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METHODICAL INSTRUCTION FOR STUDENTS OF THE III COURSE

June 20, 2024

METHODICAL INSTRUCTION FOR STUDENTS OF THE III COURSE

Medical Faculty

Module 1.

The main methods of examination of patients in the clinics of internal medicine

Content module 6. Basis of functional diagnostics

Lesson № 2 (practical – 6 hours)

Тheme 1. Methods of functional diagnostics of respiratory system

Тheme 2. Methods of the investigations of urinary tract pathology

Aim: To be able to use methods of functional diagnostics of respiratory system, to learn to use modern medical equipment in diagnostics of urinary tract diseases.

Professional orientation of students:

For forming of diagnosis, correction of treatment widely utillized not only physical but also instrumental methods of research. Pneumotachymetry allows to estimate the state of the bronchial communicating. Bronchoscopy is utillized for the review of mucus shell of trachea and bronchial tubes I, II, III orders, and also for implementation of different medical and diagnostic manipulations. Researches of sputum, pleura maintenance enable to diagnose or other pathology of the respiratory system. The intensive development of science and technique requires permanent improvement of knowledge necessary for an effective utilization of achievement of scientific progress for medical practice.

Methodology of Practical Class – 9.00-12.00:

(work done at the clinic on the basis of functional diagnostics the patient)

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

When communicating with patients in the clinic of internal medicine is necessary to:

1. Having a expression of affable on face with a smile.

2. Say hello and introduce yourself.

3. Establish contact with the patient and try to call him the confidence.

4. Maintain a soft tone of the conversation, to show interest, esteem and attention for the patient.

5. Explain to patient the aim and method of investigation approval obtained.

6. To warn of the possibility of discomfort during the investigation.

7. To comply with sanitary norms during examination, demonstrate and explain their importance to the patient.

8. Conduct a survey (the demonstration of clinical skills).

9. Correctly and is available for understanding the patient to explain the results of the investigation.

10. Involve the patient to conversation (compare the results of this research with the preliminary results, find out your explanation is understandably or no).

11. Completion of the conversation.

Work 1. Methods of functional diagnostics of respiratory system.

To familiarize with procedure and take part in conducting main methods of functional diagnosis of diseases of the respiratory system (Spirometry; Pneumotachometry; Peakflowmetry; Flow-volume curve of forced expiratory; Bronchial-provocation test; Body Plethysmography; to assess airway resistance and gas analysis of exhaled air).

To analyze results of instrumental and laboratory examinations in patients with bronchial asthma, pneumonia, bronchitis and so on.

To conduct clinical and pathophysiological interpretation of the detected change of objective methods of investigation.

Work 2. Methods of the investigations of urinary tract pathology.

To familiarize with procedure and take part in conducting main methods of functional diagnosis of diseases of the respiratory system [Urography methods (plain radiography, excretory urography, retrograde pyelography, cystography); sonography, ultrasound; computed tomography (CТ); magnetic resonance imaging (MRI) and Magnetic resonance angiography (МRА); radioisotope studies; renal angiography].

To analyze results of instrumental and laboratory examinations in patients with glomerulonephritis, pyelonephritis, chronic renal failure and others.

To conduct clinical and pathophysiological interpretation of the detected change of objective methods of investigation.

Individual Students Program.

Theme 1. Methods of functional diagnostics of respiratory system

1. Pneumotachometry (indications, contraindications, technique, technology implementation, diagnostic value).

2. Spirometry (indications, contraindications, technique, technology implementation, diagnostic value).

3. Bronchoscopy (indications, contraindications, technique, technology implementation, diagnostic value).

4. Laboratory examination of sputum (indications, contraindications, technique, technology implementation, diagnostic value).

5. Laboratory examination of bronchial washings (indications, contraindications, technique, technology implementation, diagnostic value).

6. Laboratory examination of pleural content (indications, contraindications, technique, technology implementation, diagnostic value).

Тheme 2. Methods of the investigations of urinary tract pathology

1. Basic methods of laboratory examinations of blood, urine, requirements for preparation of patients for research, quantitative and qualitative assessment of indicators

2. Functional examination methods for diseases of urinary system.

3. Endoscopic examination methods in nephrology, basic techniques and their diagnostic value.

4. Physical principles of ultrasound imaging, requirements for the preparation of the patient, the main diagnostic criteria.

Seminar discussion of theoretical issues – 12.30-14.00

1. Methods of functional diagnostics of respiratory system.

1) The instrumental methods for evaluating the functional state of the respiratory system (Spirometry; Pneumotachometry; Peakflowmetry; Flow-volume curve of forced expiratory; Bronchial-provocation test):

1) Indications for the examination.

2) The methodology of the examination.

3) Interpretation of results.

2) The laboratory methods for evaluating the functional state of the respiratory system (laboratory examination of sputum, bronchial washings, pleural content):

1) Indications for the examination.

2) The methodology of the examination.

3) Interpretation of results.

3. Methods of the investigations of urinary tract pathology.

1) The basic instrumental methods of diagnosis iephrology [Urography methods (plain radiography, excretory urography, retrograde pyelography, cystography); sonography, ultrasound; computed tomography (CТ); magnetic resonance imaging (MRI) and Magnetic resonance angiography (МRА); radioisotope studies; renal angiography].

1) Indications for the examination.

2) The methodology of the examination.

3) Interpretation of results.

2) Basic methods of laboratory examinations of blood, urine iephrology, requirements for preparation of patients for research, quantitative and qualitative assessment of indicators.

Test evaluation and situational tasks.

Test evaluation

1. The patient, aged 38, entered the pulmonology department with complaints of asthma attacks. As a result of spirography: FVC significantly decreased, FEV1 is 53% predicted. What function of respiratory system is disturbed?

A. Violation of bronchial conductivity*

B. Violation of the gas diffusion

C. Violation of the blood perfusion

D. Combined violation of diffusion and perfusion

E. The results correspond to the age norm

2. In spirometry FVC – is:

A. The total amount of air that can forcibly be blown out after full inspiration*

B. The total amount of air that caormally be blown out after normal inspiration

C. The amount of air that you can forcibly blow out in one second

D. The maximum volume of air present in the lungs

E. The maximum volume of air can be inhaled

The patient with acute renal failure has anuria (urine output is 50 ml). What is the main mechanism of its formation?

A. A decrease in glomerular filtration*

B. An increase in sodium reabsorption

C. A decrease in urine outflow

D. Disturbance of blood circulation in kidneys

E. An increase in water reabsorption

A 50-year-old man with end-stage chronic glomerulonephritis has a high level of arterial pressure. The main factor of its development is

A. An increase in renin formation*

B. An increase in adrenalin secretion

C. A decrease in vasopressin secretion

D. An increase in cardiac output

E. Excess of antidiuretic hormone

Situational tasks

Task 1. The patient K., 45 years old, diagnosed with “asthma” during the Peakflowmetry found that peak expiratory flow (PEF) is 525 l/min. Growth of patient is 175 cm.

1. Evaluate this result.

2. What type of respiratory insufficiency in a patient?

3. Describe the changes in the pathogenesis of PEF in this case.

4. Which diseases are characterized by these changes?

Task 2. The Respiratory parameters of arterial blood in a patient with a nonclosure of the ductus arteriosus following: oxygen capacity is 20 vol%, the oxygen content is 15.6 vol%, hemoglobin oxygen saturation is 82 %, oxygen tension in arterial blood – 76 mmHg.

1. Evaluate ensure of oxygen the patient.

2. What the name of this state?

3. What is the mechanism of its development?

4. What would you recommend for corrected the oxygen balance in this case?

Task 3. In the patient with chronic glomerulonephritis the pains in muscles and joints, itching of the skin, ammonia or urinelike odor to the breath have appeared. The blood creatinine level was increased to 0,80 mmol/l. The specific gravity of the urine within a week was retained at a level 1,005-1,007.

1. What pathology has the patient?

2. Explain the values of specific gravity of the urine.

3. Explain the pathogenesis of pain in joints and muscles.

4. What is the cause of itching of the skin?

5. What is the cause of ammonia odor to the breath?

Individual student work 14¹⁵-15⁰⁰ hour

Are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks).

Student should know:

1. The basic instrumental methods of functional diagnosis of diseases of the respiratory system, the indications for their carrying, methods of performance and interpretation of the results.

2. The laboratory methods for evaluating the functional state of the respiratory system (laboratory examination of sputum, bronchial washings, pleural content).

3. The basic instrumental methods of diagnosis iephrology, the indications for their carrying, methods of performance and interpretation of the results.

4. Basic methods of laboratory examinations of diagnosis iephrology, indications for their conduct, methodology of the examination and interpretation of results.

Student should be able to:

1. To conduct basic instrumental and laboratory examination of diseases of the respiratory system.

2 To evaluate the results of functional methods for diagnosing diseases of the respiratory system.

3. To conduct basic instrumental and laboratory examination of diseases of the urinary system.

4 To evaluate the results of functional methods for diagnosing diseases of the urinary system.

Correct answers of test evaluations and situational tasks:

Correct answers of test evaluations:

1. А

2. А

3. А

4. А

Correct answers of situational tasks:

Task 1.

1. The maximum expiratory flow in norma is 615 ± 48 l / min (for males 45 years and with growth is 175 cm). In this patient PEF reduced on 90 l/min, ie is 85% from the proper value.

2. The obstructive type of respiratory insufficiency is in this patient.

3. Bronchial asthma represents a reversible form of airway disease caused by narrowing of airways due to bronchospasm, inﬂammation, and increased airway secretions. Obstruction of respiratory ways is resulting narrowing the lumen and increase of resistance to movement of air. This is most expressed during expiration, as it becomes active.

4. These changes are characteristic of asthma, emphysema, bronchoectasis, chronic bronchitis.

Task 2.

1. Based on the parameters of the blood, it can be argued that the patient is provided oxygen is deficient. The oxygen content of blood is diminished (norm is 19.0 vol%), content of oxyhemoglobin is diminished (norm is 95 %), oxygen tension in arterial blood is diminished (norma is about 100 mm Hg).

2. The state, which arises owing to insufficient oxygen supply of tissues or insufficient use it by tissues is called hypoxia. Changes in respiratory blood parameters are characteristic for hypoxic hypoxia.

3. Hypoxia occurs when the oxygen enriched arterial blood mixed with oxygen-poor venous blood. As a result, the total content of oxygen in the blood decreases.

4. Сan be recommended to the inhalation of carbogen and surgery removal of arteriovenous anastomosis for the correction of the oxygen balance.

Task 3.

1. Chronic renal failure.

2. Decreased specific gravity of the urine indicates the low concentrating ability of the kidneys.

3. The joint pains and muscles are explained by deposit of urates in these anatomical frames, irritating of serous coat and development of the inflammation.

4. The itching of the skin is explained by the irritating of the nervous endings by nitrogenous wastes (urea, uric acid), which are excreted through the skin.

5. An odor to the breath (that smells like ammonia) is explained by excretion of ammonia by the gastrointestinal tract from urea under influence of bacterial enzymes.

References:

А – Basic:

1. Services Internet Resourses TDMU Classes study

2. Eugene Braunwald, Anthony Fauci et al: Harrison’s principles of internal medicine. McGraw-Hill. Medical Publishing Division, 15^th edition, 2000

3. Barbara Martin. Spirometry – A Handbook For Health Professionals, 2008

4. Vital Lung Function (Vital Guides) by Rachel Booker, 2006

В – Additional:

1. Christopher R.W. Edwards et al: Davidson’s principles and practice of medicine.

2. The Merck Manual, 19^th edition, 2006; 1876p.

3. Lectures of Internal Medicine

Methodical instruction has been worked out by:

assoc. prof. Marushchak M.I., assoc. prof. Dzyha S.V., as. prof. Bakalets O.V.