.

  12. Name main treatment principles of patients with COPD.

  13. Name drug, which are used in treatment of patients with COPD.

  14. Name the phaemacotherapy for patienta with COPD depending on the level of gravity of the disease.

  15. Role of glucocorticosteroids in treatment of patients with COPD.

  16. Name the other pharmacological treatment of patients with COPD.

  17. Rehabilitation of patients with COPD.

  18. Name the reasons exacerbations of COPD.

  19. Algorithm of managing exacerbation of COPD in the outpatient setting.

  20. Name the indications for hospitalisation in case of exacerbation of COPD.

  21. Name the indications to antibacterial therapy. What is influenced on choosing antibacterial therapy.

  22. Name antibacterial therapy of patients with COPD.


Examples of tests


  1. What is the most important cause of COPD?

    1. exposure to dusty or polluted air

    2. alpha1- antitrypsin deficiency

    3. cigarette smoking

    4. familial predisposition

    5. low birth weight

  1. Chronic cough, which characterised COPD, is:

    1. cough precedes dyspnea

    2. cough is parallel to dyspnea

    3. cough after marked dyspnea

    4. there are no defined law

    5. cough may be absent

  2. Inhalation β2- agonists of short – term action are the following drugs, except:

    1. Salbutamol

    2. Fenoterol

    3. Terbutalin

    4. Salmeterol

  3. The main symptoms of the COPD are:

    1. abdominal pain and diarrhea,vomiting

    2. cough

    3. headache

    4. constipation

    5. sneezing

  4. Differential diagnosis of the COPD with:

    1. Asthma

    2. Peritonitis

    3. Piothorax

d .appendicitis

e.myocardial infarction

6. The Symptoms and Signs of the COPD are:

    1. constipation

    2. bloody vomiting

    3. frequent headache

    4. chronic cough and sputum production

    5. sneezing


Answers to the self-assessment:

1-c, 2-a, 3-d, 4-b, 5-a, 6-d


References.


    1. Therapy: Manual. The course of lectures/V. M. Fedosyeyeva, A. A. Chrenov. – Simferopol, 2003. – 27 - 37 p.

    2. Davidson’s Principles and practice of medicine (nineteenth edition)/Christopher Haslett, Edvin R. Chilvers and others. – Edinburgh, 2002. – 508-513 p.

    3. Harrisons Principle if internal medicine (seventeenth Edition)/Fauci, Braunwald, Hasper and other. – Part 10, section 2, Chapter 254.

    4. The Merck Manual of Diagnosis and Therapy (seventeenth Edition)/ Robert Berkow, Andrew J. Fletcher and others. – published by Merck Research Laboratories, 1999.



Short theoretic material


^ CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)


Chronic obstructive pulmonary disease is the internationally preferred term encompassing chronic bronchitis and emphysema.

By definition COPD is a chronic, slowly progressive disorder characterised by airflow obstruction (FEV1 < 80% predicted and FEV1/VC ratio <70%) which does not change markedly over several months. The impairment of lung function is largely fixed but may be partially reversible by bronchodilator therapy.

Historically, the term 'chronic ronchitis' was used to define any patient who coughed up sputum on most days of at least 3 consecutive months for more than 2 successive years (provided other causes of cough had been excluded) and 'emphysema' referred to the pathological process of a permanent destructive enlargement of the airspaces distal to the terminal bronchioles. Although 'pure' forms of these two conditions do exist, there is considerable overlap in the vast majority of patients.

The death rate from COPD currently exceeds 25 000/year (> 20-fold higher than asthma) in England and Wales and this condition accounts for over 10% of all hospital medical dmissions in the United Kingdom.


Etiology


The single most important cause of COPD is cigarette smoking although in developing countries exposure to smoke from biomass and solid fuel fires is also important. Smoking is thought to have its effect by inducing persistent airway inflammation and causing a direct imbalance in oxidant/antioxidant capacity and proteinase/antiproteinase load in the lungs. Individual susceptibility to smoking is, however, very wide, with only 15% of smokers likely to develop clinically significant COPD.

Recent studies have also emphasised the strong familial risks associated with the development of COPD. A small additional contribution to the severity of COPD has been reported in patients exposed to dusty or polluted air.

An association also exists between low birth weight, bronchial hyper-responsiveness and the development of COPD.

Alpha1-antitrypsin deficiency can cause emphysema in non-smokers but this risk is increased dramatically in enzyme-deficient patients who smoke.

Stopping smoking slows the average rate of the decline in FEV1 from 50-70 ml/year to 30 ml/year (i.e. equal to non-smokers). Interestingly, there is no evidence that acute exacerbations or drug therapy affect the rate of decline of the FEV1.


Pathology


The pathologic findings include hypoplasia and hypertrophy of the submucosal bronchial mucous glands, hyperplasia of bronchiolar goblet cells, squamous metaplasia of bronchial mucosal cells, chronic and acute inflammatory infiltrates in the bronchial submucosa, profuse inflammatory exudates in the lumens of bronchi and bronchioles, and denudation of bronchial mucosa.

Airflow limitation reflects both mechanical obstruction in the small airways and loss of pulmonary elastic recoil. Loss of alveolar attachments around such airways makes them more liable to collapse during expiration.
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