foreign students' Faculty
LESSON ¹ 1 (PRACTICAL – 6 HOURS)
Theme 21: Management of patient with urinary
syndrome
Aim: to learn
criteria for diagnosis, differential diagnosis, treatment, prognosis of
the diseases with urinary syndrome .
Professional orientation of students. Although the
exact incidence of CRF at its different stages is unknown, ESRD has reached
epidemic levels, causing a major burden to health care resources. The incidence
of new patients with ESRD in the
Methodology of Practical Class
Introduction
by the teacher, control the initial level of knowledge – 09.00-09.30
Individual
students' work with patients - 09.30-12.00
Break
– 12.00-12.30
Seminar (discussion of theoretical questions, practical work with patients) - 12.30-14.00
Break
– 14.00-14.15
Individual
work 1415-1500 (students
who didn`t pass the tests in Moodle
system, complete the individual work).
Algorithm
of students’ communication with patients with pathology in subject
(communication skills) (for clinical department):
During
examination of the patient students have to use such communicative algorithm:
Complaints
and anamnesis taking in patients
1.
Friendly facial expression and smile.
2.
Gentle tone of speech.
3.
Greeting and introducing.
4.
Take complaints and anamnesis in a patient.
5.
Explain to the patient results of his/her lab tests correctly and accessibly.
6.
Explain to the patient your actions concerning him/her (the necessity of
hospitalization, certain examinations and manipulations), which are planned in
future.
7.
Conversation accomplishment.
Objective
examination:
Physical
methods of examination of patients with internal diseases
1.
Friendly facial expression and smile.
2.
Gentle tone of speech.
3.
Greeting and introducing.
4.
Explain to a patient, what examinations will be carried out and get his/her
informed consent.
5.
Find a contact with the patient and make an attempt to gain his/her trust.
6.
Inform about the possibility of appearing of unpleasant feelings during the
examination.
7.
Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).
8.
Examination (demonstration of clinical skill).
9.
Explain to the patient results of his/her lab tests correctly and accessibly.
10.
Conversation accomplishment.
Estimation
of laboratory and instrumental investigations
Informing
about the results of examination of patients with internal diseases
1.
Friendly facial expression and smile.
2.
Gentle tone of speech.
3.
Greeting and introducing.
4.
Explain to a patient results of his/her lab tests correctly and clearly.
5.
Involve the patient into the conversation (compare present examination results
with previous ones, clarify whether your explanations
are clearly understood).
Planning
and prognosis the results of the conservative treatment
Friendly facial expression and smile.
1.
Gentle tone of speech.
2.
Greeting and introducing.
3.
Correct and clear explanation of necessary treatment directions.
4.
Discuss with a patient the peculiarities of taking medicines, duration of their
usage, possible side effects; find out whether your explanations are clear for
him/her or not.
5.
Conversation accomplishment.
Work 1. Work at the patient’s ward. The student collects the complaints,
anamnesis of disease and life, perform objective examination of the patient,
identify the main syndrome, formulate preliminary diagnosis and prescribe plan
of investigations.
Work 2. The student estimates results of laboratory and
instrumental investigations, makes a differential diagnosis and formulates the
clinical diagnosis, based on the diagnostic criteria of the disease.
Work 3. The student prescribes appropriate treatment and
defines individual management program for patient.
·
Under the tutor’s supervision students should be able
to elicit the patient’s chief complaint, history of present illness, past medical
history, social, family, occupational histories and complete a review of
systems.
·
Perform a physical examination in a logical, organized
and thorough manner.
·
Demonstrate the ability to construct an assessment and
plan for an individual patient organized by problem, discussing the likely
diagnosis and plan of treatment.
·
Demonstrate the ability to record the history and
physical in a legible and logical manner.
·
Demonstrate the ability to write daily progress notes
on the ward and appropriate outpatient progress notes.
·
Orally present a new patient's case in a focused
manner, chronologically developing the present illness, summarizing the
pertinent positive and negative findings as well as the differential diagnosis
and plans for further testing and treatment.
·
Orally present a followup
patient's case, focusing on current problems, physical findings, and diagnostic
and treatment plans.
·
Diagnostic Decision Making
·
Formulate a differential diagnosis based on the
findings from the history and physical examination.
·
Use the differential diagnosis to help guide
diagnostic test ordering and its sequence.
·
Participate in selecting the diagnostic studies with
the greatest likelihood of useful results.
·
Recognize that tests are limited and the impact of
false positives/false negatives on information.
·
Test Interpretation
·
Describe the range of normal variation in the results
of a complete blood count, blood smear, electrolyte panel, general chemistry
panel, electrocardiogram, chest X-ray, urinalysis,
pulmonary function tests, and body fluid cell counts.
·
Describe the results
of the above
tests in terms of the
related pathophysiology.
·
Understand test sensitivity, test specificity,
pre-test probability and predictive value.
·
Understand the importance of personally reviewing
X-ray films, blood smears, etc., to assess the accuracy and importance of the
results.
·
Therapeutic Decision Making
·
Describe factors that frequently alter the effects of
medications, including drug interactions and compliance problems.
·
Formulate an initial therapeutic plan.
·
Access and utilize, when appropriate, information
resources to help develop an appropriate and timely therapeutic plan.
·
Write prescriptions accurately.
·
Monitor response to therapy
Seminar discussion of theoretical issues
1.
Urine sediment changes in
glomerulonephritis.
2.
Urine sediment changes in
pyelonephritis.
3.
Urine sediment changes in
nephrolithiasis.
4.
Urine sediment changes in renal
tuberculosis.
5.
Urine sediment changes in renal
amyloidosis.
6.
Urine sediment changes in renal tumour.
7.
Involvement of the kidneys in the
connective tissue diseases:
7.1.
Rheumatoid arthritis.
7.2.
Systemic lupus erythematosus.
7.3.
Systemic sclerosis.
7.4.
Sjogren's
syndrome.
7.5.
Polyarteritis nodosa.
8.
Diabetic nephropathy.
9.
.Criteria of
diagnostics of acute and chronic
glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
10.
Differential
diagnosis of acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
11.
Clinical
diagnosis of acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
12.
Principles of
treatment and prophylaxis of acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
Choose the correct answer/statement:
1.
What factors are significantly make heavier duration of acute pyelonephritis and may significantly worsen the
prognosis?
A.
Proteus as the agent process
B.
Stafilococcus aureus which is coagulated
plasma as a causative agent of the process
C.
Ascendant urinogenic route of infection
D.
Acute occlusion of the urinary tract
E.
Hyperuricemia
2.
What is the sign of pyelonephritis
distinguishes it from other interstitial renal lesions?
A.
Tubular dysfunction in violation of the
acidification of urine
B.
Resistant hypertension
C.
Edema and neutrophil infiltration of the renal pelvis
D.
The development of
"the kidney, which
is losing salt" with hypotension
E.
Infiltration of lymphocytes and histiocytes, and sclerosis of the
renal pelvis
3.
What drugs should not be prescribed
in pyelonephritis in CKD stage?
A.
Aminoglycosides
B.
Oxacillin
C.
Erythromycin
D.
Polymyxin
E.
carbenicillin
4.
Which of
these diseases rarely leads to the development of pyelonephritis?
A.
Diabetes mellitus
B.
Using of hormonal contraceptives
C.
Rheumatoid arthritis
D.
Pregnancy
E.
Prostatitis
5.
Select
the drug which may be effective in treating urinary tract infections.
A.
Gentamicin
B.
Nitrofuratoin
C.
Cephalexin
D.
Carbenicillin
E.
Chloramphenicol.
6.
The presence of white cell casts is
diagnostic of:
A.
glomerular
bleeding;
B.
glomerulonephritis:
C.
pyelonephritis;
D.
amyloidosis;
E.
deep vein thrombosis
7.
Urinary examination according to Zimnitsky is needed for evaluation of all of
following except:
A.
the common diuresis;
B.
daily urine;
C.
renal clearance;
D.
night urine;
E.
fluctuation of the specific
gravity of urine in every portion
8.
Urinary examination according to Nechyporenko determines:
A.
amount of erythrocytes in 1 ml (or
B.
amount of leucocytes in 1 ml (or
C.
amount of casts in 1 ml (or
D.
all of them;
E.
none of the above
Real-life situations to be solved:
Initial level of knowledge and skills 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. Modern views of the etiology, pathogenesis of acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
2. Classification of acute and chronic
glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
3. Clinical, laboratorial findings of acute and chronic acute
and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases Differential
diagnosis of acute and chronic pyelonephritis
4. Differential diagnosis of acute
and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic nephropathy, involvement
of the kidneys in connective tissue diseases
5. Treatment acute and chronic
glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
Student should be able to:
1. History
taking and physical examination of the patients with acute and
chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic nephropathy, involvement
of the kidneys in connective tissue diseases
2. To
determine main clinical syndromes in patients with acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases
3. To compose the plan of laboratory and
instrumental examination of the patient with acute and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic
nephropathy, involvement
of the kidneys in connective tissue diseases s.
4.
To interpret the results of laboratory and instrumental
methods of examinations.
5.
To put clinical diagnosis according
to clinical classifications.
6.
To make differential diagnosis of urinary syndrome
7. Prescribe the treatment of acute
and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic nephropathy, involvement
of the kidneys in connective tissue diseases
8. Evaluate
prognosis for patient with acute
and chronic glomerulonephritis, pyelonephritis, tuberculosis, amyloidosis, renal tumour, nephrolithiasis, diabetic nephropathy, involvement of
the kidneys in connective tissue diseases
Correct
answers of test evaluations and situational tasks:
Multiple
Choice.
Real-life situations. 1. Intravenous pyelography. 2. The
routing urine analysis. Microscopic examination of urine
reveals numerous pus cells and organisms, some red cells and epithelial cells. Pyuria and low level proteinuria
are common for chronic pyelonephritis, but not
invariable.
References.
A
- Basic:
1.
Davidson’s Principles and practice of
medicine (21st revised ed.) / by Colledge
N.R., Walker B.R., and Ralston S.H., eds. – Churchill Livingstone, 2010. – 1376
p.
2.
3.
The Merck Manual of Diagnosis and
Therapy (nineteenth Edition)/ Robert Berkow, Andrew
J. Fletcher and others. – published by Merck Research Laboratories, 2011.
4.
Web -sites:
a)
www.tdmu.edu.ua:
Management of patients with urinary syndrome
b)
http://emedicine.medscape.com/
c) http://meded.ucsd.edu/clinicalmed/introduction.htm
B
– Additional:
1.
Lawrence M. Tierney, Jr. et al:
Current Medical Diagnosis and treatment 2000, Lange Medical Books, McGraw-Hill,
Health Professions Division, 2000.
Methodical
instruction has been worked
out by:
assist. prof. Gusak S.R.
Methodical instruction was discussed and adopted
at the Department sitting 12.06.2012, Minute ¹ 12
Methodical instruction was adopted and reviewed at the Department sitting
25.06.2013, Minute ¹ 17