Of medical and pedagogical faculty worker program on the subject of «internal diseases» for VII



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Medicine for travelers. Advice to travel . Consultations after traveling . Immunization. Changing climate and time zones . Motion sickness and altitude sickness . Travel medical kit


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Differential diagnosis of diffuse connective tissue diseases.

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Differential diagnosis in the practice of GPs. A presumptive diagnosis. The most dangerous disease. Diagnostic errors. Diseases simulators. Mental disorders and Simulation.

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Chest pain. Differential diagnosis of coronary heart disease , myocarditis , myocardial dystrophy , and degenerative disc disease of the thoracic spine, intercostal neuralgia , chest trauma , herpes zoster . Tactics GPs. Outpatient treatment and prevention .


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Heartbeat . Differential diagnosis of atrial arrhythmias: sinus tachycardia, sinus bradycardia, respiratory arrhythmia, extrasystoles . Tactics GP


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Heartbeat . Differential diagnosis of heart circulatory insufficiency, anemia, thyrotoxicosis, Neurocirculatory distoniya.Taktika GP

Diff. Diagnosis of chronic heart failure in stages . Tactics GPs.




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Headache. Diff. diagnosis of headache. Tactics GPs.

 Differential diagnosis of hypertension and sclerotic arterial hypertension . Tactics GPs.




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Coughing up phlegm .

Differential diagnosis of acute respiratory infections, acute bronchitis and pneumonia . Tactics GP

Prevention and treatment of respiratory diseases in rural health units


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Shortness of breath , choking . Differential diagnosis of bronchial asthma , emphysema , pneumatic sclerosis . Chronic respiratory failure . Tactics GPs. Diagnosis of COPD in primary health care . Principles for the prevention and treatment of chronic obstructive pulmonary disease in a hovercraft . Tactics GPs.

Differential diagnosis of chronic respiratory failure in powers . Tactics GPs.




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Coughing up phlegm . Differential diagnosis of chronic bronchitis and bronchiectasis. Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of prophylaxis . Definition of disability . Topics of teaching principles . " Problem-based learning module " rural medical point" - the syndrome of " cough with sputum»

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" Shortness of breath , choking . " Shortness of breath , choking . Diseases that occur with shortness of breath or suffocation . The most dangerous diseases that occur with shortness of breath or suffocation . Differential diagnosis of bronchial asthma , emphysema , pulmonary fibrosis . Chronic respiratory failure . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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" Shortness of breath , choking . " Shortness of breath , choking . Diseases that occur with shortness of breath or suffocation . The most dangerous diseases that occur with shortness of breath or suffocation . Differential diagnosis of bronchial asthma , emphysema , pulmonary fibrosis . Chronic respiratory failure . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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Shortness of breath , choking . Differential diagnosis of pulmonary heart . Management of the patient with chronic pulmonary heart . Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Definition of disability . Topics of teaching principles . " Problem-based learning module " rural medical point" - syndrome " Shortness of breath , choking ."


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Coughing up phlegm .

Differential diagnosis of acute respiratory disease, SARS, acute bronchitis and pneumonia . Tactics GP



Prevention and treatment of respiratory diseases in family clinics


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“ Dyspepsia ( indigestion, nausea , vomiting ) . Differential diagnosis of biliary dyskinesia and cholecystitis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , monitoring, control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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" Dyspepsia ( indigestion, nausea , vomiting ) . Differential diagnosis of gastritis , duodenitis and peptic ulcer disease . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , monitoring, control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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" Dyspepsia ( indigestion, nausea , vomiting ) . Differential diagnosis postcholecystectomy syndrome and diseases of operated stomach . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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" Abdominal pain. Differential diagnosis of diseases that occur with pain epi , meso and hypogastric regions . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles "


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«Abdominal pain. Differential diagnosis of chronic cholecystitis and chronic pancreatitis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

».


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“Diarrhea . Differential diagnosis of diarrhea, infectious and noninfectious etiologies. Hypovitaminosis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

"


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“Diarrhea . Differential diagnosis of diarrhea, infectious and noninfectious etiologies. Hypovitaminosis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

"


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Constipation. Differential diagnosis of irritable bowel syndrome , senile constipation and colon tumors. Tactics GPs.


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«Constipation . Differential diagnosis of irritable bowel syndrome , senile constipation and colon tumors. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics of teaching principles . " Problem-based learning module " rural medical point" - the syndrome of " constipation "


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«Hepatomegaly . Differential diagnosis of acute and chronic hepatitis , alcoholic liver disease . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics of teaching principles . " Problem-based learning module " rural medical point " - " constipation " syndrome, " dyspepsia " , " abdominal pain " , " hepatomegaly

”.


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«Articular Syndrome . Diseases that occur with articular syndrome . The most dangerous diseases that occur with articular syndrome . The differential diagnosis of infectious arthritis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Definition of disability . Topics Teaching Principles

»


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«Articular Syndrome . Differential diagnosis of osteoarthritis and gout . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Definition of disability . Topics Teaching Principles

»


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Fever of unknown origin . The nature, types of fevers , plan survey for fever . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Principles of teaching about " Problem-based learning module " rural medical point " - the problem of" fever of unknown origin "


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«Differential diagnosis of fever in infectious diseases ( bacterial, viral ) . GP tactics depending on the disease . Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles»

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«Differential diagnosis of fever in rheumatic diseases and malignant neoplasms . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

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Dysuria . Differential diagnosis of uric acid diathesis and cystitis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , monitoring, control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles


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«Dysuria . Differential diagnosis of acute and chronic pyelonephritis . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

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«Changes in urinary sediment . Differential diagnosis of nephrotic syndrome . Tactics GPs. Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics Teaching Principles

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Edematous syndrome . Differential diagnosis of swelling of various etiologies ( circulatory failure , renal , endocrine ) . Tactics GPs.


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Edematous syndrome . Differential diagnosis of swelling of various etiologies ( circulatory failure , renal , endocrine ) . Indications for referral to a specialist or hospitalization in profile department . Principles of treatment , clinical supervision , control and rehabilitation in a family clinic. Principles of prophylaxis . Topics of teaching principles .


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Total:

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2. The content of the material lecture materials

1.Sudden death. Tactics GP (2 hours)
Under sudden cardiac death (SCD) understand the death that has developed immediately or within hours after manifestation of changes in the clinical status of the patient.

Cardiac arrest (Sardiacarrest) - a condition associated with loss of consciousness due to asystole, ventricular tachycardia or ventricular fibrillation. Prerequisite diagnosis of cardiac arrest is to record these episodes electrocardiographic way.

According to the WHO - today one million people a week die suddenly 30 people. In 1985, the United States about 400,000 deaths were classified as sudden in individuals older than 25 years (NIH Publication 83-2035). Out of the total mortality at a fraction of sudden cardiac death accounts for about 10%. Sudden cardiac death is 15-20% of all non-violent deaths among residents of industrialized countries. The share of coronary heart disease accounts for about 80% of all sudden deaths (Myerbug RJ etall., Heartdisease: a textbook ...; 1992). In 25% of cases of coronary heart disease manifests the development of BCC (Kennel WB etall., Circulation 1975). Suddenly die 50% of CHD patients (Gillum RF., Circulation 1989). Approximately 400,000 ARIA annually in Europe. Among them: less than 10% are hospitalized; (<40,000); Half of these survivors died before discharge (20,000); survive 20,000 patients in need of treatment (ESC, 2001).

In the Russian Federation, official statistics on the subject are contradictory because of objective and subjective reasons. Taking into account the fact that the life expectancy of the male population in Russia is much lower than in industrialized countries and is 57 years old, it can be assumed that the absolute number of sudden deaths in the general population is high.

There are different definitions of sudden cardiac death. Myerburg and Castellanos (2001) gives the following definition:

About 80% of cases of sudden cardiac death due to coronary heart disease (NA Mazur, 1999). This sudden death may be designated as sudden cardiac death. In the classification of CHD indicated that one of the forms of ischemic heart disease is sudden cardiac death, which can be defined.

There are certain age and gender characteristics of sudden cardiac death.

There are two types of age-related sudden cardiac death: neonatal (in the first 6 months of life) and adults (aged 45-75 years) (Burch et al., 1965). Among infants the incidence of sudden cardiac death is about 0.1-0.3%. At the age of 1-13 years, only 1 out of 5 cases of sudden death caused by cardiac disease, aged 14-21 years, this figure rises to 30%, and in middle and old age of 88% of all cases of sudden death are sudden cardiac death.

There are gender differences in the incidence of sudden cardiac death. Sudden cardiac death in young and middle aged men indicated 4 times more often than women, aged 45-64 years in men sudden cardiac death is recorded in 7 times more often than women, and only in the age group 65-74 years the frequency sudden cardiac death in men and women expressed by the ratio of 2: 1.

In the United States more than 250,000 recorded cases of sudden cardiac death each year.

According to WHO, the incidence of sudden cardiac death is 30 cases per week for 1 million. Population, ie in Tajikistan can expect more than 4 500 cases.

Incidence of sudden cardiac death, according to the WHO in different countries ranges from 19% to 149 per 100,000 population, and with respect to all patients who died underwent autopsy is:

aged 30 - 39 years - 5.9%;

aged 40 - 49 years old - 20.2%;

aged 50 - 59 years - 28.3%;

aged 60 - 69 years old - 44.7%;

In men, sudden cardiac death observed in 2.5-3 - 4 times more often.

Most often sudden cardiac death occurs in early morning and early morning hours, and in the first half of the day. During this period, almost half of all registered cases of disasters. At the same period, the peak episodes of silent myocardial ischemia, coronary thrombosis, myocardial infarction (MI), stroke.

There are some forms of sudden cardiac death, occurring at night. Such forms are described as "death in a dream" (Laos) "sudden and unexpected death" (Japan), "wake up and groan in his sleep" (Philippines).

In 69% of all cases of sudden cardiac death occurs at home, 18% - on the street or transport, 7% -on paper, 6% - in other places. These statistics show that in almost all cases of sudden death, with proper organization of primary health care, the patient may be affected resuscitation.

According to statistics in the world each year about 160 episodes of sudden death during sutochnogomonitorirovaniya ECG.Without interest, and the following data. During execution of cardiac rehabilitation programs BCC occurs in about 1 in 12,000-15,000 patients, and during the load tests - in one case, a 2000 study.

The concept of sudden death encompasses not only the specific cause of death, as its specific mechanism, which applies to all categories of cardiovascular disease »(MasoodAkhtaretal).

The content of the term "specific mechanism" to disclose the analysis of unique Holter monitor ECG recorded at the time of sudden cardiac death, first of all, this arrhythmia. Of great interest are the data holterovskogomonitorirovaniya in healthy individuals: supraventricular arrhythmias - from 14 to 91%, PVCs - 46-89%, pacemaker migration - 7-54%, "fly-out" areas - from 4 to 46%.

Literature: Oh (main) -1,3,6,8 D (optional) -1,2,7,8,10


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