METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE

June 25, 2024
0
0
Зміст

METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE

MEDICAL FACULTY

LESSON12 (PRACTICAL6 HOURS)

 

Theme:

1.      Examination of the patient with neurological symptoms at vertebral osteochondrosis.

Aim: To know how to diagnose cervical and lumbar radiculopathy and other neurological syndromes of osteochondrosis at cervical, thoracic and lumbar levels, to prescribe treatment, to develop preventive measures, to carry out examination of patient’s workability.

 

Professional orientation of students: Diseases of peripheral nervous system take considerable value in general scheme of all diseases of nervous system and first place among the reasons of temporary work inability. In connection with polietiology of diseases of peripheral nervous system doctors of many specialties meet them. Therefore it is necessary for each doctor to know the signs of peripheral nervous system injury, to know how to differentiate, to recognize lumbosacral and cervical radiculitis and other development signs of vertebral osteochondrosis, to prescribe in time consultation of specialist.

 

Methodology of Practical Class (9:00-12:00).

Algorithm of students’ communication with patients with pathology in subject (communication skills):

Complaints and anamnesis taking in patients

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing

4. Find a contact with a patient, try to gain his/her confidence

5. Correct inquest, listening to the patient’s explanation.

6. Conversation accomplishment.

 

Physical methods of examination

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing

4. Find a contact with a patient, try to gain his/her confidence

5. Explain to the patient the nessessity of the examination and its aim, get his/her informed consent

6. Explain to the patient examination details, its safety and possible sensations

7. Prepare for the examination (clean, warm hands, ets.)

8. Explain to the patient results of his/her tests correctly and accesibly

9. Conversation accomplishment.

 

Informing about the results of examination

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing

4. Interpretation of test results

5. Calm a patient in the case of precense of pathological changes, inform about the following actions

6. Assure in positive changes and favourable prognosis at implementation of all of the medical recommendations

7.Conversation accomplishment

 

Examination of the patient with neurological symptoms at vertebral osteochondrosis.

Step I:  Aim: To put of clinical diagnosis. It is necessary:

1.      To examine the patient.

2.      To learn the main clinical signs of osteochondrosis.

3.      To find X-ray signs of osteochondrosis.

4.       To formulate the clinical diagnosis

Step II: Aim: To prescribe treatment. It is necessary to prescribe correct pathogenetic and symptomatic therapy, physiotherapeutic treatment depending on the main syndrome and stage of disease.

 In stage of peaking we prescribe:

1.      Medicamental treatment:  dehydrating drugs (Euphyllinum, Lasix, Dexonum); spasmolytics (Platyphyllinum, Nospanum, Halidorum, Baralginum, Spasmalginum), analgetics (Dipidololum, Tramadolum, Morfilong, Analginum, Baralginum, Spasgamum); antiinflammable  nonsteroid drugs (Pyrabutolum, Methindolum, Voltarenum, Naprossinum, Indomethacinum);  relaxants (Myolastinum, Mydocalmum, Syrdalud).

2.      If there are signs of losses: biostimulants (Rumalonum, aloe, vitreous); anticholinaesterase drugs (neostigmine methylsulfate, Galantaminum); vitamins (group В)

3.      Physiotherapeutic treatment: phonophoresis with Hydrocortizonum, electrophoresis with Novocainum, ultrasonics. Thermal procedures are prescribed at reduction of pain syndrome.

4. If necessary we prescribe orthopedic (skeletal traction) and surgical (intralaminar deleting of hernia of the disc) treatment.

Step III: Aim: To conduct expert-preventive measures. Outgoing from the clinical diagnosis and

taking into account effectiveness of treatment to form prognosis, providing of preventive measures, to provide expertise of workability, military-medical expertise.

 

Individual Students Program.

You should be prepared for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

1. Etiology and pathogenesis of neurological signs of osteochondrosis:

а) the main reasons of radiculopathy       

б) pathogenesis of cervical and lumbosacral radiculopathy and other neurological signs of osteochondrosis,

2. Clinical features of vertebrogenic syndrome:

a)      pressure of vertebral muscles, b) small lumbar lordosis, c) kyphosis, d) reduction of motions in  column, e) scoliosis, f) painful points (juxtaspinal, acanthas, interosseous intervals and others)

3. Clinical feature of main syndromes of osteochondrosis at lumbosacral level:

а) classification of vertebrogenic changes at lumbosacral level,

b) clinical features of reflexional syndromes: the lumbago, lumbalgia and lumboischialgia (muscle – tonical, neurodystrophical and vegetative – vascular form),

c) clinical features of compressive radicular syndrome (clinical picture of  compression of radices L4-L5, S1)

d) clinical features of vascular radiculospinal syndrome

4. Clinical features of neurological syndromes at cervical osteochondrosis

а) classification of syndromes of osteochondrosis at cervical level

b) clinical features of  reflexional syndrome: cervicalgia, cervicocranialgia, cervicobrachyalgia (vegetative – vascular form),

 c) clinical features of compressive radicular syndrome (clinical picture of compression of radices С6, С7, С8)

d) clinical features of vascular radicospinal syndrome

e) clinical features of spinal  syndromes

f) clinical features of syndrome of backbone arteries (cervical migraine, back cervical sympathetic syndrome)

5. Treatment of radiculopathies:

а) medicines pathogenetic and symptomatic treatment

б) physiotherapeutic treatment

в) orthopedic treatment

г) surgical treatment depending on signs of  osteochondrosis

6. Expertise of workability, preventive measures:

а) expertise of workability

b) preventive measures

c) military-medical expertise

Seminar discussion of theoretical issues (12:30-14.00).

 

Test evaluation and situational tasks.

                         Tests

1.      Signs of vertebrogenic  syndrome.

2.      X-ray signs of vertebral osteochondrosis.

3.      Reflex signs of vertebral osteochondrosis.

4.      Reflex syndromes of cervical osteochondrosis.

5.      Reflex signs of lumbal osteochondrosis.

6.      General (а) and differential (б) signs of lumbago (1) and lumbalgia (2).

7.      Common (а) and differential (б) signs of lumboischialgia (1) and lesion of radices.

8.      Common (а) and differential (б) signs of cervicalgia (1) cervicobrachyalgia (2)

9.      The muscle – tonic syndromes of lumboischialgia (а) and cervicobrachyalgia (б)

10.  Neurodystrophycal syndromes of lumboischialgia (а) and cervicobrachyalgia (б).

11.  The main signs of scalenus-syndrome.

12.  The main signs of piriformis muscle syndrome

13.  The main signs of periomarthrosis.

14.  The main signs of neurodystrophycal syndrome “shoulder – arm”.

15.  Syndromes of cervicocranialgia.

16. Stages of neurodystrophycal syndromes of cervicobrachyalgia.

17. The clinical differential tests under piriform lameness of Popelansky

18. Lesion of radices С6

19. Lesion of radices С7

20. Lesion of radices С8

21. Lesion of radices L5

22. Lesion of radices S1

23. Signs of ventral compression of spinal cord by disc hernia of С6-С7

24. Signs of radiculomyeloischemia in the basin Deprog-Gotteron arteria.

Real-life situations to be solved:

1. Name the signs of radix L5 compression

2. Name the signs of radix S1 compression

3.   Name the signs of tension in patients with lumbosacral radiculopathy.

 

Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.

 

Student should know:

1. Signs of vertebrogenic syndrome.

2. X-ray signs of vertebral osteochondrosis.

3. Reflex signs of vertebral osteochondrosis.

4. Reflex syndromes of cervical osteochondrosis.

5. Reflex signs of lumbal osteochondrosis.

 

Student should be able to:

1.      Diagnose the Neurological signs of osteochondrosis.

2.      Examine the neurological patient

3.      History taking

4.      Formulate clinical pre-diagnosis and make differential diagnostics

5.      Find level of pathologic focus

6.      Introduce dates of special methods for patients’ objective investigation

7.      Make the topical and clinical diagnosis

8.      Prescribe adequate treatment program and prophylactic measures

9.      Examine the ability to work in disabled person

10.  Record the patient’s Case report.

 

Correct answers of test evaluations and situational tasks:

1. Sensory disturbances. Hyperesthesia and pain on external surface of thigh, front-external surface of crus, forward surface of feet and in region of 1 toe. Propulsion disorders: hypotrophy of muscles on anterior surface of crus, decrease of extensor surface of the large toe and foot. Patient cannot walk on crus

2. Sensation disorders: Hyperesthesia of pain on anterior surface of thigh, posterolateral surface of crus and in the field of 4,5 toe. Propulsion disorders: hypotrophy of crural muscles, reduced force foot tensors of and large toe, decrease or absence of Achilles reflex.

3. Laseg, Matskevich, Nery, Degeryn, Sirar, Wasserman, Turin, Bone – Bobronicova symptoms.

 

Independent work of students (14:15-15:00).

 

References:

А – Basic:     

1. WEB-site of tdmu.

Material for classes

2. Basic Neurology. Second Edition. John Gilroy, M.D. – McGraw-Hill International edition.- Pergamon Press.- 1992

3. Merritt’s Textbook of neurology. – 7th edition. – Edited by Lewis P. Rowland.

4. Neurology for house officer. – 3th edition.

В – Additional:           

4. A Textbook of neurology. – H. Houston Merritt. -6th edition.

5. Handbook of Symptom Oriented Neurology/ William H. Olson, Roger A. Brumback, Generoso Gascon, Vasudeva Iyer, Year book medical publishers, Inc.

6. Neurology in lectures. Textbook. Edited by the head of Neurology Department – prof. S.І. Shkrobot. – 2006.

 

Methodical instruction has been worked out by: dotsent N.R. Sokhor

                                   

Methodical instruction was discussed and adopted at the Department sitting

29.05.2013  . Minute9

Methodical instruction was adopted and reviewed at the Department sitting

__________201 . Minute № ___

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Приєднуйся до нас!
Підписатись на новини:
Наші соц мережі