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Ministry of health care of ukraine




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1. /госпитальной терапии/Рабочая прогр. для мед.ф-тета 6к (на англ.яз).rtfMinistry of health care of ukraine



MINISTRY OF HEALTH CARE OF UKRAINE

Odessa State Medical University


ENDORESED”

Vice-prorector from science-educational work

Professor Y.І.BAJORA

«____»_______________________________2006


PROGRAMM

FROM INTERNAL MEDICINE

For the speciality “Medical Care” - 8.110101.

Medical Faculty.

Hospital Therapy Department.

Normative information___________________________



Form of studies

Course

Semester

Amount of hours

DifferentialTest Test

(semester)

Examinations

(semester)










In all

Audience

Individual studetnt’s work



















Lecture

Practical employments

Laboratory employments

Seminar employment










Daily

6

XI-XII

414

18

246

-

6

144

XI-XII

XII

The programm was made: Professor N.A. Zolotaryova, associate professor Мuravskay О.М.


on the basis of the typical program from hospital therapy is Kiev, in 1996 and

Educational-qualifying description of specialist”- Kiev, 2003.


The program is discussed on meeting of department of 12.09.2006

Protocol № 2 .

Head of department___________________________MD, PhD, Professor N.A. Zolotaryova

(signature, scientific rank, last name, initials)

The program is accepted on meeting of subject cyclic methodical comette

Protocol № 1 from 14.09.06

Head of subject cyclic methodical commission

__________________________________ MD, PhD, Professor V.М. Yurlov

(signature, scientific rank, last name, initials)


Addition and changes in the programman on 2006-2007 ed. year


During conducting of the state practically-oriented examination from internal, professional and infectious diseases by the chairmens of government exam comission the good domain by practical skills, poor knowledges of graduating students, was marked not enough from the method of inspection of patient .

In this communication, in the programman from internal disease there were changed:


- 10 hours were selected on the capture by practical skills and method of inspection of patient (the controls to the test from every theme substituted by training on to practical skills from a cardiology, pulmonology, gastroenterology, nephrology and haematology).


The programm was re-endoresed on meeting of department

“ ___”_______2006 Protocol № _____.


Head of the department__________________MD, PhD, Professor N.A. Zolotaryova

(signature, scientific rank, last name, initials)


Section 1. Aims and task of discipline, its place in educational process.

1.1. Purposes of teaching of discipline.

Knowledge of basics of Internal medicine has the primary value for preparation of doctor of general type.During study of internal diseases basics of clinical thoughts are formed, there is mastering of skills by inspection of patients,mastering of skills to apply adequate treatment,to give first aid help.

Professional preparation of the medical personnel assumes forming of not only the system of knowledges, abilities and skills, but also development of the specific special qualities which answer the necessities of professional activity.

The basic whole teachings of Internal diseases in 6th course includes:

Consolidation of knowledges and abilities which were acquired in previous courses;

Mastering of skills, conducting of differential diagnosis of basic syndromes in damage of internal organs;

to appoint differential individualized therapy;to give help in condotions threatening to life;to acquire knowledge on the questions of medical etiquette and deontology;mastering of methods of rehabilitation of patients health, medical examination;mastering of skills to conduct medical documentation;mastering principles of work of a district doctor;

The ideological orientation of educational process is determined by «Law of education» of Ukraine, Orders of DMH of Ukraine, decisions of Scientific Council of university and Central Methodical Council of university about humanization, democracy of educational process, which are directed on forming professionally important qualities of future doctor – citizen – patriot – internationalist.

As a result of study of discipline of 6 course students must:

Know:

basic principles of organization of health care of Ukraine and organization of work of district doctor – internist;

basic legislation of Ukraine about health care;

modern domestic and foreign conceptions of theoretical and practical medicine by questions of health of man and its diseases;

modern classifications, etiology and pathogenesis of diseases of internal organs, foreseen by an on-line tutorial;

methodical basics of medical diagnostics, methodical deontology;

clinical pharmacology, pharmacodynamics of basic medications, mechanism of action of physiotherapeutic and balneologic procedures, medical physical education, character of individual reactions to them;

basics of rational nutrition of healthy and ill man;

principles of actions of modern medico-diagnostic apparatus, that is used in medical establishments;

basic examinations of temporary and permanent loss of working capacity;

To be able:

to conduct general inspection of patients (inspection, palpation,percussion,auscultation), set a preliminary diagnosis;

to appoint the plan of inspection of patients, estimate the results of laboratory (general analyses of blood, urine, creatinine clearance, Nechiporenko test, Amburzhe,Ziminitsky test, character of pleural contents, coprology, biochemical criteria of rheumatic diseases, CHD, atherosclerosis, kidney, hepatic-cellular insufficiency, icterus, immunological indexes, frequent gastric, duodenal sounding), instrumental (X-rays of lungs, heart, stomach, gall-bladder, intestine, kidneys, joints, ЕCG), to represent the diagnostic value of(PCG, ВЕМ, EchoCG, RVG, angiography and cathetrization of cavities of heart, Us examination of organs of abdomen, endoscopic investigations of esophagus, stomach, intestine, bronchi, CT scan , radionuclide methods) of researches;

to choose anchorman syndrome and conduct differential diagnosis with the similar syndrome diseases;

to settle clinical diagnosis taking into account intranosologic structure on the basis of modern classifications of diseases and their complications;

to appoint the differentiated treatment of diseases and their complications;

to diagnose and give help in emergency states (stop of circulation of blood and breathing, acute coronary insufficiency, cardiac asthma, edema of lungs, attack of bronchial asthma, asthmatic status, loss of consciousness, shock, exudative pleurisy, ТEPA, hypertensive crisis, acute violations of cardiac rhythm and conductivity, colics, swoollen lymph nodes, allergic edema of larynx);

to fulfil all functional duties of district doctor; to determine the states related to the temporary and permanent loss of working capacity; to design medical documentation (feasible sheets on LTEK, sheets of incapability to work);


List of disciplines which provides following discipline.


Discipline which provides

Following discipline

Semester

Name of discipline


Name of sections

Semester

Sections and themes

1

2

3

4

5




Normal physiology



Physiology of breathing and circulation of blood at MKK (basic constants of pulmonary circulation of blood)


Physiology of circulation of blood (basic constants of local circulations of blood)

#

Physiology of cardiac contractions (phases of cardiac activity, basic constants)

#

Physiology of excitation, conductivity of heart (biochemical, electric processes, constants)

11,12


11,12



DD of lung infarct

#

DD of violations of bronchial patency

#

DD of disseminated diseases of lungs

#

DD of cor pulmonale

DD of cardialgias

#

DD of cardiomegaly

#

DD of disorder of cardiac rhythm and conduction

#

DD of syndrome of arterial hypertension

#

DD of syndrome of Heart Insufficiency

DD of urinary and nephrotic syndrome









Physiology of urine formation (filtration, reabsortion, circulation of blood in kidneys, constants)


Physiology of hemopoiesis (theory of hemopoiesis, proliferation, differentiation of cells, basic constants).


Physiology of digestion (secretion, mechanisms of movements of food, bile formation, exocrine function of pancreas, intestinal digestion, absiorption, basic constants).



11,12


11,12


11,12


#

DD of chronic renal insufficiency

#

DD of anaemic syndrome

#

DD of leukemias, hyperleucocytosis

#

DD of hemorrhagic syndrome

#

DD of dyspeptic syndrome

DD of hepatomegaly

DD of Jaundice syndrome

DD and treatment of chronic pancreatitis



4,5


7,8


9,10

Pathological physiology


Biochemistry


Propedeuticsof internal diseases


Faculty therapy


Hospital therapy

Types of pathological states:

-Damage;

-Disorders of microcirculation;

-Violation of local circulation of blood;

-Inflammation;

-Fever;

-hypoxia;

-immunopathologic processes;

-Disorders of metbolism exchange:

-Disorder of tissue growth;

Etiology. Pathogenesis of diseases of organs of breathing, circulation of blood, digestion, urine formation, immune diseases.

Biochemistry of connections with the methods of determination of their contents:

-Carbohydrates;

-lipids;

-Albumins;

-Mineral connections;

-Enzymes;

-Vitamins;

-Hormones;

Method of inspection of patients (subjective, objective)

Semiotics of diseases of :

-breathing organs;

-organs of circulation of blood;

-organs of digestion;

-organs of urine formation;

-organs of hemopoiesis;

-immune diseases

(symptoms, syndromes basic laboratory – instrumental data)

Clinical manifestations of typical forms of basic diseases, internal organs, diagnostics, principles of treatment.

Variants of clinical actions and complication of the most widespread diseases of internal

organs, diagnostics, differential diagnosis,

differential treatment.

11,12


11,12


11,12


11,12


11,12


11,12

Corresponding themes (vide supra)


Corresponding themes (look prophetic)

Corresponding themes (vide supra)


Corresponding themes (vide supra)


Corresponding themes (vide supra)


Corresponding themes (vide supra)



Section 2. Table of contents of discipline.


2.1. Themes of lectures, their contents and duration in hours:








Name of theme and its contents

Lecture classes







Duration in hours

Semester



Basic methods and principles of medical diagnostics. Method and methodology of differential diagnosis.

Entry. Acquaintance with the features of teaching of internal diseases in 6th course. Clinical thoughts: concept, structure. Diagnosis, its aspects, structure, functions. Principles of making diagnosis. Basic principles of medical diagnostics. Method and methodology of differential diagnosis. Criticism of bourgoiese conceptions by the questions of medical diagnostics . Scientific- technical revolution and medicine. Medical deontologic value.

2

11,12


2.

Differential diagnosis of anaemic syndrome.

Clinical analysis of patient. Classifications of anaemias (etiopathologic, morphological). Differential diagnosis of different variants of anaemias taking into account clinical information, results of laboratory – instrumental investigations. Principles of treatment (medicinal, surgical). Indications to hemotransfusion.

Settle diagnosis of patient (primary, secondary anaemia, degree of severity, complication). Treatment.


2

11,12


3

Differential diagnosis of hemorrhagic syndrome

Clinical analysis of patient. Concepts. Types of hemorrhages. Classification of diseases with the syndrome of increased bleeding. Differential diagnosis taking into account the feature of clinical, laboratory – instrumental information. Complication. Principles of the differentiated treatment.

Substantiation of diagnosis of patient. Treatment.


2

11,12


4

Differential diagnosis of comatose states.

Clinical analysis of patient (anamnesis of patient). Classification of the comatose states in endocrine diseases (ketoacidosis, hyperosmolaric, hypoglycemia, cerebral in diabetes mellitus, hyperthyroid crisis, hypothyroidism, hypopituitarism in diseases of hypophysis,Addison’s crisis – in diseases of adrenal glands. Differential diagnosis taking into account the features of clinic, laboratory – instrumental researches. Substantive provisions in relation to principles of taking out of patients from the comatose endocrinology states.

Substantiation of diagnosis of patient. Treatment.

2

11,12


5

Differential diagnosis of Fever of unknown origin (FUO).

Clinical analysis of patient. Determination of concept. List of diseases with the possible syndrome FUO (sepsis, infectious endocarditis, diffuse diseases of connectve tissue, tumour, hemoblastosis, chronic purulent inflammations, disease of thyroid gland, tubercular infection, diencephalon damage). Differential diagnosis taking into account features


2

11,12


6

Differential diagnosis of edematic syndrome.

Clinical analysis of patient. Determination of concept. Reasons and types of edema: local and general; cardiac, renal, angioneurotic; as a result of diseases of liver, thyroid gland, lymphostasis, mechanical squeezing of vessels and others like that. Differential diagnosis taking into account the clinical features of laboratory – instrumental researches.

Substantiation of diagnosis of patient. Treatment.


2

11,12


7

Differential diagnosis of Jaundice syndrome.

Clinical analysis of patient. Determination of concept. Classification: suprahepatic, hepatic, subhepatic. Differential diagnosis taking into account a clinic and laboratory features.

Substantiation of diagnosis of patient. Treatment.


2

11,12


8

Differential diagnosis and treatment of Ischemic Heart Disease. Clinical analysis of patient (hospital charts) with the complicated form of acute infarct of myocardium. Early and late complications. Emergency states. Reanimative measures.

Modern looks on etiology and the IHD pathogenesis. The ЕCG-Мonitoring Place, determination of myocardial enzymes, coagulating factors of blood, in diagnostics. The treatment of IHD depends on antianginal ,thrombolytics and antiatherogenic drugs.


2

11,12


9

Differential diagnosis of Arthritis syndrome.

Clinical analysis of patient. Determination of concept. Features of arthritis syndrome depending on a nosologic form (mono-,oligo-,polyarthritis, damage of small, large joints, deformities, , presence of visceral damages). Differential diagnosis.Substantiation of diagnosis of patient. Treatment.

2

11,12





IN ALL

18






2.2. Practical classes, their contents and duration in hours.









Name of theme and its contents

Practical classes







Duration in hours

Type of classes

Semester



Differential diagnosis of murmurs in heart. Functional and organic cardiac murmurs. Thematic round of patients with systolic murmur (organic and relative insufficiency of mitral valve, prolapse of mitral valve, stenosis of aorta, defect of interatrial and interventricular septum, stenosis of pulmonary aorta, the Phallo’s defect). Criteria of diagnosis. Differential diagnosis. Modern methods of diagnostics. Features of therapeutic tactic. Indications and variants of surgical treatment.

Themes. Round of patients with diastoloc murmur. Features of disturbances of hemodynamics. Criteria of diagnosis taking into account etiology. Differential diagnosis. Substantiation of diagnoses. Features of therapeutic tactic. Indications and variants of surgical treatment. Discussion of problem of bacterial endocarditis (etiology, pathogenesis, clinical manifestations, inspection of patients, treatment).



8



PЗ.

Themes.

Round



11,12





Differential diagnosis and treatment of Cardiomegaly. Thematic round of patients (diffuse myocarditis, dilatative cardiomyopathy, exudative pericarditis, acquired defects of heart, cardiosclerosis). Criteria of diagnosis taking into account etiology, pathogenetic mechanisms. Differential diagnosis. Subxtantiation of diagnoses. Treatment of patients.


8

.

Themes.

Round


11,12



Clinical variants of course and treatment of Myocardial Infarction and its complications.

Clinical analysis of patient by the acute myocardial Infarction (complicated form, cardiogenic shock, cardiac asthma and pulmonary edema). Criteria of diagnosis. Differential diagnosis. Volume of medicinal remedies. Rehabilitation of patients with the acute heart attack of myocardium. Use of tests with loading.

8

.

Clinic.

treat.


11,12



Variants of clinical course and treatment of the chronic forms IHD.

Thematic round of patients (stable angina pectoris, atherosclerotic and postinfarctional cardiosclerosis). Criteria of diagnosis. Differential diagnosis.

Seminar: differentiated treatment (antianginal,correction of cogulation of blood, antiatherogenic, metabolites, surgical treatment).

6


2

.

Themes.

Round


11,12

5.

Differential diagnosis of heart pain .

Thematic round of patients (myocardial infarction, angina pectoris, neurocirculatory dystonia, myocarditis, dilated aneurism of aorta, pericarditis, left-side pleurisy, osteochondrosis of thoracic part of spine, myositis, intercostal neuralgia). Criteria of diagnosis taking into account etiology, features of course. Differential diagnosis. Substantiation of diagnoses. Treatment of patients


8

.

Themes.

Round


11,12

6.

Differential diagnosis and treatment of edematic syndrome.

Thematic round of patients (chronic cardiac insufficiency, nephrotic syndrome, hypothyreosis). Criteria of diagnosis taking into account etiology, clinical variants. Differential diagnosis. Differentiated treatment depending on etiology, pathogenetic, clinical variants. Medicinal therapy (chronic cardiac insufficiency, diet, cardiac glycosides, vasodilators, diuretics, etiology, clinical variant.Differential variants.


8

.

Themes.

Round


11,12

7.

Differential diagnosis and treatment of cardiac arrhythmias and conduction.

Thematic round of patients (atrial fibrillation, paroxysmal tachycardia, extrasystole, violation of sinoatrial, atrioventricular, intraventricular conductivity). Criteria of diagnosis (clinical, electrocardiography). Establishment of mechanism of origin.


8



PЗ.

Themes.

Round


11,12

8.



Differential treatment of disorders of rhythm and conduction.

Differential treatment (planned, emergency, prevention of attacks, medicinal, electrotherapy).


8

PЗ.

Themes.

Round

11,12

9.

Differential diagnosis and treatment of arterial hypertension.

Thematic round of patients (hypertensive disease, symptomatic hypertension-renal, endocrial, hemodynamical). Criteria of diagnosis. Differential diagnosis. Features of clinical course and complications of different forms and clinical variants).

Seminar: differential therapy of hypertensive disease, hypertensive crisis.


6


2

PЗ.

Themes.

Round

11,12

10.

Training of practical skills and abilities in cardiology.

Differential diagnosis and treatment of arthritis syndrome.

Thematic round of patients (rheumatic arthritis, deforming osteoarthroses,gout,Reiter’s syndrome, rheumatism, Bechtreeve’s disease, diabetic arthropathy, reactive arthritis). Criteria of diagnosis taking into account etiology, variants of clinical course. Differential diagnosis of Arthritis syndrome taking into account its features at each nosoform.. Differentiated treatment. Discussion of treatment of patients, that supervised.


2


8



PЗ.

Themes.

Round

11,12

11.

Differential diagnosis and treatment of diffuse diseases of connecting tissue (DDCT) and systemic vasculitides (SV).

Clinical analysis of patient with system lupus erythematosus (SLE). Criteria of diagnosis (clinical, laboratory, instrumental). Differential diagnosis with other DDCT and SV. Place of methods of biopsy in verification of diagnosis.Substantiation of diagnosis of patient and treatment

Seminar: principles of therapy in rheumatology, etiotropic,pathogenetic (basic,first line and second line drugs), symptomatic, methods of gravitation surgery of blood (plasmophoresis, immunosorbtion).



4


2


2

PЗ.

Clini. treat.

11,12

12.

Differential diagnosis of pulmonary infiltrate.

Thematic round of patients (acute and croupous pneumonia, cancer of lungs, eosinophilic infiltrate, tuberculosis of lungs, infiltrative abscess and gangrene of lungs,infarct of lungs,atelectasis, pleurisy). Criteria of diagnosis taking into account the feature of etiology, variants of course, complications, description of infiltrate, differential diagnosis of lung infiltrate syndrome. Principles of treatment of patients. Discussion of treatment.


8



PЗ.

Themes.

Round

11,12

13.

Differential diagnosis of disseminated damage of lungs

Thematic round of patients (diffuse pneumosclerosis,pneumoconiosis,disseminated TB of lungs,sarcoidosis,fibrous alveolitis,candidomycosis).Criteria of diagnosis taking into account features of etiology,clinical course,complications.Differential diagnosis of disseminated damage of lungs. Principles of treatment. Substantiation ofdiagnosis and treatment of patients.

Seminar: principles and tactics of antibacterial therapy.

6


2

.

Themes.

Round

11,12

14.

Differential diagnosis and treatment of violations of bronchial patency.

Clinical analysis of patient of bronchial asthma. Criteria of diagnosis taking into account the features of syndrome of bronchial obstruction, etiopathogenesis, complications. Differential diagnosis of syndrome of bronchial obstruction (chronic bronchitis, bronchial asthma,). Substantiation of diagnosis and treatment of patient. Principles of therapy (planned therapy, emergency therapy of bronchial asthma, asthmatic status, spontaneous pneumothorax).

8



PЗ.

Themes.

Round

11,12

15.

Differential diagnosis and treatment of chronic cor pulmonale(CCP).

Clinical consideration of patient with CCP. Criteria of diagnosis taking into account etiology (bronchial, vascular, thoracodiaphragmmatic CCP), stage of complications. Principles and features of treatment. Prognosis. Discussion of diagnosis and treatment of patient.


8

P3.

Clini.

treat.

11,12

16.

Differential diagnosis and therapy of Acute respiratory insufficiency.

Themes. Round of patients with cardiac and bronchial dyspnea, edema of lungs, allergic edema of larynx, thromboembolism of pulmonary artery(TEPA) is the criteria of diagnosis, features of clinical course, complication, differential diagnosis, emergency therapy.

Training of practical skills and abilities from pulmonology.


4


2

PЗ.

Themes.

Round

11,12

17.

Differential diagnosis and treatment of dyspeptic syndrome.

Thematic round of patients: functional disorders of stomach, different variants of chronic gastritis, ulcerous disease, cancer of stomach. Criteria of diagnosis taking into account etiology, features of localization of pathological process and variant of functional violations of secretion and motor function, complications. Place of endoscopic investigation of esophagus, stomach, duodenum with biopsy in diagnostics. Differential diagnosis of dyspeptic syndrome. Discussion of diagnosis and treatment of patients. First aid in gastrointestinal bleeding (reasons, signs, determinations of degree of severity, tactics of treatment; blood replacement fluids, еrythromass).



8

PЗ.

Themes.

Round

11,12

18.

Differential diagnosis and treatment of chronic pancreatitis.

Clinical consideration of patient: with chronic pancreatitis, criteria of diagnosis taking into account the variant of clinical course, complications, concomitant pathology. Differential diagnosis on to the syndromes: diarrhea, pain, icterus, maldigestion). Discussion of diagnosis and treatment of patient. Principles of treatment of chronic pancreatitis Discussions of diagnoses and treatments of patients. .


6

PЗ.

Clini.treat.

11,12

19.

Differential diagnosis of hepatomegaly and hepatosplenic syndrome..

Thematic round of patients: different variants of chronic hepatitis, cirrhosis and cancer of liver, parasitic diseases. Criteria of diagnosis taking into account etiology, variants of clinical course, complications. Differential diagnosis. Chronic viral hepatitis has non hepatic manifestations, markers of diagnostics, transformation in the cirrhosis of liver, hepatocellular carcinoma, treatment (antiviral facilities). Discussion of diagnosis and treatment of patients.

Thematic round of patients: В12-folate deficient anaemias, hemoblastosis,lymphogranulematosis. Criteria of diagnosis (clinical, lab.-instrumental,biopsies). Differential diagnosis taking into account the features of hepatosplenic syndrome. Discussion of diagnosis of patients. The Hepatocellular carcinoma-reasons, clinical manifestations, diagnostics, degrees of severity, first aid.

Training of practical skills and abilities from gastroenterology.


6


2

PЗ.

Themes.

Round

11,12

20.

Differential diagnosis of Jaundice syndrome.

Thematic round of patients: variants of chronic hepatitis, cirrhosis of liver, cancer of liver, hemolytic anaemias, cholelithiasis, cancer of caput of pancreas, Faterow’s cancer, benign hyperbilirubinemias. Criteria of diagnosis taking into account the features of syndrome of icterus (suprahepatic, hepatic, subhepatic), clinical course of disease, complications. Differential diagnosis. Discussion of diagnoses and treatment of patients.


8

PЗ.

Themes.

Round

11,12



21.

Differential diagnosis of violations of functions of intestine.

Thematic round of patients: Crohn’s disease, unspecific ulcerous colitis, syndrome of irritation of colon, spastic colitis, tumours of bowel,hypothyreosis. Criteria of diagnosis taking into account etiology, variants of clinical course,, complications. Differential diagnosis of syndromes of diarrhea , constipation, intestinal bleeding. Discussion of diagnoses and treatment of patients.


6



PЗ.

Themes.

Round

11,12

22

Differential diagnosis and management of hyperglycemias. Themes. round of patients with diabetes mellitus,Cushing’s syndrome, pheochromocytomas,acromegaly..

8

.

Themes.

Round

11,12

23

Differential diagnosis and management of enlaged thyroid gland.

Themes. round of patients with a diffuse and nodular goitre, thyroiditis, tumours of thyroid gland.

8







24.

Differential diagnosis of urinary syndrome.

Thematic round of patients: acute and chronic glomerulonephritis,nephrolithiasis, pyelonephritis, «stagnant kidney»,diabetic nephropathy,hypernephroma, cystitis, cancer of urinary bladder, hemorrhagic vasculitis. Criteria of diagnosis by the account of etiology, variants of course, complications. Differential diagnosis of urinary syndrome with the selection of nephritic and inflammatory variants.

8

.

Themes.

Round

11,12

25.

Differential diagnosis and treatment of chronic renal insufficiency (CRI).

Clinical consideration of patient: chronic glomerulonephritis-complication CRI.Criteria of the CRI diagnosis taking into account stage, indexes of renal functions, complications. Discussion of diagnosis and treatment of patient. Principles of treatment (conservative therapy, postrenal purification of blood, renal transplantation).


8

PЗ.

Themes.

Round

11,12

26.

Differential diagnosis of Nephrotic syndrome.

Thematic round of patients: acute and chronic glomerulonephritis, amyloidosis of kidneys,Kimmestil-Wilson’s syndrome. Criteria of diagnosis taking into account etiology, features of clinical course, complications

Training of practical skills and abilities from nephrology.

6


2

.

Themes.

Round

11,12

27.

Differential diagnosis and treatment of anaemias.

Thematic round of patients with acute and chronic posthemorrhagic, iron deficiency,magaloblastic(В12-folate deficient), hypoplastic,hemolytic anaemias. Criteria of diagnosis taking into account etiology, features of clinical course, results of laboratory-instrumental inspection. Differential diagnosis of anaemic syndrome. Discussion of diagnoses and treatment of patients. Principles of treatment of anaemias.


8

PЗ.

Themes.

Round

11,12

28.

Differential diagnosis and treatment of hemoblastosis.

Thematic round of patients with different variants of acute and chronic leukemias. Criteria of diagnosis (clinical and laboratory, myelograms). Differential diagnosis of syndromes of leucocytosis, hyperleucocytosis. Discussion of diagnoses and treatment of patients. Principles of treatment of leukemia (stages, mono,polychemotherapy). Criteria of remission.


8

PЗ.

Themes.

Round

11,12

29.

Differential diagnosis at lymphoadenopathy.

Clinical analysis of patient with lymphogranulematosis. Criteria of diagnosis taking into account the features of syndrome of lymphoadenopathy,

results of cytological and histological investigations, signs of activity of process. Differential diagnosis with tuberculosis, infectious mononucleosis,toxoplasmosis AIDS, DST, acute and chronic leukemias. Discussion of diagnosis and treatment of patient.


8

.

Clini.

trea.

11,12

30.

Differential diagnosis of hemorrhagic syndrome.

Thematic round of patients: hemorrhagic vasculitis, haemophilia, Verlgof’s disease, Randu-Osler’s disease. Criteria of diagnosis taking into account the features of syndrome of increased bleeding, etiology, laboratory investigations. Differential diagnosis of hemorrhagic syndrome. Discussion of diagnoses and treatment of patients.

Seminar: DIC-syndrome.

Training of practical skills and abilities from haematology.

8


2

4



.

Themes.

Round


11,12





Final test control .

6












Test of practical skills.

6










Total

252









2.3. Independent work of students, contents and duration in hours.




Theme

Table of contents of educational material

Control forms

Duration in hours



Differential diagnosis of syncope conditions.



Determination of concept.

Diagnostic criteria.

Periods in the clinic of syncope.

Syncope states in illnesses of neurology (epilepsy, vertebrobasilar insufficiency, syndrome of arc of aorta, vasculoro-vegetative and neurocirculatory dystonia, syndrome of sleepy sinus, hysteria) and therapeutic (drug orthostatic hypotension and iatrogenic hypoglycemia, acute posthemorrhagic anemia,insulinoma, hypoparathyreosis) type. To pay attention to possibility of syncope in: myocardial infarct, heart cessation (fibrillation and paroxysmal ventricular tachycardia, complete AV blockade), syndromes of weakness of sinus node, syndromes of ventricular extrasystoles, pathology of aortic valves, prolapse of mitral valve, with biks and spherical thrombosis of atrium, ТЕPA, primary pulmonary hypertension MKK. During conduction of differential diagnosis estimate:

-what precedes the fainting fit;

- anamnesis;

-physical pose during attack;

-ЕCG;

blood tests.

The border control, rector control, examination


20



Differential diagnosis of ascites.

Determination of concept.

Etiology and features of course of ascites in portal hypertension, tumours of abdominal region, stagnations in vena cava inferior, inflammations of bacterial and immune origin, exchange – dystrophic violations.

Веріфікуючі methods of inspection. Differential diagnosis.



The border control, rector control examination.

15



Differential diagnosis of hemoptysis.



Determination of concept.

Criteria of hemoptysis and pulmonary bleeding.

Etiology and features of course of the pulmonary bleeding and hemoptysis in:

1. tumour diseases of bronchial tubes and lungs; 2. infectious diseases of bronchial tubes and lungs;

3. parasitic diseases of lungs;

4. pneumoconioses;

5. foreign bodies in bronchial tubes and lungs;

6. traumas of thorax;

7. cardiovascular disease;

8. systemic vasulitides and hemorrhagic diatheses;

9. destructive diseases of bronchial tubes and lungs;

Verifying methods of inspection. Differential diagnosis.

The border control,rector control,examination

14






.Etiology and features of course of destructive processes in lungs in:

1.infectious inflammations in lungs;

2.cavities as a result of parasitic diseases

3.cavities of tumour origin;

4.defects of development;

5. bullous emphysema of lungs;

specific laboratory and instrumental manifestations. Differential diagnosis.

The border control, rector control, examination


15



Differential diagnosis of gastric dyspepsia.


Determination of concept.

Symptoms of gastric dyspepsia. Functional dyspepsia (dysmotoric, refluxive,idiopathic); Organic dyspepsia (reflux-esophagitis, gastritis, peptic ulcer,tumours of stomach, pancreatitis, biliary pathology, diaphragmatic hernia, drug induced). Research methods for verification.

Place of biopsy in diagnostics. Differential diagnosis.


The border control, rector control, examination


15



Differential diagnosis of acute abdomen.


Disease with the possible syndrome of acute pain in a stomach:

-acute appendicitis;

-disease of stomach and duodenum;

-disease of liver and biliary tract;

-disease of pancreas;

-disease of the intestine;

- primary recidive inflammation of peritoneum;

-damage of vessels of abdominal region;

-damage of the nervous system;

-disease of organs of urinary ystem;

-disease of genitals;

-endocrine diseases and metabolic disturbances;

-disease of thorax;

Criteria of diagnosis. Differential diagnosis.

The border control, rector control, examination


15



Differential diagnosis of malabsorption and maldigestion


Determination of concept.

Etiology of malabsorption and digestion(hereditary, primary, secondary violations).

Secondary violations:

1.post-operative;

2.inflammatory diseases of intestine;

3.tumours of small intestine;

4.systemic diseases;

5.endocrine pathology;

6.vascular violations;

7.parasitoses;

8.pathology of stomach, pancreas.

Criteria of diagnosis (diarrhea, weight loss, intestinal dyspepsia, trophic disturbances, hemorrhagic syndrome, osteoporosis, cramps, hypofunction of sexual glands, edema, hypovitaminosis, polyneuritis, asthenia). The verificative methods of research are histological, endoscopic, roentgenologic, immunological. Differential diagnosis.

The border control, rector control, examination


15



Functional investigative methods in diseases of stomach , intestine,

and hepatobiliary systems.


Includes methods for research of secretory and motor functions gastric – intestinal tract : X-ray of stomach, duodenum and SI with a barium mixture; irigoscopy which allows to expose both functional (hyper-, hypomotoric disturbances, obstruction) and morphological component of disease; frequent factious gastric sounding with determination of secretory and acid secreting functions on empty stomach and after stimulation;acidometry of gastric contents; factious duodenal sounding; unfolded coprologic research with estimation of function of digestion and absorption. Investigation of function of liver includes: markers of damage of hepatocytes (AST, ALT, LDG); cholestasis (bilirubin, AP, gamma-GTP, serum PAWS); markers of synthetic function (albumens, fibrinogen, prothrombin, coagulating factors of blood V, VII, IX, X; ; VII, IX, X_lipoproteins, phospholipids); markers of absorption – function (test with bromosulphane, bengali rose) detoxificating function (urea of blood). Investigation of function of biliary tracts includes: pigmental exchange and manifestations of cholestasis (vide supra); factious duodenal sounding, cholecystography(oral, intravenous); hypotonic duodenography; ERCP

The border control, rector control, examination


15



Differential diagnosis of stable cardiac insufficiency.

Etiology and pathogeny of insufficiency of circulation of blood.

Principal reasons of chronic circulatory insufficiency

Factors, which predetermine the origin, progress or exacerbation of insufficiency of circulation of blood.

Intercommunication between pathophysiologic shifts and clinical manifestations of circulatory insufficiency.General questions of diagnostics and the CCI classification.

The CCI Classification.

Differential diagnostics of stable CI. Chronic stable CI.

Acute stable CI. Approach to CI treatment.

The border control, rector control, examination


20







Total

144





3. KINDS OF METHODICAL PROVISIONS OF DISCIPLINE :


3.1.Texts of lectures № 18 (the texts of lectures are added).

3.2.Methodical developments of practical classes for teachers № 126(methodic-developments are added).

3.3.Methodical instructions from practical classes for students № ( methodic-instructions are added).

3.4.Methodical recommendations for students with СРС № 9(methodic-recommendations are added).


The indicated materials are educative-methodical documentation, that provides realization of working from discipline.


3.5. List of technical and evident facilities of studies, which are used by department for reading of lectures and conduction of practical classes.




Name of associations and technical facilities

Numbers of themes, in which are used

Amount



Codoscope

Lectures №№

1



Films-codograms

Lectures №№






Educational tables

Lectures №№






Sciagrams

P3 №№






ECG

P3 №№






Slide Projector «Etude»

P3 №№

2



Slides

P3 №№






Scanner

P3





3.6. Tests for determination of basic, current and final control of knowledges and collections of situational tasks.

3.6.1. Tests for the basic (outcome) level of knowledges – 80 tests.

3.6.2. Tests for the current control of knowledges: cardiology – 237 tests, cardiorheumatology-69т., pulmonology– 128т., gastroenterology-116 of т., nephrology and endocrinology –93 т., haematology –82т.

3.6.3. Tests for the final control – 10 variants for 200 tests.

3.6.4. Tests for the Rectorial control – 2000 tests.

3.6.5. Collection of situational tasks.


3.7.Criteria of assessment of knowledges by students.

3.7.1. Criteria of assessment of knowledges of students during the border and final test control.

The final control of knowledges of students allows:
  1   2   3   4

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