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


Differentsialnaya diagnostics arrhythmias. Clinical and ECG diagnosis. Emergency care (2 hours)



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2.Differentsialnaya diagnostics arrhythmias. Clinical and ECG diagnosis. Emergency care (2 hours)
Cardiac arrhythmias and conduction - a large group of transient or permanent disorders of heart rhythm, mainly arising from the organic lesions of the cardiovascular system. They are caused by violations of the most important functions of the myocardium: automatism, excitability and conductivity.

Of organic lesions of the cardiovascular system are the most common arrhythmia in ischemic heart disease, myocarditis, cardiomyopathy, heart defects, disease of large vessels ( Aortic aneurysms and tears, Takayasu's disease), hypertension, pericarditis, cardiac tumors. Arrhythmias are also seen in endocrinopathy (pheochromocytoma, thyrotoxicosis), intoxications medicines (glycosides, catecholamines), acute infectious diseases, anemia, and other pathological conditions.

Arrhythmias may be related to features of the conduction system, such as in cases Wolff syndrome, Chron's disease Wight.

Often arrhythmias develop disorders of electrolyte balance, especially potassium, calcium and magnesium.

Sometimes arrhythmias occur under the influence of excessive consumption of coffee, alcohol, smoking, often with hidden lesions of the myocardium. Some types of arrhythmias may develop in healthy lyudey'v response to exercise or stress.

The diagnosis of cardiac arrhythmias is based on clinical and electrocardiographic data. For a healthy person is characterized by sinus rhythm.

Literature: A: D 1,3,6,8: 1,2,7,8,10
3.Differentsialnaya diagnosis of chest pain with noncoronary nature (2 hours)
In the practice of general practitioners often have to deal with different situations, accompanied by chest pain, which often require a doctor's quick, efficient care to patients. What should be help at various specific situations depends on what kind of pathology in the patient - whether it threatens the patient's life? What is the reason the appearance of these pains? In this chapter we will focus on some diseases that are accompanied by chest pain noncoronary character. First of all, eliminate the most dangerous diseases that threaten the life of the patient:

• Myocardial infarction

• Spontaneous pneumothorax

• PE


• Dissecting aortic aneurysm

Only removing them, you should look for other causes of chest pain. So consider separately some pathology, accompanied by chest pain.

Literature: Oh (main) -1,3,6,8 D (optional) -1,2,7,8,10
4. The differential diagnosis of cough, sputum and hemoptysis. Tactics GP (2 hours)

Cough may be wet or dry depending on the availability of sputum, paroxysmal (whooping cough), periodic (bronchitis), continuous and short (with pleurisy), barking (with the defeat of the larynx and hysteria), husky (with inflammation of the vocal cords).

classification:

1. According to the character:

- Non-productive, or dry;

- Productive or wet - with expectoration.

2. The intensity of:

- Cough;


- Light;

- Strong.

3. Duration:

- Short-term episodic;

- Paroxysmal;

- Permanent.

4. Adrift:

- Sharp - up to 3 weeks;

- Lingering - more than 3 weeks, but less than 3 months;

- Chronic - 3 months or more.

The origin of the cough can be assumed, analyzing his character. So loud dry, hacking (barking) cough occurs with inflammation of the larynx, the trachea; whooping cough with fast successive shocks is interrupted noisy exhalation, leading to vomiting observed with such infectious diseases such as whooping cough; against the background of wheezing - in bronchial asthma. Analyzing the nature of productive cough, you should pay attention to the features of sputum. Thus, cough with sputum light, acquiring yellow-green in periods of exacerbation, is possible with chronic bronchitis, phlegm with blood happens, for example, pulmonary tuberculosis, etc.

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


5. Differential diagnosis of abdominal pain (2 hours)
Abdominal pain is the most common complaint of patients, commonly faced on a daily basis by a general practitioner. Timely diagnosis of the causes of this syndrome determines the correct tactics to further examination and treatment of the patient, which often depends on his life.

The complexity of interpreting pain syndrome is pain that in the abdominal cavity may occur not only in the pathology of its organs, but also in many other diseases, not anatomically associated with this region, due to the nature of vegetative pain. The mechanism is different pain spasms, tension, inflammation, necrosis, compression, etc.

At the bedside, you must first rule out acute surgical diseases accompanied clinic "acute abdomen" and requiring emergency surgery. Early diagnosis of acute abdomen reduces the number of complications and mortality. The pathogenesis of the clinic "acute abdomen" is caused by different processes:

- Inflammation - appendicitis, cholecystitis, pancreatitis, etc .;

- Destructive - peptic ulcer disease, tumors;

- Circulatory disorders of the body - embolism, atherosclerosis, mesenteric vessels spasm, hypovolemia with arterial thrombosis, vascular compression of the outside;

- Obstruction - congenital malformations, tumors, parasites, foreign bodies, the decay products of the tumor.

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


6. The differential diagnosis of intestinal dysfunction. Dysbacteriosis. Modern principles of treatment and prevention (2 hours)
Chronic enteritis. Abdominal pain with CE is not the leading symptom and often localized around the navel. For percussion of the abdomen with flatulence common tympanitis noted that decreases after defecation and flatus. With involvement in the inflammatory process of the mesentery of the small intestine is determined by pain at Porges (left and above the navel level XII thoracic and lumbar vertebrae I. Auscultation is determined by a loud rumbling in the stomach.

Laboratory and instrumental examination. In a blood test: signs of anemia, hypoproteinemia, hypoalbuminemia, hypoglycemia, elevated liver enzymes, sometimes, reducing the level of electrolytes. Urinalysis is often unchanged, but in severe proteinuria and microscopic hematuria observed. For coprological analysis in ChE characterized by the following specific changes changes: polifekaliya (up to 300 grams or more per day); stool color straw-yellow or greenish-yellow; Presence of pieces of undigested food; a small amount of slime; steatorrhea (a large number of defined fatty acids and soap); kreatoreya (defined in the feces undigested muscle fibers); ameloreya (undigested starch); gas bubbles, frothy stools at fermentative dyspepsia.

X-ray examination of the small intestine are determined uneven thickening and deformation relief mucosal folds are smoothed, increased motility of the small intestine, the accumulation of fluid and gas.

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


7. Differential diagnosis in fevers. Tactics GP (2 hours)
Increased body temperature is one of the most characteristic manifestations and many infectious and noncommunicable diseases. Often, practitioners, identifying the patient improved temperature of body already assume his infection. However, the prevalence of fever, which can be almost all infectious diseases, causes difficulties of differential diagnosis of this syndrome, especially because increasing of body temperature is one of the earliest signs when there are no other clinical manifestations of the disease, including many parameters fever with differential diagnostic value (duration, nature of the temperature curve and others.).

We must bear in mind that not every fever is a fever, and infectious disease characterized by just it. Under fever understand thermoregulatory fever, which is organized and coordinated body's response to the disease, ie, the body itself under-takes the body temperature above normal [.

Increased body temperature can be due not only regulatory mechanisms, but may also occur as a result of an imbalance between heat production and heat transfer, which leads to an increase in body temperature despite attempts keep up normal body temperature. Such a rise in body temperature is called hyperthermia (this term should not be considered as synonymous with fever, sometimes in the literature).

Hyperthermia occurs when the so-called thermal diseases (heat stroke, hyperthyroidism, atropine poisoning, etc.). Finally, the temperature rise may be due normal activity or physiological processes. A slight increase in body temperature may be associated with circadian rhythm (diurnal variations). The body temperature of a healthy person usually reaches a maximum level to a minimum of 18 hours and 3 hours overnight. A slight increase in body temperature can na¬stupit after a heavy meal and more significant - after severe and prolonged physical activity. Thus, we can govo¬rit different mechanisms fever.

Literature: Oh (main) -1,3,6,8 D (optional) -1,2,7,8,10
8. Differential diagnosis of diffuse connective tissue diseases. (2 hours)
Diffuse diseases of connective tissue (DZST) - a group of diseases characterized by systemic immunoinflammatory lesion of connective tissue and its derivatives.

When DZST develop autoimmune processes, ie the appearance of antibodies or sensitized lymphocytes directed against the body's own antigens (autoantigens).


Common features DZST:

- In the pathogenesis - a violation of immune homeostasis in the form of uncontrolled production of autoantibodies and formation of immune complexes circulating in the blood and tissues fixed in the development of inflammation (in the microvasculature, kidneys, joints, etc.);

- The similarity of morphological changes (vasculitis, lymphoid and plasma cell infiltrates and so on.);

- Chronic;

- Aggravation under the influence of nonspecific effects (infection, insolation, vaccination et al.);

- Multisystem involvement (skin, joints, serous membranes, kidneys, heart, lungs);

- The therapeutic effect of immunosuppressive agents (corticosteroids, cytostatics).

Currently DZST to include:

1. SCR - idiopathic; drug lupus syndrome

2. SS - idiopathic; induced (chemical, pharmaceutical)

3. Diffuse eosinophilic fastsiit-

4. Dermatomyositis (polymyositis) - idiopathic, paraneoplastiche-sky, juvenile

5. Sjogren's syndrome - primary (Sjogren's disease), secondary

6. Cross-syndrome

7. Relapsing polychondritis

8. relapsing panniculitis (Weber-Christian disease).

8. Antiphospholipid syndrome

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


9.Differential diagnosis of nephrotic syndrome. (2 hours)
Nephrotic syndrome (NS) - syndrome, which includes a number of clinical signs, most of which are proteinuria greater than 3.5 g / day, swelling, as well as a number of specific metabolic changes - violations, especially protein and lipid metabolism (Dysproteinemia, hypoproteinemia, hyperlipidemia). It is considered that the term "nephrotic syndrome" was introduced in the literature W.Nonnenbruch (1949).

In the etiology of nephrotic syndrome are two types of kidney changes - different versions of glomerular lesions and amyloidosis. In most cases, nephrotic syndrome occurs in diseases of the kidney itself - acute and chronic glomerulonephritis. However, kidney damage can be caused by systemic (systemic lupus erythematosus, a hemorrhagic vasculitis, periarteritis nodosa, scleroderma, rheumatic fever, etc..), Infectious etiology (chronic suppurative processes of the lung, bone, tuberculosis, syphilis, etc.), Parasitic (malaria , schistosomiasis), diseases of liver disease; blood diseases, allergic diseases, and others. Nephrotic syndrome can be induced by drugs (antiepileptics, drugs bismuth, gold, mercury, D-penicillamine, antibiotics, vitamins, etc.).

With all these diseases nephrotic syndrome is realized through the above two options kidney damage - change type of glomerulonephritis and amyloidosis.

Thus, the etiology is diverse, but its clinical manifestations are nonspecific same type that, to a certain extent, due to the common pathogenetic mechanisms.

Literature: Oh (main) -1,3,6,8 D (optional) -1,2,7,8,10
Calendar -tematichesky plan lecture materials in internal medicine




The theme of the lectures

Hours:

VII to rate

1

Sudden death. tactics GP

2

2

Differential diagnosis of arrhythmias. Clinical and ECG diagnosis. urgent Care

2

3

Differential diagnosis of chest pain nekoronogennogo character

2

4

The differential diagnosis of cough, sputum and hemoptysis. Tactics GP (

2

5

Differential diagnosis of abdominal pain

2

6

The differential diagnosis of intestinal dysfunction. Dysbacteriosis. Modern principles of treatment and prevention

2

7

Differential diagnosis in fevers. tactics GP

2

8

Differential diagnosis of diffuse connective tissue diseases.

2

9

Differential diagnosis of nephrotic syndrome.

2




Total:

18

2.2. RECOMMENDED PRACTICAL CLASSES

For students VII Course
1. Prevention in the GP. Types of prevention.Promotion of healthy lifestyles.Food hygiene and living conditions.Preventive examinations, screening.Prevention of communicable and non-communicable diseases.Immunization.Programs and activities. Principles of Teaching-topic (6.0 hours)
Activities of general practitioners by 80-90% consists of preventive work. Promoting healthy lifestyles and responsible attitude of people towards their health, identification and elimination of risk factors for various diseases, early diagnosis and timely treatment, prevention of complications, provision of social and household assistance to disabled persons, all contribute to better health. Teach GP implementation of preventive measures, immunization and promote healthy lifestyles among population .To familiarize GPs with views prophylaxy . To teach GP propaganda healthy lifestyle among the population, food hygiene. To teach SPM methods for conducting routine inspections and screening .To train immunization activities among population.Types of prevention in the work of GPs.

On the principles of healthy lifestyles and their use in educating the public and patients.

Prepare brochures, lectures and notes in the media on topics: alcoholism, drug addiction, smoking, tuberculosis, hepatitis, AIDS, contraception.To make up pyramid of healthy eating.

Mapping and evaluate screening . To plan immunized population.

Conduct routine inspections to improve the health of the population by screening population . To carry out talks and lectures in local communities (schools, mahallas) .To carry out immunization activities.

Teach GP implementation of preventive measures, immunization and promote healthy lifestyles among naseleniya.Familiarize GPs with views prophlaxy . To train GP propaganda healthy lifestyle among the population, food hygiene . To train SPM methods for conducting routine inspections and screening . To train immunization activities among the population.

Learning technologies used during the lesson: "Brainstorming", "handle in the middle of the table", "Work in small groups"

Literature: A: D 1,3,4,5: 1,2,5,6,7,10,11


2.Work with different groups of people. Children, adolescents, women (women of childbearing age, pregnant women), men, seniors.Workers in industries and agriculture.Socially disadvantaged people.Patients hard sick, the dying patient. The rehabilitation and clinical examination.Examination of disability. Principles of Teaching-topic (6.0 hours)
Observation and treatment of the patient throughout life - the essence of general practice. The doctor knows the patient and his family, the conditions of his work and leisure. Caring, responsible and knowledgeable doctor - a reliable support of the patient and his family. Unfortunately, the families do not always perceive the general practitioner as an advisor, do not realize that they can turn to him with questions not only of a medical nature, so the doctor himself tactfully to offer themselves as such. This is particularly relevant during the consultation couple plan to marry, pregnancy, under the supervision of the growth of children and adolescents, women of childbearing age, pregnant women, well, especially the elderly. Communication during this period establishes a new relationship between doctor and patient, facilitates further work with GPs .To teach work with different groups of people - children, adolescents, women (women of childbearing age, pregnant women), men, seniors, workers in production and agriculture, socially unprotected people, difficult patients dying patients; address the issues of rehabilitation and medical examination, prepare documents for examination disability. Learn to work with different groups of people: children, adolescents, women (women of childbearing age, pregnant women), elder people .To teach work with production workers and agriculture. Learn to work socially unprotected people. Learn how to work with difficult patients dying bolnymi.To carry out questions dispensary .To know rehabilitation and how to prepare documents for examination disability. Be able to work with different groups of people: children, adolescents, women (women of childbearing age, pregnant women), men, older .. To be able to work with production workers and rural society .To know work with unprotected people. To know work with difficult patients dying patients. to carry out the rehabilitation and dispensary.To prepare documents for examination labor ability .To know work with different groups of people: children, adolescents, women (women of childbearing age, pregnant women) . To know work with production workers and rural society . To carry out rehabilitation and dispensary .To prepare documents to the examination of disability.

Learning technologies used during the lesson: "Brainstorming", "handle in the middle of the table", "Work in small groups"

Literature: A: D 1,3,4,5: 1,2,5,6,7,10,11
3.Affects of risk factors. Health education.The impact of the main causes of morbidity and mortality.Promoting mental status.Environmental and occupational factors. Patient education, "school" - (6,0chasov)
Teach GP - prevention of CHD and stroke, malignant neoplasms (especially lung cancer, breast, cervix and skin), injuries and intoxications, infections, diseases of the musculoskeletal system, diabetes, dental disease, asthma, mental disorders, disabilities. Reducing the prevalence of smoking, alcoholism, drug abuse, poor nutrition, sedentary lifestyle.

The decrease in arterial hypertonia . Decrease hyperlipoproteidemia . Learning about the dangers of promiscuous sexual life .Decrease effects of occupational exposures and adverse environmental factors sredy.Sanitarnoe education. Impact on the main causes of morbidity and mental mortality and professional factors. Patient education, "school" .To know conduct prevention of CHD and stroke, malignant neoplasms (especially lung cancer, breast, cervix, and skin), injuries and intoxications, infections, diseases of the musculoskeletal system, diabetes, dental disease, bronchial asthma , mental disorders, disabilities.

Educate the patient - that is the main cause of morbidity and mortality (accessible explanation of the etiology and pathogenesis him of his illness, treatment guidelines, the need for adherence and diet) .Obuchat patient - healthy lifestyle.To teach each patient how to influence risk factors (smoking, alcoholism, addiction, nutrition, adverse environmental factors, promiscuous) . To teach patient prevention of mental narusheniy. To teach patient how to carry out prevention against professional diseases. To teach patient how to reduce exposure to adverse environmental factors. Make the patient feel responsible for their own health, and guide to healthy lifestyle .To know convince the patient and guide to healthy lifestyle . prevention of CHD and stroke, malignant neoplasms (especially lung cancer, breast, cervix, and skin), injuries and intoxications , infections, diseases of the musculoskeletal system, diabetes, dental disease, asthma, mental disorders, disabilities.

Learning technologies used during the lesson: "Brainstorming", "handle in the middle of the table", "Work in small groups"

Literature: A: D 1,3,4,5: 1,2,5,6,7,10,11
4.Meditsina for travelers. Advice to travel.Consultation after the trip.Immunization.Changing climate and time zones.Motion sickness and altitude sickness. Travel medical kit. Principles of Teaching topic - (6,0chasov)
Teach GP - be consulted before travel, after consultation travel, immunize, when changing climate and time zones, with motion sickness and altitude sickness. To be able to collect road nabor. To carry out medical advice prior to travel, to hold consultations after the trip, immunize, consult with the change of climate and time zones, consult with motion sickness and mountain road disease . To be able collect medical advice before traveling . At include intestinal infections, travelers' diarrhea, chronic diarrhea and prevention of malaria. Prevention of sexually transmitted diseases and narkomanii.Pri consultation after travel should know about the prevention of sexually transmitted diseases, gastrointestinal dysfunction, fever, malaria, typhoid fever, dengue fever, meningococcal disease and Japanese encephalitis. Rare infektsii sleeping sickness (African trypanosomiasis), cutaneous leishmaniasis, schistosomiasis, hookworm, strongyloidiasis, Lyme disease, melioidosis, sigvatera.S.Simptoms motion sickness, mountain bolezni. To carry out immunization: mandatory - against cholera and against yellow fever, voluntary - against Hepatitis "A" and "B", typhoid fever, Japanese encephalitis, meningococcal, rabies, typhoid, chumy.Immunization : mandatory - against cholera and against yellow fever, voluntary - hepatitis A and B, typhoid fever, Japanese encephalitis , meningococcal, rabies, typhoid, chumySobirat travel medical kit. Be consulted before travel, after consultation .To carry out travel, immunize, consult with the change of climate and time zones, consult with motion sickness and mountain road disease. To be able to collect medical documents.

Learning technologies used during the lesson: "Brainstorming", "handle in the middle of the table", "Work in small groups"

Literature: A: D 1,3,4,5: 1,2,5,6,7,10,11


Kataloq: syllabus -> 3-sonli-ichki-kasalliklar-kafedrasi-2017 -> 1.Ўқув-услубий%20мажмуа -> Ишчи%20дастурлар -> Ишчи%20дастур%202016-2017
3-sonli-ichki-kasalliklar-kafedrasi-2017 -> Toshkent tibbiyot akademiyasi uasht ichki kasalliklar va endokrinologiya kafedrasi
3-sonli-ichki-kasalliklar-kafedrasi-2017 -> Emotional Emotional
3-sonli-ichki-kasalliklar-kafedrasi-2017 -> Umumiy amaliyot shifokori oldida quyidagi muammolar turadi: Umumiy amaliyot shifokori oldida quyidagi muammolar turadi
1.Ўқув-услубий%20мажмуа -> «tasdiklayman»
1.Ўқув-услубий%20мажмуа -> O’zbekistоn Respublikаsi sоg’liqni sаqlаsh vаzirligi Тоshkent tibbiyot аkаdemiyasi Тibbiy pedаgоgikа fаkultetining
1.Ўқув-услубий%20мажмуа -> O’zbekisthon Respublikаsi Sog’liqni Sаqlаsh Vаzirligi Toshkent Tibbihyot Аkаdemiyasi Tibbiy-рedаgogikа fаkultetining

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