Ministry of Public Health in Ukraine Donetsk M. Gorky National Medical University
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Зміст Tasks for self-testing of initial level of knowledge-skills.Technological chart of study. |
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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
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. ^ 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:
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?
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:
The basic theoretical questions on the basis of which you can do the purpose task activities:
The sources of educational information:
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?
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:
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?
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"?
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?
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:
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:
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?
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. ^
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" |
