General Surgery Department
MINISTRY OF PUBLIC HEALTH OF UKRAINE
BUKOVINA STATE MEDICAL UNIVERSITY
DEPARTMENT OF GENERAL SURGERY
GUIDELINES
Methodical guidelines for the 3rd year students
Chernivtsi
2007-2008
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 1 for 3rd – year students of the medical
faculty
THEME:
1. Introduction in surgery. Hygiene in a surgical hospital. Work of the average
personnel in conditions of surgical department.
2. The organization of work in a clean dressing room. A desmurgy, a dressing
material. Typical gause bandages. Bandages on the head, neck and thorax.
Patient's care, has an operation on a head, a neck and thorax.
3. Patient's care, has an operation on organs of abdominal cavity, a perineum,
extremities. Bandages on a stomach, a perineum, extremities.
AIM: To familiarize with hygiene of a surgical hospital, duties of the average
medical personnel. To familiarize with a history of development of a desmurgy,
concepts about a bandage and a dressing. To learn the basic kinds of a dressing
material. To seize a technique of applying of different kinds of bandages on their
purpose and localization and a kind of damages. To familiarize with features of
зatient's care, has an operation on a head, a neck, on abdominal cavity, a perineum
and extremities.
PROFESSIONAL MOTIVATION:
Nursing activity consists of a complex of actions which provide all-round
service of the patient, creation of appropriate hygienic conditions. Patient's care is
the integral amounting part of treatment. For granting a medical care by the patient
with traumas, in the postoperative period the highly skilled nurse should know
features of different damages, a desmurgy, plaster engineering, devices and
adaptations for treatment of injured patients. To be able to impose a various kind of
a bandage.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
I.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Theme 1. Introduction in surgery. Hygiene in a surgical hospital. Work of the
average personnel in conditions of surgical department.
1. To know features of hygiene in a surgical hospital;
2. To know rules of behaviour in surgical clinic and bases medical deontology;
3. To know the basic ways of diffusion hospital infection and principles of its
prophylaxis.
Theme 2. The organization of work in a clean dressing room. A desmurgy, a
dressing material. Typical gause bandages. Bandages on the head, neck and thorax.
Patient's care, has an operation on a head, a neck and thorax.
1. To know substantive provisions of work in clean dressing-room;
2. To know the basic kinds of a dressing material, its property;
3. To know engineering of applying typical gause bandages, and bandages on
the head, neck and thorax;
Theme 3. Patient's care, has an operation on organs of abdominal cavity, a
perineum, extremities. Bandages on a stomach, a perineum, extremities.
1. To know features of patient's care, has operation on organs of abdominal
cavity, the basic bandages on abdomen, a perineum and extremities;
2. To know features of patient's care with fractures;
3. To know the basic kinds of plaster bandages, assays on quality of a plaster
powder. Rules of plaster engineering.
II.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. The patient with varicose illness of the lower extremities had bleeding from
varicose node. What kind of a bandage you used?
A. Immovable bandage;
B. Protective bandage;
C. Hemostatic bandage
D. Occlusive bandage;
E. Plaster bandage.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
2. During game in volleyball the sportsman has twisted of foot. It is diagnosed
sprain of ligaments of ankle joint. What kind of a bandage with the purpose
of a first aid you impose?
A. Remedial bandage;
B. Immovable bandage;
C. Compressing bandage;
D. Occlusive bandage;
E. Hemostatic bandage.
3. The victim, 36 years old, has received penetrating wound in area of the right
half of thorax. Which it is necessary to bandage?
A. Remedial bandage;
B. Immovable bandage;
C. Compressing bandage;
D. Occlusive bandage;
E. Hemostatic bandage.
4. What the basic ways of infection are possible at surgical manipulations?
A. Contact.
B. Air-droping.
C. Carriers of bacilli.
D. Implantational.
E. Hematogenic.
5. What diseases are transmitted through footwear?
A. Pediculosis.
B. Erypsipelas.
C. Epidermophytosis.
D. Anthracis.
E. Virus of hepatitis.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Real-life situations to be solved:
6. In the surgical unit is two sections – aseptic and purulent, legibly divided.
What premises are to be in each section?
7. Before disclosing of the sterilized drum nurse carefully has examined it. Last
is hermetically closed, its tagging-out is carried out, is sealed up. Having
opened a drum, nurse has noted, that probes of Mykulich whitened, the
inscription is legiblly visible on it: “Sterile”, nevertheless linen wet, in the
indicator of melting (in ampule) a powder of Acidum benzoicum is there.
Of what it is necessary to think?
III.
Answers to the Self-Assessment:
1.
2.
3.
4.
5.
6.
7.
IV.
C;
B;
D;
A, B, D;
C;
Manipulation room, dressing room, wards, bathroom, canteen.
About non-observance of a regimen of sterilization.
References:
Essential reading:
1. Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
2. Lectures prof. B.I. Dmitriev from Odessa State Medical University.
3. Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
4. Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
5. Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
1. Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
2. Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3. Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
Students’ Practical Activities:
V.

9.00 - 12.00
Theme 1. Introduction in surgery. Hygiene in a surgical hospital. Work of the
average personnel in conditions of surgical department.
 Work 1. Students get acquainted with frame of surgical clinic, the order of
conducting the medical documentation in a surgical hospital, the basic
sanitary-and-hygienic demands to a surgical hospital.
 Work 2. Students independently work in conditions of a surgical hospital in
a role of the average medical personnel (nurse on duty, ward nurse, the
dressing-room nurse).
Theme 2. The organization of work in a clean dressing room. A desmurgy, a
dressing material. Typical gause bandages. Bandages on the head, neck and thorax.
Patient's care, has an operation on a head, a neck and thorax.
 Work 3. Students get acquainted with work in a clean dressing room, help
the doctor during dressings, impose typical gause bandages on the head, a
neck and thorax.
 Work 4. Students help in a care of patients which have transferred
operative measures on a head, to a neck and thorax.Realizations of an
infiltration anesthesia.
Theme 3. Patient's care, has an operation on organs of abdominal cavity, a
perineum, extremities. Bandages on a stomach, a perineum, extremities.
 Work 5. Students help in a care of patients which have transferred
operative measures on abdomen, to a perineum, extremities.

Work 6. Students help to impose plaster bandages the patient with
fractures in conditions of traumatology department, splint room and ward.
VI.

Seminar Discussion Of Theoretical Questions And Practical Work:
12.30 - 14.00
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
VII. 7. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 Basis of organization of work in a surgical hospital.
 Functional duties of the nurses of a hospital (charge nurse, ward nurse,
manipulation nurse, sister in charge of inspections and other medical
procedures).
 Function duties of junior medical personnel and sister for patient’s care.
 Rules of the internal schedule and sanitary – hygienic regimen of a surgical
hospital.
 The regime of work of admitting office.
Students should be able to:
 Admit the patient in an admitting office, carrying out nurse’s functions, to
fill in the relevant documentation.
 Carry out a cleansing of the patient and disinfection of subjects by agents
for it.
 Transport the patient from a admitting office to the surgical one.
 Dispose the patient in ward according to character of pathology.
 Prepare the patient for operation.
 Determine a status of the patient and according to this volume of a
cleansing.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 2 for 3rd – year students of the medical
faculty
THEME:
1. An antisepsis. A care of patients with a purulent pathology.
2. A bandaging material and operational linen sterilization. The organization
of work in operational block. A surgical treatment of the surgeon's hands
and a surgery field.
3. The organization of work in sterilization room. Preparation and sterilization
cutting, optical and surgical instruments. Sterilization of a suture material.
AIM: To acquire modern principles of prophylaxis of an intrahospital infection. To
learn the basic kinds of antisepsis and methods of their use. To determine
indications to application of the basic substances of antisepsis. To be able to
diagnose cases of hospital infection.
PROFESSIONAL MOTIVATION: Antisepsis belongs to potent and wide-spread
enough methods of prophylaxis and treatment of local infectious diseases and a
sepsis. Daily according to the World Organization of public health Services in the
world dies from infectious diseases over 50 thousand and annually more as 17
million people. 35-40 % of patients of a surgical structure are made by patients
with pyoinflammatory processes, postoperative purulent complications arise in 30
% of patients. In the general frame of a lethality in a surgical hospital the mortality
in connection with infectious complications reaches(achieves) 42-60 %.
Using modern methods of antisepsis and preparations it is possible not only
to suppress growth of a pathological microflora but also to stimulate a immunebiological condition of an organism on struggle against a surgical infection.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
VIII. Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. An antisepsis. A care of patients with a purulent pathology.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
1. To know the basic groups of substances chemical antiseptics and indications
to their application.
2. To know features of a care of patients with a purulent pathology.
3. To know features of dressings for patients with anaerobic infection.
Theme 2. A bandaging material and operational linen sterilization. The
organization of work in operational block. A surgical treatment of the surgeon's
hands and a surgery field.
To familiarize with a technique of manufacturing of napkins, tampons,
globules.
To know methods of preparation of the surgeon's hand and to be able to be
prepared for operation.
To acquire the basic methods of transportation of patients in operational room.
Rules of clothing of operational linen.
Theme 3. The organization of work in sterilization room. Preparation and
sterilization cutting, optical and surgical instruments. Sterilization of a suture
material.
1. Features of preparation of instruments to operation. Preparation of washing
and disinfectant substances.
2. To carry out tests on quality before-sterilization processings of instruments.
A technique of sterilization of cutting, optical and surgical instruments.
IX.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1.
The founder of antisepsis was:
A. I.Mechnikov;
B. N.Pirogov;
C. E.Bergman;
D. J.Lister;
E. J.Pringl.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
2.
An antisepsis is a complex of the actions directed on destruction or decrease
of microorganisms in:
A. A dressing material;
B. Instruments;
C. A suture material;
D. A wound;
E. Operation room.
3.
What preparation of antisepsis belong to haloids
A. Spirt solution of iodine
B. Iodonatum
C. Ethil alcohol
D. Furacillin
E. Rokkal
4.
Choose a preparation of group of oxidizers
A. Jodopiron
B. A potassium permanganate
C. Rivanolum
D. Dimexidum
E. A corrosive sublimate
Real-life situations to be solved:
5.
During examination of otorhinolaryngologist at the nurse of surgical
department, they discover a chronic tonsillitis. During bacteriological
examination of mucous from the throat they discover a patogenic
staphylococcus. Your actions as a chief of department.
6.
A patient N., 48 years old, entered to traumatological department with cutelacerated wound at the region of external condylus of the right femur, after 24
hours from the moment of trauma. A primary surgical cleansing was carried
out, during which a tendon of digitorum flexor muscle was sewed. A primary
sutures were put on the wound. During examination, after 3 days, they noticed
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
a dropsy of surrounding tissues hyperemia, purulent discharges from the
wound. What have developed? What is the reason of it?
X.
Answers to the Self-Assessment:
1.
2.
3.
4.
5.
C;
D;
A;
B;
For some days move aside from the work and carry out a sanitation of oral
cavity. If results are negative, during inoculation, the admittance to the
work is possible.
6. Complication is developed – suppuration of the wound in consequence of
incorrect actions of the surgeon. Primary surgical cleansing of the wound
after 24 hours in not aloud.
XI.
References:
Essential reading:
6. Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
7. Lectures prof. B.I. Dmitriev from Odessa State Medical University.
8. Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
9. Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
10.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
4. Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
5. Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
6. Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
XII. 5. Students’ Practical Activities:

9.00 - 12.00
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Theme 1. An antisepsis. A care of patients with a purulent pathology.
 Work 1. Students independently will carry out a care of patients with a
purulent pathology, get acquainted with the organization of work in a
purulent dressing room.
 Work 2. Students take part in a care patient's
care
with anaerobic
infection, realizations of a dressing help the dressing-room nurse in time of
bandaging.
 Work 3. Students get acquainted with modern agents of antisepsis and
apply them during dressings.
Theme 2. A bandaging material and operational linen sterilization. The
organization of work in operational block. A surgical treatment of the surgeon's
hands and a surgery field.
 Work 4. Students preparing the napkins, tampons, globules, take part in
preparation of operational linen and a dressing material for operation,
acquire a technique of stacking of linen in drums.
 Work 5. Students process arms before operation, get acquainted with
processing a surgery field.
 Work 6. Students get acquainted with a structure of a surgery block, help to
transport patients in- and from operational block.
Theme 3. The organization of work in sterilization room. Preparation and
sterilization cutting, optical and surgical instruments. Sterilization of a suture
material.
 Work 7. Students take part in preparation of instruments for sterilization.
Carry out tests on quality before-sterilization processings of
instruments.
 Work 8. Students take part at sterilization surgical, optical and cutting
instruments.
 Work 9. Students get acquainted with a technique of sterilization of a
suture material.
XIII. Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
XIV. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 a history of development of antisepsis;
 kinds of antisepsis;
 classification and the characteristic of the basic preparations of antisepsis,
the indication to their application;
 substantive provisions of normative documents on struggle with hospital
infection;
 definition of an intrahospital infection;
 the basic sources of an intrahospital infection;
 rules and principles of prophylaxis of an intrahospital infection.
Students should be able to:
 To determine indications to application of the basic substances of antisepsis;
 To process correctly hands before operation;
 To process a surgery field;
 To carry out a patient's care with a purulent pathology;
 To carry out tests on quality of before-sterilization processings of the
instruments;
 To be able to sterilize of surgical instruments;
 To make the program of struggle against an intrahospital infection;
 To determine preventive actions for struggle against an intrahospital
infection in surgicaldepartment and a surgery block.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No3 for 3rd - year students of the medical
faculty
THEME:
1. Surgical operation. Preparation of patients to the operation. Patient’s care in
the postoperative period.
2. A local anesthesia.
3. Inhalation anesthesia. Noninhalation anesthesia.
AIM: To study the main tasks of the preoperative period. To establish indications
and contraindications to operation, a kind and terms of performance of operative
measures. To be able to estimate functions of the vital systems of an organism, a
degree of operational risk. To acquire the basic diagnostic and medical
manipulations necessary for preparation of patients to operation.
To study the basic tasks and the periods of the postoperative period. To
acquire the basic complications, which arise now, to learn to carry out their
diagnostics, treatment, prophylaxis and a patient’s rehabilitation.
To learn the basic tasks of an anesthesia, kinds of anesthesia, indications and
contraindications to the certain kind of an anesthesia. To learn the mechanism of
action of anesthetics and their groups. To learn the stages of anesthesia, possible
complications, a technique of realization of an endotracheal narcosis.
PROFESSIONAL MOTIVATION: Surgical operation – the major and responsible
stage in treatment of the surgical patient. Nevertheless, that effect of a surgical
intervention was maximal, the appropriate preoperative preparation, the qualified
realization of an operative measure and treatment in the postoperative period is
necessary.
Thus, the basic stages of treatment of the surgical patient are:
 preoperative preparation;
 surgical operation;
 treatment in the postoperative period.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Mistakes by granting medical service by the surgical patient at the given
stages may result in adverse result, or considerably continue the period of
convalescence.
Any operative measure should be carried out under the certain kind of
anesthesia. The perfect knowledge of kinds of a narcosis, the mechanism of action
of anesthetics, indications and contraindications to each kind of an anesthesia is the
precondition for adequately spent operative measure and the prevention of
complications, both in intra-operative, and in the postoperative period.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
XV. Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Surgical operation. Preparation of patients for operation. A patient's care
in the postoperative period
1. Concepts about surgical operation.
2. Classification of operative measures, stages of performance.
3. The preoperative period, its tasks.
4. Features of preparation of patients to planned and urgent operations.
5. The preoperative period: a care of a patient's skin, sanitation of a mouth,
shave of hair, a cleaning of intestine with the help of clysters, hygiene of
linen and clothes of patients.
6. Main principles of a care of patients in the postoperative period.
7. Prophylaxis of possible complications.
8. A diet of patients.
Theme 2. A local anesthesia.
1. Versions of a local anesthesia (level-by-level infiltration, regional, spinal,
intraosseous).
2. Preparations for a local anesthesia.
3. Indications and contraindications.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
4. Possible complications.
Theme 3. Inhalation anesthesia. Noninhalation anesthesia.
1. Indications and contraindications.
2. Possible complications.
3. Concepts about a premedication.
4. Preparations for inhalation and endotracheal narcosis.
5. Stages of an ether anesthesia.
6. Aperture-mask narcosis, a technique of realization.
7. The structure of the device for inhalation narcosis.
8. Types of respiratory contours.
9. The technique of realization of an endotracheal narcosis.
10. Versions of noninhalation narcosis. The preparations. Techniques of
application.
11. Complications of a narcosis according stages and levels.
XVI. Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1.
Patient A., 32 years old, has admitted in a hospital with clinic of a phlegmon
of the right brush. The given disease is:
A. Absolute display to an urgent operation
B. Absolute display to planned operation
C. Relative display to an urgent operation
D. Relative display to planned operation
E. Relative contraindication to operation
2.
In what cases the planned operation is postponed?
A. At complications of a basic disease
B. At purulent eruption on the skin
C. At a hyper sensibility to Novocain
D. At presence at the patient of harmful habits
E. At presence of a varicose phlebectasia of the lower extremities
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3.
Patient D., 65 years old, was operated concerning a ventral hernia.
Concomitant disease - is varicosity of hypodermic veins of the right lower
extremity. What complication is possible in the postoperative period?
A. A bleeding from a wound
B. An atelectasis of lung
C. Tromboembolism a pulmonary artery
D. A peritonitis
E. Development of bedsores.
4.
To a conduction anesthesia carry:
A. Blockade of intercostals nerves,
B. Paranephric block,
C. Irrigation of mucous membranes,
D. Vàgosympathetic block,
E. Anesthesia by Lukashewich-Oberst.
Real-life situations to be solved:
5.
In the patient with acute surgical disease of organs of abdominal cavity urgent
operation under inhalation narcosis is supposed. What intraoperational
complication may arise in the patient on the part of respiratory system? Its
prophylaxis.
6.
After the spent operative measure, the patient is in the compelled position on a
back. For 3-rd day in a region of coccygeal bone at the patient the serous
bubble in diameter up to 6 cm has appeared. The skin around swollen,
hyperemia, places of the phenomenon of maceration. It is necessary to think
of what complication of the postoperative period? Its prophylaxis.
XVII. Answers to the Self-Assessment:
1.
2.
3.
4.
5.
A;
B;
C;
E
Aspiration of vomit masses during realization of a narcosis. The patient in
the preoperative period should enter a probe into a stomach and to evacuate
gastric contents.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
6. In the patient the bedsore was developed. Prophylaxis of bedsores is
according to the standard rules.
XVIII.
References:
Essential reading:
11.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
12.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
13.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
14.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
15.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
7. Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
8. Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
9. Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
XIX. Students’ Practical Activities:

9.00 - 12.00
Theme 1. Surgical operation. Preparation of patients for operation. A patient's care
in the postoperative period.
 Work 1. Subjective and objective examination of the patient. The care of
the patient's skin, sanitation of oral cavity, shave of hair, a purgation with
the help of clysters, hygiene of linen and clothes of patients.
 Work 2. To determine a kind and volume of an operative measure on terms
and the purposes of performance of operation. To estimate a degree of
operational risk at the patient.
Theme 2. A local anesthesia.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 3. Definitions of indications and contraindications to realization of a
local anesthesia.
 Work 4. Realizations of an infiltration anesthesia.
Theme 3. Inhalation anesthesia. Noninhalation anesthesia.
 Work 5. Definitions of indications and contraindications to the general
anesthesia.
 Work 6. Prophylaxis of ingalation anesthesia' complications.
XX. Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
XXI. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
1. Concepts about surgical operation.
2. Classification of operative measures, stages of performance.
3. Concept of the preoperative period and its tasks.
4. Features of preparation of patients to planned and urgent operations.
5. Concept of the preoperative period: a care of a skin of the patient, sanitation
of a mouth, shave of hair, a cleaning of intestine with the help of clysters,
hygiene of linen and clothes of patients.
6. Main principles of a care of patients in the postoperative period.
7. Prophylaxis of possible complications in preoperative, intraoperative and
postoperative periods.
8. A diet of patients.
9. Versions of a local anesthesia (level-by-level infiltration, regional, spinal,
intraosseous).
10. Preparations for a local anesthesia.
11. Indications and contraindications to a local anesthesia.
12. Possible complications of a local anesthesia
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
13. Indications and contraindications to the general anesthesia.
14. Possible complications of the general anesthesia.
15. Concept about a premedication.
16. Preparations for inhalation and endotracheal narcosis.
17. Stages of an ether anesthesia.
18. Aperture-mask narcosis, a technique of realization.
19. The structure of the device for inhalation narcosis.
20. Types of respiratory contours.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 4 for 3rd – year students of the medical
faculty
THEME:
1. Bleeding and a hemorrhage. Methods of a temporary and final control of a
bleeding.
2. Doctrine about a blood. Tests at a hemotransfusion.
3. Hemotransfusion, transfusion of blood preparations, blood substitutes.
Complications at hemotransfusions.
AIM: To acquaint students with the general attributes of a bleeding and a
hemorrhage. To acquaint students with bases of transfusiology: techniques of
definition of blood groups and a rhesus of an accessory. Realization individual, a
rhesus and biological compatibility, ways of preparation, conservation and
reservation of hemotransfusion agents. To acquaint with modern indications and
contraindications to a hemotransfusion, rules and engineering of transfusion
therapy, preparation of system for a hemotransfusion. And also, to acquaint
students with possible reactions and complications at a hemotransfusion, its
components, preparations, blood substitutes, their prophylaxis, treatment, filling of
the medical documentation.
PROFESSIONAL MOTIVATION: The bleeding - one of the most drama
situations in medicine and consequently takes a special place in surgery. It arises
both at mechanical damages and at many surgical diseases. The loss of blood
causes in an organism of change and frames threat for life of the patient. Delayed
recognition and overdue representation both the first medical, and the surgical aid
may result in unforeseen consequences. In this case, infusional-transfusion therapy
takes the important place, concerns to its outstanding achievements and there is no
alternative replacement at treatment serious blggd loss and many other acute and
chronic diseases, in particular a hematological structure. Any of mistakes at
definition as groups of a blood, and may result a rhesus of the factor in serious
consequences for life of patients and victims. The opportunity of restoration of a
hemorrhage has considerably expanded a range of surgical interventions not only
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
by granting the help by the patient with massive hemorrhages, and also at
performance of difficult surgical interventions. The special discipline - clinical
transfusiology which surveys different aspects of a hemotransfusion, its
components, and blood substitutes for today is generated. The transfusion to the
patient of a blood of its components and preparations may be carried out only
under the consent of the patient. He should know, than refusal of application of
hemotransfusion agents threatens him, at the same time he should be informed,
what complications and consequences of such treatment may be. So modern
international conventions on human rights and laws of Ukraine.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
XXII. Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Bleeding and a hemorrhage. Methods of a temporary and final control of
a bleeding.
1.
Concept about a bleeding and blood loss.
2.
Classification of bleedings (on the mechanism, the attitude to medium,
term of occurrence, clinical course).
3.
Local attributes of an external bleeding.
4.
General attributes of a hemorrhage and an anemia.
5.
Basic attributes of an internal bleeding.
6.
Degrees of an acute hemorrhage.
7.
Techniques of determination of blood loss volume.
8.
That such Algover index?
9.
What mechanism of an independent control of bleeding?
10. Main principles of treatment of bleedings.
11. Methods of a temporary control of bleeding (pressing of vessels in a
wound, a compressing bandage, a flexion of an extremity, pressing of
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
vessels on an extent, a dense tamponade of a wound, an applying a
tourniquet, garrot, a clamp on a vessel).
12. Methods of a final control of a bleeding (mechanical, physical, chemical,
biological).
13. The vascular seam. Concept about a transplantation and an alloplasty.
14. Complications of bleedings: a loss of consciousness, a collapse, a
hemorrhagic shock, clinical attributes, the first medical service.
Theme 2. Doctrine about a blood. Tests at a hemotransfusion.
1.
Blood group systems.
2.
Antigens AB0.
3.
Antibodies of system AB0.
4.
Methods of determination of blood groups of system AB0.
5.
Agglutinogenes revealating by direct reaction.
6.
Revealing агглютининов by an indirect way.
7.
Blood cross-match.
8.
Methods of blood grouping in AB0.
9.
Causes and prevention of mistakes at blood-grouping.
10. Blood-groups of rh-system.
11. Methods of determination of the rh-factor.
12. Preparation of system for blood transfusion.
Theme 3. Hemotransfusion, transfusion of blood preparations, blood substitutes.
1.
List the indications for blood transfusion;
2.
What is necessary to carry out before blood transfusion?
3.
Contraindication for blood transfusion;
4.
What methods of hemotransfusion do you know?
5.
Kinds of blood transfusions depending on term of introduction of blood;
6.
Clinical features of posttransfusinal reactions;
7.
Clinical features of posttransfusional shock;
8.
Preventive maintenance and treatment posttransfusional reactions and
complications of blood transfusion.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
XXIII.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. Indications for blood transfusion are:
A. an allergic status of the patient;
B. a shock;
C. presence of hepato-kidney insufficiency;
D. a loss of consciousness;
E. presence of avitaminosis at the patient;
2. Optimum temperature for keeping of conserved blood:
A. from 0 up to +2С;
B. from +4 up to +6С;
C. from +8 up to +10С;
D. -1С;
E. -2С.
3. Point out the main differential diagnostic sign between acute and chronic
blood loss.
A. speed of arterial pressure decrease;
B. indices of red blood;
C. hematocrit index;
D. size of a "shock" index;
E. volume index of circulating blood.
4. Define the correctly signed blood group A(II) according to agglutinogenagglutinin system.
A. А;
B. 0;
C. В;
D. АВо;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Real-life situations to be solved:
5. Patient М., 27 years old, blood group 0(I). She is in medical establishment
concerning late miscarriage, posthemorrhagic anemia, septicemia. Is
carried out scraping of cavity uterine. The blood transfusion of group
B(III) is wrongly began. After introduction 100 ml of blood at the patient
the pains in back, shiver have appeared. The transfusion is stopped. In 15
minutes the state shortly has worsened: adynamia, acute pallor,
acrocyanosis, down-pour sweat, shiver. Pulse 96 per minute, weak filling,
arterial pressure of 75/40 mm of a hg. What hemotransfusional
complication was developed at the patient?
6. Patient G., 34 years old, was operated concerning broken tubal pregnancy.
In postoperative period the transfusion one group of blood was carried out.
During one from injections at the patient the pains in muscles have
appeared a headache. Temperature of a body 37,7С. what kind of
hemotransfusional complication was developed at the patient?
XXIV.
1.
2.
3.
4.
5.
6.
Answers to the Self-Assessment:
B;
B;
A;
A;
Hemotransfusional shock, II level.
Pyrogenous reaction, not serious level.
XXV. References:
Essential reading:
16.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
17.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
18.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
19.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
20.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
10.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
11.Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
12.Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
Students’ Practical Activities:
XXVI.

9.00 - 12.00
Theme 1. Bleeding and a hemorrhage. Methods of a temporary and final control of
a bleeding.

Work 1. To determine a kind of external bleeding.

Work 2. Selection of kind of temporary method control of bleeding.
Theme 2. Doctrine about a blood. Tests at a hemotransfusion.
 Work 3. Determination of the blood groups with the help of standart serum.

Work 4. Determination of the Rh- factor with the help of antirhesus serum.
 Work 5. Realization of tests before a hemotransfusion.
Theme 3. Hemotransfusion, transfusion of blood preparations, blood substitutes.
 Work 6. Choice of a hemotransfusion agent for transfusion therapy.
 Work 7. Transfusion documentation.
XXVII.

Seminar Discussion Of Theoretical Questions And Practical Work:
12.30 - 14.00
XXVIII.
The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
To estimate the data of the general blood test.
To estimate results of the anamnesis, given objective inspection.
To estimate a degree of gravity of a bleeding.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
To know signs of an acute and chronic bleeding.
Definition individual and rhesuses - compatibilities.
The choice of a hemotransfusion agent for transfusion therapy.
Rules of filling of the documentation after a hemotransfusion.
Students should be able to:
1.
To estimate given digital research of a rectum at a gastrointestinal
bleeding.
2.
To define of blood groups and a rhesus - accessory.
3.
To diagnose the basic complications after transfusion therapy.
4.
To give the first help during complications at hemotransfusional therapy.
5.
To prepare equipment for realization of definition of blood groups by
standard serums and monoclonal antibodies.
6.
To carry out definition of blood groups with the help of standard serums
and monoclonal antibodies.
7.
To prepare equipment for realization of definition of a Rh factor and to
determine a Rh factor of a blood. To determine individual and rhesus compatibility of a blood.
8.
To choose of a hemotransfusion agent for transfusion therapy.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 5 for 3rd - year students of the medical
faculty
THEME:
1. Wounds and wound's process. Prophylaxis of development of an infection
into the wound. Treatment of clean wounds.
2. Infected wounds.
3. The closed damages of soft tissues of a skull, a thoraxl, bodies of a
abdominal cavity.
AIM:
1. To know classification of wounds, biology of a wound process, kinds of a
surgical treatment of a wound. To be able to determine phases of a course of
a wound's process and a kind of a wound healing. To know methods and
engineering of realization of a primary surgical treatment of a wound.
2. To receive concept about infected wounds, To familiarize with features of a
course of a wound process of contaminated wounds. To familiarize with
modern methods of complex treatment of contaminated wounds. To learn to
apply agents to local treatment of such wounds and to acquire principles of
their surgical treatment.
3. To determine the basic clinical and laboratory attributes of disease, to
acquire algorithm, principles of diagnostics and treatment of damages of a
forward abdominal wall, bodies of abdominal cavity.
PROFESSIONAL MOTIVATION:
1. Wounds are one of kinds of damages which extremely wide-spread both in
peace and in a wartime. In many cases they are a principal cause of a
disability and a lethality. The history of surgery is a history of treatment of
wounds. For any other purpose in surgery agents of treatment and their
combinations, as for treatment of wounds were not offered so much. And in
modern conditions annually there are many new methods of treatment of an
above named pathology. Despite of it, the problem of treatment of wounds,
in particular purulent, remains not up to the end decided.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
2. Despite of appreciable progress of surgery, the problem of treatment of
purulent wounds to nowadays remains actual in connection with formation
antibiotic resistances cultures of the microorganisms, expressed allergization
and immunodepressive influences on the population.
3. The trauma of a stomach concerns to damages extremely dangerous to life
and is accompanied by a high lethality. It caused by damage of vitally
important organs, and also complexity of diagnostics. Therefore doctors of a
surgical structure should know main principles of diagnostics and treatment
of traumatic damages of a stomach.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
XXIX.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Wounds and wound's process. Prophylaxis of development of an
infection into the wound. Treatment of clean wounds.
1. Definition of concept of a wound;
2. Classification of wounds;
3. Principles of wound's healing, features of each phase of a wound
process;
4. Definition of concept of an primary surgical treatment of a wound, initial
and secondary seams;
5. A technique of realization of an primary surgical treatment of a
contaminated wound;
6. Indications to performance of an primary surgical treatment and
applying of a different kind of seams.
Theme 2. Infected wounds.
1. Definition of concept "wound";
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
2. Definition of concept " a primary surgical treatment of wounds ", "
initial and secondary seams ";
3. Classification of wounds;
4. Principles of wound's healing, features of each phase of a wound
process;
5. A technique of realization of an initial surgical treatment of
contaminated wounds;
6. Indications to performance of an initial surgical treatment and applying
of different kinds of seams.
7. The basic characteristics of the general condition of the patient, ways of
their definition;
8. Conditions which assist development of a pyesis of a wound;
9. Principles of antibacterial therapy;
10.Principles of a surgical treatment of contaminated wounds (their
advanced processing);
11.Methods of a stimulation of processes of regeneration;
12.Local and general treatment of contaminated wounds.
Theme 3. The closed damages of soft tissues of a skull, a thoraxl, bodies of a
abdominal cavity.
1.
Classification of damages of abdomen;
2.
The clinical picture of damages of a forward abdominal wall, hollow
and parenchymatous organs;
3.
Complications of the closed damages of soft tissues of a skull, a thorax,
orgabs of abdominal cavity;
4.
Diagnostic value of the data laboratory, instrumental, X-ray
examinations;
5.
Laparocentesis, laparoscopy, engineering of their performance;
6.
Main principles of treatment of traumatic damages of abdomen.
XXX. Tests and Assignments for Self – assessment
Multiple Choices.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Choose the correct answer/statement:
1. Secondary infection of wounds is probably at infringement corrected
asepsises:
A. At the moment of granting the first medical service;
B. During a dressing;
C. During operation;
D. During reception of a wound;
E. All answers true.
2. The penetrating wound of abdomen refers wound with damage:
A. Skin;
B. A subskin fat;
C. Muscles;
D. Parietal peritoneum;
E. Visceral peritoneum.
3. What wound is healed faster others:
A. Incized;
B. Chopped;
C. Bite;
D. Contused;
E. Gunshot.
4. For freshen wounds typically all without:
A. Pain;
B. Bleeding;
C. Defect of tissues;
D. Sensations of twitching in a wound;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
E. Hiatus
Real-life situations to be solved:
5. The patient for the fourth day after appendectomy had throbbing pain in the
region of a postoperative wound, the body temperature increased, the
leukocytosis is observed.
What complication has arisen at the patient?
6. After the transferred traffic accident to the patient of 63 years old in
conditions of a dressing room of admitting room have not washed out a
cavity of a wound a solution of oxidizers, did not drain a wound, and on
have indistinctly sewed up.
Whether doctors have correctly arrived? What possible complications it is
necessary to wait in the postoperative period?
XXXI.
1.
2.
3.
4.
5.
6.
XXXII.
Answers to the Self-Assessment:
B;
D;
A;
D
Postoperative wound infection.
Incorrectly. Development of anaerobic surgical infection.
References:
Essential reading:
21.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
22.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
23.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
24.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
25.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
13.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
XXXIII.

Students’ Practical Activities:
9.00 - 12.00
Theme 1. Wounds and wound's process. Prophylaxis of development of an
infection into the wound. Treatment of clean wounds.
 Work 1. Work 1. To provide and warn development of a wound infection;
 Work 2. To estimate a course of a wound process;
 Work 3. To impose and remove seams.
Theme 2. Infected wounds.
 Work 4. To carry out an primary surgical treatment of infected wounds;
 Work 5. To carry out necrectomy of purulent wound;
 Work 6. To carry out a dressing of an infected and purulent wound with
application of modern antiseptics;
Theme 3. The closed damages of soft tissues of a skull, a thoraxl, bodies of a
abdominal cavity.
 Work 7. To determine and estimate a condition of the patient with a
polytrauma
XXXIV.

Seminar Discussion Of Theoretical Questions And Practical Work:
12.30 - 14.00
XXXV.
The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
Wounds: definition, classification.
Frame of a wound and a course of a wound process in a clean wound.
The characteristic of separate types of wounds and a first aid at them.
Conditions of occurrence of an infection in a wound, elimination of these
conditions.
Frame of a clean wound.
The initial surgical treatment of a wound.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Kinds of initial seams.
Treatments of a clean wound in the postoperative period.
Contaminated wounds.
Course of a wound process in a purulent wound.
The surgical treatment of a purulent wound, kinds of secondary seams.
Treatments of a purulent wound according a phase of a wound process.
Kinds of a drainage of a purulent wound.
Concepts about a traumatism.
Clinical symptoms of the closed damage of soft tissues, skull, a thorax, organs
of abdominal cavity.
Prophylaxis of development of a traumatic shock, a pheumothorax, an internal
bleeding.
Features of first-aid treatment and transportation of patients at these damages.
Students should be able to:
To apply occlusive bandage at penetrating damage of a thorax
To diagnose phases of a wound process;
To determine a kind of wound's healing;
To take a material for cytologic and microbiological researches;
To render the first medical aid at wound;
To apply and remove sutures.
To carry out a dressing of a purulent wound with application of modern
antiseptics;
To impose an immovable bandage.
To allocate the basic clinical attributes of damage of a forward abdominal
wall, hollow and parenchymatous organs of abdominal cavity;
To make the circuit of diagnostic search;
To estimate results of laboiratory - instrumental methods of diagnostics;
To prove main principles of treatment of separate damages of a stomach (an
abdominal wall, hollow and parenchymatous organs).
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 6 for 3rd - year students of the medical
faculty
THEME:
1. Fractures. the mechanism of occurrence. formation of the osteal callositas.
The first aid at fractures.
2. Treatment of fractures in the hospital, the care of the patients with fractures,
plaster engineerin. Dislocations.
3. Reanimation actions at surgical patients.
AIM: To learn to diagnose damages of osteal system and to give the first medical
aid at fractures and dislocations of bones, to carry out reanimation actions in
surgical patients.
PROFESSIONAL MOTIVATION: Among damages of a locomotorium fractures
of bones and dislocations are one of serious traumas who are accompanied by a
long disability and quite often result in physical inability.
The result of treatment of damages to many cases depends on quality of granting of
a first aid. Poor given medical care may cause occurrence of various complications
which predetermine a proof disability.
In this connection, each doctor, despite of specialization, should know
clinical simptoms of fractures of bones and dislocations and to be able to give the
first medical aid, reanimation actions by the patient with a traumatic shock.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
XXXVI.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Fractures. the mechanism of occurrence. formation of the osteal
callositas. The first aid at fractures.
1. Definitions of fractures. Classification of fractures. Mechanisms of
occurrence.
2. Kinds of repair of bone’s tissues.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3. A first aid at fractures.
Theme 2. Treatment of fractures in the hospital, the care of the patients with
fractures, plaster engineerin. Dislocations.
Methods of conservative and surgical treatment of fractures.
Acare of patients with fractures.
Definition of dislocations.
Classification of dislocations.
Methods of conservative and surgical treatment of dislocations.
Kinds and engineering of applying of plaster bandages.
Theme 3. Reanimation actions at surgical patients.
1. Rendering an acute management by the surgical patient on pre-admission
stage.
2. Realization of reanimation actions by the surgical patient on pre-admission
stage.
XXXVII.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. As to localization, the following types of the fractures are identified:
A. Epiphysial, diaphyseal, metaphyseal.
B. Subperiosteal, epiphiseal, methaphyseal.
C. Epiphyseolis, diaphyseal, methaphyseal.
D. Metaphyseal, subperiosteal, epiphiseolysis.
E. Intrajoint, diaphyseal, methaphyseal.
2. The local reasons of delayed-union of fracture are:
A. Interposition of the soft tissues, beriberi;
B. Mineral violation, beriberi;
C. Violation of blood supply of bone’s fragments, mineral violation;
D. Correct of bone’s fragments displacement, beriberi;
E. Interposition of the soft tissues, violation of blood supply of bone’s
fragments.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3. What kinds of embolism possible during fracture?
A. Air embolism.
B. Fat embolism.
C. Clot-embolism.
D. Embolism of amniotic fluid.
4. Bony crepitus and abnormal mobility are absent in cases of fracture (by
localization):
A. Epiphysial;
B. Diaphyseal;
C. Metaphyseal;
D. Subperiostal;
E. Periostal.
5. The method of transport immobilization during fracture of femur is:
A. Applying Diterich’s splint;
B. Applying Cramer's splint;
C. Applying plaster bandage;
D. Applying compression osteosynthesis;
E. Applying distraction osteosynthesis.
Real-life situations to be solved:
6. Patient N., 54 years old, admit to the traumatic department with diagnosis:
Intra-joint fracture of humerus bone’s column. What is the fracture?
7. Patient B., 36 years old, admits to the urgent hospital with diagnosis: Closed
comminuted fracture of medial third of left humerus. Patient’s complains:
numbness, swelling and blue color of skin of left hand. What complication
has this patient? What kinds of treatment indicated in this case?
XXXVIII. Answers to the Self-Assessment:
1.
2.
3.
4.
– A.
– E.
– B.
– C.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
– A.
– Epiphyseal.
– Interposition of soft tissues with compression of humerus artery.
Treatment – urgent operation.
5.
6.
7.
XXXIX.
References:
Essential reading:
26.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
27.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
28.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
29.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
30.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
14.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
15.Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
16.Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
XL. Students’ Practical Activities:

9.00 - 12.00
Theme 1. Fractures. the mechanism of occurrence. formation of the osteal
callositas. The first aid at fractures.
 Work 1. Mastering of substantive provisions from clinic, diagnostics and
treatments of fractures.
 Work 2. Inspection of patients and a spelling of algorithm of diagnostics,
granting of first aid and treatment of fractures of a different kind and
localization.
Theme 2. Treatment of fractures in the hospital, the care of the patients with
fractures, plaster engineerin. Dislocations.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 3. Work 3. Inspections of patients and a spelling of algorithm of
diagnostics and treatment of dislocations of a different kind and
localization.
 Work 4. Mastering of the basic moments of a care of patients with fractures
and dislocations.
 Work 5. Features of applying of plaster bandages.
Theme 3. Reanimation actions at surgical patients.
 Work 6. Acquaintance with principles reanimation actions in surgical
patients.Definitions of indications and contraindications to the general
anesthesia.
XLI. Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
XLII. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:








The mechanism of occurrence of fractures;
The classification of fractures;
Basic (absolute) symptoms of fractures;
Relative symptoms;
Methods of the first help at fractures;
Processes of healing of fractures;
Methods of treatment of fractures.
Classification of dislocations.
 Clinical symptoms of dislocation.
 Methods of dislocation reducing (humerus, femur, lower jaw).
 Methods and time of immobilization.
Students should be able to:
 To choose from given history the items of information, which are specify
for damage;
 To make the individual circuit of diagnostic search;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 To estimate the results of clinical and X-ray inspection;
 To allocate the basic symptoms of fractures of bones and to prove the
diagnosis;
 To render the first medical aid;
 To determine medical tactics and capacity of rendering assistance.
 To diagnose the main symptoms of traumatic dislocation;
 To choose from anamnesis data, which indicated on mechanism of trauma
and on presence of dislocation;
 To make up individual scheme of diagnostic search;
 To find of informative objective dislocation symptoms;
 To prove plan of treatment;
 To learn the main methods of dislocation reducing.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 7 for 3rd – year students of the medical
faculty
THEME:
1. Acute purulent diseases of soft tissues: an abscess, a phlegmon, a furuncle,
an anthrax. A clinical picture. Methods of diagnostics and differential
diagnostics. Operative measures.
2. Acute purulent diseases of soft tissues: a hydradenitis, a mastitis, an
erypsipelas, a paraproctitis. A clinical picture. Diagnostics, treatment.
3. Acute purulent diseases of lymph nodes and vessels, a lymphadenitis, a
lymphangitis. A clinical picture. Diagnostics, treatment.
AIM: To determine the basic local and general clinical symptomes of an acute
purulent nonspecific infection (APNI) on its kind, to acquire algorithm of
diagnostic search, modern approaches to surgical and conservative treatment, a
way of prophylaxis of acute purulent diseases of soft tissues.
PROFESSIONAL MOTIVATION: The surgical infection occupies one of the
main places in frame of surgical illnesses. Frequency of wound's infectious
complications achieves 14-20 %. About 40 % of lethal outcomes after operative
measures are predetermined by purulent - septic complications. The quantity of
patients with extensive purulent processes which result in development of septic
conditions has increased.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
XLIII.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Acute purulent diseases of soft tissues: an abscess, a phlegmon, a
furuncle, an anthrax. A clinical picture. Methods of diagnostics and differential
diagnostics. Operative measures.
1. To determine the basic local and general symptomes of an inflammation;
2. To make algorithm of individual diagnostic search;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3. To establish a role of additional methods of research for statement of the
diagnosis.
Theme 2. Acute purulent diseases of soft tissues: a hydradenitis, a mastitis, an
erypsipelas, a paraproctitis. A clinical picture. Diagnostics, treatment.
Versions of a local anesthesia (level-by-level infiltration, regional, spinal,
intraosseous).
1. To prove the diagnosis at the concrete patient;
2. To prove the plan of conservative and surgical treatment;
3. To formulate main principles of prophylaxis of complications.
Theme 3. Acute purulent diseases of lymph nodes and vessels, a lymphadenitis, a
lymphangitis. A clinical picture. Diagnostics, treatment.
1. To allocate the basic attributes of an acute purulent nonspecific infection;
2. To determine the basic local and general symptomes of an inflammation;
3. To prove the diagnosis at the patient with acute purulent diseases of soft
tissues.
XLIV.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
7.
Specify the most wide-spread localization of ?carbuncle:
A. On a neck;
B. On a femur;
C. On a head;
D. On a face;
E. On a perineum.
8.
Than the abscess differs from a phlegmon?
A. By form;
B. By localization;
C. Presence of a pyogenic capsule;
D. Depth of a locating;
E. Presence of a various kind of a purulent infection.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
9.
At patient Ô., 42 years old, for 5 day after fall on beaten glass in a site of
an eminence of the first finger of the right arm have appeared a swelling, a
redness, local rise in temperature of a skin. The struck site morbid at
movements and a palpation, the fluctuation is determined. What treatment
should be applied?
A. UHF-therapy;
B. Opening a phlegmon, a drainage, antibacterial therapy;
C. General antibacterial therapy;
D. A puncture of a site of a pyesis with introduction of proteolytic
enzymes;
E. Half-alcohol compresses and an antibiotic therapy.
Real-life situations to be solved:
10. At the patient an inguinal lymphadenitis is diagnosed. A sign of fluctuation
doubtful. With what manipulation it is possible to confirm abscess
formation a lymphadenitis?
11. In patient with a purulent wound in area of femur on bacteriogramm
detected rod of blue-green pus. What antiseptic you have offered for local
treatment of this wound?
12. Patient G., 27 years old, admitted to the hospital with accidental wound by
nail on foot. All symptoms of inflammation and discharge of pus are
present. Is this wound bacterial soil or infected?
XLV. Answers to the Self-Assessment:
1.
2.
3.
4.
5.
6.
A;
C;
B;
Puncture of the limphadenitis;
Dioxidin.
Infected.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
XLVI.
References:
Essential reading:
31.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
32.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
33.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
34.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
35.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
17.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
18.Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
19.Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
XLVII.

Students’ Practical Activities:
9.00 - 12.00
Theme 1. Acute purulent diseases of soft tissues: an abscess, a phlegmon, a
furuncle, an anthrax. A clinical picture. Methods of diagnostics and differential
diagnostics. Operative measures.
 Work 1. Students independently collect complaints, an anamnesis of
disease and life, will spend objective examination, allocate the basic
clinical signs of an abscess, a phlegmon, a furuncle, an anthrax.
 Work 2. Students make the diagnostic program, formulate the diagnosis.
 Work 3. Students on the basis of complaints, anamnesises of disease and
life, the data of objective, laboratory research will carry out the differential
diagnosis between an abscess, a phlegmon; a furuncle and an anthrax and
make the diagnostic program of treatment.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Theme 2. Acute purulent diseases of soft tissues: a hydradenitis, a mastitis, an
erypsipelas, a paraproctitis. A clinical picture. Diagnostics, treatment.

Work 4. Students independently collect complaints, an anamnesis of
disease and life, will spend objective examination, allocate the basic
clinical signs of a hydradenitis, a mastitis, erysipelas, a paraproctitis.
 Work 5. Students on the basis of the complaints, the given objective
methods of examination make the diagnostic program, formulate the
diagnosis.
 Work 6. Students make the diagnostic program, formulate the diagnosis.
Appoint conservative treatment and a method of operative treatment.
Theme 3. Acute purulent diseases of lymph nodes and vessels, a lymphadenitis, a
lymphangitis. A clinical picture. Diagnostics, treatment.
 Work 7. Students independently collect complaints, an anamnesis of
disease and life, will carry out objective inspection, allocate the basic
clinical signs of an acute purulent nonspecific infection of lymph nodes
and vessels.
 Work 8. Students make the diagnostic program, formulate the diagnosis.
Appoint conservative treatment and a method of operative treatment.
 Work 9. Students will carry out the differential diagnosis between a
lymphadenitis and a hydradenitis, a lymphangitis and an erypsipelas.
XLVIII.

Seminar Discussion Of Theoretical Questions And Practical Work:
12.30 - 14.00
XLIX.
The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
1. An etiology and a pathogeny of an acute purulent nonspecific infection;
2. Factors of nonspecific and specific protection of an organism;
3. Features of a structure of a skin and a hypodermic fat, on anatomic
localization;
4. A clinical picture of an acute purulent nonspecific infection;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
5. Local and general symptomes of an inflammation;
6. Features of a blood supply on the face;
7. Features of development of the purulent diseases of a skin and a
hypodermic fat, accordimg a stage of inflammatory process;
8. Surgical accesses at different kinds of purulent diseases of a skin and a
hypodermic fat;
9. Principles of treatment of purulent diseases of a skin and a hypodermic fat,
on a stage of an inflammation;
10.prophylaxis of complications;
11.Agents of etiological, pathogenetic and symptomatic therapy.
Students should be able to:
1. To allocate the basic attributes of an acute purulent nonspecific infection;
2. To determine the basic local and general signs of an inflammation;
3. To make algorithm of individual diagnostic search;
4. To establish a role of additional methods of research for statement of the
diagnosis;
5. To prove the diagnosis at the concrete patient;
6. To prove the plan of individual surgical and conservative treatment;
7. To formulate main principles of prophylaxis of complications.
.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 8 for 3rd – year students of the medical
faculty
THEME:
1. Acute purulent diseases of a hand.
2. Purulent diseases of bones.
3. An acute specific surgical infection.
Independent student’s work (1hour). Purulent - necrotic processes of a
brush.
AIM: To learn a symptomatology of different forms of panaritiums and phlegmons
of a hand, to seize their diagnostics. To acquire questions of prophylaxis and
modern principles of treatment. To learn to distinguish a symptomatology of
osteomyelitis. To acquire modern methods of diagnostics, principles of treatment
and prophylaxis of occurrence of purulent diseases of bones and joints.
To learn to distinguish and estimate value of syndromes in early
diagnostics of a tetanus, to carry out complex prophylaxis and treatment. To
acquaint students with clinical displays of anthrax, a diphtheria of wounds, to
methods of prophylaxis and treatment.
PROFESSIONAL MOTIVATION: Hand - the basic organ of work, organ of
influence of the person on an environment. Values of a brush in human life induces
physicians to concern with special attention to prophylaxis and treatment of its
diseases and traumas.
Almost 2 % of the population is sick on acute purulent diseases of a hand and
fingers which in polyclinic surgical practice occupy one of the first places. That is
all 1/3 patients on different purulent diseases which for the first time have addressed
in a polyclinic, make persons with purulent-inflammatory diseases of a hand and
fingers.
Purulent diseases of a hand are the important social problem in connection
with high frequency of occurrence, a plenty lost operating time, the material inputs
connected to payment of a temporary disability, and by adverse results. They
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
demand of the doctor of a profound knowledge and skills in questions of
diagnostics and medical tactics.
Necessity of illumination of problem of osteomyelitis caused by insufficient
studying of a pathogeny, difficulty of diagnostics, late hospitalization, absence of
unity of views on a choice of methods of diagnostics, rational volume of operation,
conducting the postoperative period.
The tetanus continues to remain one of 10 main reasons of mors of the
population. Extremely long conservation of spores of the originator of anthrax in
ground will cause of constant vigilance and knowledge of all aspects of this illness
dangerous to the person. Important value gets also the professional factor. At
cattlemen, shepherds, workers of the leather industry possible antrax, and at
diggers, workers of an agriculture - a tetanus.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
L.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Acute purulent diseases of a hand.
1. To teach anatomico-physiological features of a structure of a hand.
2. Classification, features of clinic and treatment of a panaritium.
3. Classification, surgical approach and treatment of phlegmons of a hand.
Theme 2. Purulent diseases of bones.
1. The reasons of occurrence and classification of acute diseases of bones.
2. Features of a clinical course and treatment of acute diseases of bones.
3. Atypical forms of osteomyelitis.
Theme 3. An acute specific surgical infection.
1. The etiology, a pathogeny, clinic, diagnostics and treatments of a tetanus.
2. The reasons of occurrence of feature of clinic and treatment of a wound's
diphtheria.
3. The anthrax. An etiology, a pathogeny, clinic, diagnostics and treatments.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
LI.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1.
Patient A., 22 years old, has addressed for medical aid with complaints to a
pain of constant character in a site of the right palm which amplifies at
movements by fingers, the general delicacy, subfebrile temperature.
Objectively: at the basis of the third finger of the right hand on a palmar
surface it is marked callosity skins around of which the edema and hyperemia
of skin are observed. Through epidermis the purulent exudation is visible. A
palpation of a place of defeat morbid, violation of function of fingers and
brushes. It is possible to think of what pathology?
A. A hypodermic panaritium of the basic phalanx IIIrd finger of the right
hand.
B.
A dermal panaritium of the basic phalanx IIIrd finger of the right
hand.
C.
A phlegmon of median checkered space of the right hand.
D. Subcallosal abscess.
E.
2.
Articular panaritium of the IIIrd finger of the right palm.
Patient G., 28 years old, has addressed for medical aid with complaints to a
pain of constant character in a region of IInd finger of the left hand,
infringement of function of a finger. Objectively: on a dorsum of the basic
phalanx of the IInd a finger of the left brush the inflammatory infiltrate 1,5×2
сm with a necrotic hinge in center is determined . What disease takes place in
the patient?
A. A skin panaritium.
B.
A subskin panaritium.
C.
A carbuncle.
D. A furuncle.
E.
Erizipelid.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
3.
Patient A., 26 years old has received a microtrauma (puncture) of a nail
phalanx of the IInd finger of the left hand. 5 days later has addressed in a
polyclinic where the diagnosis was exposed: a hypodermic panaritium of nail
phalanx of the IInd finger of the left hand. Under what anesthesia it is
expedient to execute disclosing of a panaritium?
A. Local infiltrative anaesthesia.
B.
An intravenous narcosis.
C.
Intraosseous anaesthesia.
D. A conduction anaesthesia by Oberst-Lukachevitch.
E.
4.
Intubation narcosis.
Patient M., 60 years old, admit in surgical department 10 days later from the
beginning of disease with complaints to pains in a region of the IInd finger of
the left hand, infringement of function of a finger, the general delicacy, a
fervescence up to 38°С. Objectively: a condition of the patient satisfactory,
pulse 90 per 1 minutes, arterial pressure - 120/80 mm Hg., a body temperature
38°С, IInd finger of the left hand dwarfed, deformed, a skin hydropic,
cyanotic. In the field of an average phalanx on a palmar surface - is a fistula
up to 0,3 sm with purulent discharges. Flexion contracture of finger. Active
movements are absent. On a roentgenogram a destruction of a bone of
middlephalanx is determined.
What disease at the patient?
A. A bone panaritium.
B.
A pandactylitis.
C.
Tendovaginitis.
D. A subskin panaritium as "cuff link".
E.
A thecal whitlow.
Real-life situations to be solved:
5.
Patient E., 35 years old, was treated during 3 days concerning a thecal
whitlow of the fifth finger of the left hand. On given time of the complaint for
a pain in a hand, infringements of a flexion of the Ist and Vth fingers.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Objectively: expressed edema and morbidity in the field of the Ist and Vth
fingers, rise in temperature up to 38°C. What complication was developed in
the patient?
6.
Patient K., 18 years old, has addressed in surgical department with complaints
to a throbbing pain in the field of the thumb of the right hand. From an
anamnesis it is known, that 2 days later has received insignificant wound in
time of nails paring. Objectively: nails platen is swollen in lateral side,
hyperemia is observed. From under it is allocated insignificant quantity of
white pus.
Diagnose. Your tactics.
LII.
Answers to the Self-Assessment:
1.
2.
3.
4.
5.
6.
D;
D;
D;
B;
U-like phlegmon of the left hand.
Diagnosis: paronychia of the thumb of the right hand. Tactics: to raise with
the help of a scalpel the nail platen for pus discharge.
LIII. References:
Essential reading:
36.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
37.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
38.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
39.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
40.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
20.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
LIV. Students’ Practical Activities:

9.00 - 12.00
Theme 1. Acute purulent diseases of a hand.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 1. To distinguish the basic clinical attributes of acute purulent
diseases of fingers and hands;
 Work 2. To leaddiagnostics of an acute purulent pathology of fingers and
hands on its kind and localization;
 Work 3. To prove the plan of individual treatment (conservative and
surgical);
Theme 2. Purulent diseases of bones.
 Work 4. To distinguish the basic attributes of purulent diseases of bones;
 Work 5. To make the individual circuit of diagnostic search.
 Work 6. To design and prove the plan of individual surgical and
conservative treatment;
Theme 3. An acute specific surgical infection.
 Work 7. To distinguish the basic clinical attributes of a tetanus, antrax and
diphtheria of wounds;
 Work 8. Methods of specific prophylaxis and treatment of an acute specific
surgical infection;
 Work 9. - to prove the plan of individual treatment (conservative and
surgical) an acute specific surgical infection;
LV. Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
LVI. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 Definition, classification of a panaritium, a phlegmon of hand;
 A clinical picture of a panaritium, a phlegmon of a hand;
 Diagnostics and treatment of a panaritium, a phlegmon of a hand.
 An etiology, a pathogeny acute hematogenous osteomyelitis;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Diagnostics and medical tactics of purulent diseases of bones;
 Kinds of operative treatment; Chronic forms of osteomyelitis, their treatments;
 An etiology, a pathogenesis, methods of diagnostics, the basic clinical
attributes of a tetanus, antrax, diphtherias of wounds;
 Methods of specific prophylaxis and treatment of an acute specific surgical
infection.
Students should be able to:
 to collect an anamnesis;
 to lead objective inspection of the patient;
 to distinguish the basic clinical attributes of purulent diseases of fingers
and hands;
 to lead diagnostics of an acute purulent pathology of fingers and hands on
their kind and localization;
 to prove the plan of individual treatment (conservative and surgical);
 to give the reference on an aftertreatment of patients.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 9 for 3rd – year students of the medical
faculty (6 hours + 1 hour – independent student’s work)
THEME:
1. A general purulent infection (sepsis).
2. An endogenic intoxication at an acute surgical infection.
3. Chronic specific surgical diseases.
4. Independent work of students: The tuberculosis of bones and joints.
AIM: To determine the basic clinical and laboratory attributes of a sepsis and a
chronic specific surgical infection; to acquire algorithm and principles of
diagnostics, ways of treatment and prophylaxis of the given diseases. To learn
clinical-laboratory attributes of an endogenic intoxication and methods of
desintoxication of the organism.
PROFESSIONAL MOTIVATION: Despite on modern achievements of surgery
the quantity of purulent - septic diseases has no the tendency to decrease. The
tragical ending of the given diseases is a sepsis which up to this time remains a
problem which serves as the reason of a high lethality. So, doctors of a surgical
structure should know major principles of diagnostics, treatment and prophylaxis
of occurrence of a sepsis; to know clinical-laboratory attributes of an endogenic
intoxication and the basic methods desintoxication of the organism.
The quantity of patients with chronic specific surgical diseases, such as, a
tuberculosis, an actinomycosis is not reduced. Actual there is a problem
extrapulmonary forms of a tuberculosis: a tuberculosis of bones and joints,
genitourinary organs, lymph nodes, a peritoneum etc.
With actinomycosis are amazed mainly cervical - gnathic site, lungs and
organs of abdominal cavity that may be shown by attributes of an acute surgical
pathology.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
LVII. Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. A general purulent infection (sepsis).
1. Modern regulations about a sepsis, classification, pathogenetic features of
course of a sepsis.
2. Modern methods of diagnostics of a sepsis.
3. Modern methods of treatment of a sepsis.
Theme 2. An endogenic intoxication at an acute surgical infection.
1. An endogenic intoxication at a surgical infection.
2. Methods of desintoxication and immunecorrection.
3. Surgical aspects of AIDS and a narcomania.
Theme 3. Chronic specific surgical diseases.
1. An etiology, a clinical picture, diagnostics and treatment of a tuberculosis.
2. An etiology, a clinical picture, diagnostics and treatment of an
actinomycosis.
LVIII.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. At planning the program of antibacterial therapy of a sepsis first of all it is
necessary to provide:
A. Ways of introduction of antibiotics.
B. Permanence of an infusion.
C. A single dose.
D. A daily dose.
E. Sensitivity of the agent.
2. If in the patient with a sepsis there is a clinic of a respiratory distress
syndrome – it testifies about:
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
A. Metastatic pneumonia.
B. Multiple organ failure.
C. A septic shock.
D. A syndrome of the systemic inflammatory answer.
E. An abscess of lung.
3. Name one of early diagnostic attributes of an osteal tuberculosis:
A. A throbbing pain;
B. The expressed inflammatory reaction;
C. A high body temperature;
D. Inexplicable occurrence of an exudate in a joint;
E. An intoxication, a fever.
4. What methods of operative treatment apply at tuberculosis of bones and
joints?
A. Punctures and disclosings of abscesses;
B. Economical resections of joints;
C. Resections in borders of healthy tissues;
D. Amputation;
E. All above-enumerated.
Real-life situations to be solved:
5. The patient was operated concerning a perforated ulcer of a stomach. A
terminal phase of general peritonitis and endotoxic shock are determined. In
the postoperative period artificial ventilation of lungs with an inhalation of
60 % Oxygenium performed. Blood gases will be carried out: ÐÎ2 = 70-78
mm.water column, the hypoxia does not decrease, the central venous
pressure is 150-180 mm. water column., arterial pressure is 90/60 m.Hg (on
a background of application of the big doses of Dofaminum). On a
roentgenogram diffuse infiltration of lungs. What reason of a proof arterial
anoxemia?
6. At patient R., 45 years old, that is treated concerning a pancreatonecrosis on
the basis of the clinical and microbiological data the diagnosis of
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
complication of a basic disease is fixed: "Sepsis". At a bacteriological blood
analysis Proteus mirubilis is sown. What variant of antibacterial therapy in
this case will be the best?
LIX. Answers to the Self-Assessment:
1.
2.
3.
4.
5.
6.
E;
B;
D;
E;
Respiratory distress.
Therapy by tienam.
LX. References:
Essential reading:
41.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
42.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
43.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
44.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
45.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
21.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
LXI. Students’ Practical Activities:

9.00 - 12.00
Theme 1. A general purulent infection (sepsis).
 Work 1. To determine diagnostic criteria of a sepsis.
 Work 2. To make the program of treatment of a sepsis.
Theme 2. An endogenic intoxication at an acute surgical infection.
 Work 3. To make the program desintoxication at a generalized
purulent infection.
 Work 4. To develop the circuit of treatment of a furuncle at AIDSpatient.
Theme 3. Chronic specific surgical diseases.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 5. To make the program of diagnostics and treatment of an
articular tuberculosis.
 Work 6. To make the program of diagnostics and treatment of an
actinomycosis.
LXII. Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
LXIII.
The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 Modern regulations about a sepsis, classification, pathogenetic features of
course of a sepsis.
 Modern methods of diagnostics of a sepsis.
 Modern methods of treatment of a sepsis.
 Displays of an endogenic intoxication at a surgical infection.
 Methods of desintoxication and immunecorrection.
 Surgical aspects of AIDS and a narcomania.
 An etiology, a clinical picture, diagnostics and treatment of a tuberculosis.
 An etiology, a clinical picture, diagnostics and treatment of an
actinomycosis.
Students should be able to:
 To carry out diagnostics of an osteal tuberculosis on roentgenograms.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 10 for 3rd – year students of the medical
faculty
THEME:
1. Practical skills of work in a polyclinic.
2. Tumours.
3. Examination of the surgical patients. A spelling of a case history.
AIM: To teach the general principles of the organization of rendering of an
ambulatory care to the population. To study frame and a fuctioning of surgical
department, surgical room of a polyclinic, the organization of a domiciliary care,
dispensary method of the account and treatment, feature of work of the surgeon of
a polyclinic and to fill in the necessary documentation.
To receive modern representations about an etiology and a pathogeny of
malignant tumours, main principles of the organization of oncologic service; to
learn to tap signs of malignant and denign tumours and to estimate their value.
PROFESSIONAL MOTIVATION: Steady ascending of malignant tumours
worldwide which ascertain during XX century, predetermines topical character of a
problem of well-timed diagnostics and adequate treatment of neoplasms. In
Ukraine their growtht is connected to the received and expected consequences of
Chernobyl accident.
The case history (medical card of the inpatient) is an official document
which displays the clinical diagnosis, a condition of the patient, dynamics of the
disease, given clinical inspection, additional methods of research, conservative
volume of treatment, a technique of surgical treatment and its result.
It is the registration form of the medical documentation and is object of
clinical and scientific research. Besides the case history has the important legal
value.
Student's, or the academic case history consists practically of the same
sections, as well as official, however is adapted to the program, in this case the
general surgery with precisely outlined by the purpose and tasks. The third year
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
student should develop the first, basic habits on inspection of the patient with
surgical pathology and acquire key rules of a spelling of a case history.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
LXIV.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. Practical skills of work in a polyclinic.
1. Frame of consulting surgical room of a polyclinic
2. Bases of conducting out-patient reception hours of surgical patients.
3. Diagnostic and medical procedures in consulting surgical room of a
polyclinic.
Theme 2. Tumours.
Classification of tumours and clinical groups of oncologic patients.
The international classification of tumours.
Differential diagnostics of malignant and benign tumours.
A clinical picture of tumours of various localization.
Modern methods of diagnostics and treatment of tumours.
Theme 3. Examination of the surgical patients. A spelling of a case history.
1. Studying the given additional methods of examination of patients.
2. Entering the data in a case history.
3. Mounting a case history.
LXV. Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. Who should be informed about the fixed diagnosis, when the doctor of a
polyclinic the postinfectious abscess is diagnosed?
A. To the head physician.
B. To the assistant to the head physician on medical work.
C. To the manager of department.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
D. To the district doctor.
E. To sanitary-and-epidemiologic institution.
2. What kind of sterilization don’t used at present time?
A. Sterilization in an autoclave.
B. Sterilization by boiling.
C. Sterilization by gamma-rays.
D. Sterilization in dry-hot safe.
E. Sterilization in steams of Formalinum.
3. To benign tumours concerns:
A. A melanoblastoma.
B. A fibroma.
C. A sarcoma.
D. A cancer.
E. All set forth above.
4. The sign of fluctuation specifies presence:
A. An abscess;
B. An infiltrate;
C. Tumours;
D. Air;
E. Inflammations.
Real-life situations to be solved:
5. The patient it is directed in oncologic dispensary with suspicion on a
carcinoma of the stomach.
What methods of inspection are necessary for applying?
6. At cytologic research of an enlarged axillary lymph node the answer is: cells
of malignant growth. What your tactics?
LXVI.
1.
2.
3.
4.
Answers to the Self-Assessment:
E;
B;
B;
A;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
5. Fiber-optic endoscopy with a biopsy of a suspicious site.
6. The patient is subject to complex inspection in conditions of an oncologic
clinic.
LXVII.
References:
Essential reading:
46.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
47.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
48.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
49.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
50.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
22.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
23.Polskaya L.V. Nursing procedures in therapeutic practice.- Simpheropol,
Universum, 2004.- 192 p.
LXVIII.

Students’ Practical Activities:
9.00 - 12.00
Theme 1. Practical skills of work in a polyclinic.
 Work 1. To learn frame of surgical department of a polyclinic
 Work 2. To learn bases of conducting outpatient reception hours of surgical
patients.
 Work 3. To carry out diagnostic and medical procedures in surgical
department of a polyclinic.
Theme 2. Tumours.
 Work 4. To carry out differential diagnostics of malignant and benign
growth of tumours.
 Work 5. To develop the circuit of treatment of malignant tumours of
various localization.
 Work 6. To develop the circuit of an aftertreatment of patients after radical
treatment of malignant tumours.
Theme 3. Examination of the surgical patients. A spelling of a case history.
 Work 7. To teach the data of additional methods of examination of
patients.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 8. Entering of the data in a case history.
 Work 9. Mounting of a case history.
LXIX.
Seminar Discussion Of Theoretical Questions And Practical Work:
 12.30 - 14.00
LXX. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 Frame of surgical department of a polyclinic
 Bases of conducting outpatient reception hours of surgical patients.
 Diagnostic and medical procedures in surgical department of a polyclinic.
 Classification of tumours and clinical groups of oncologic patients.
 The international classification of tumours.
 Differential diagnostics of malignant and benign growth.
 A clinical picture of tumours of various localization.
 Modern methods of diagnostics and treatment of tumours.
 Studying the given additional methods of examination of patients.
 Entering the data in a case history.
 Mounting a case history.
Students should be able to:
 To make the program of diagnostics and treatment of out-patient surgical
patients.
 To make the program of diagnostics and treatment of patients with tumours
of different localization.
 To issue a case history.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 11 for 3rd – year students of the medical
faculty (6 hours + 1 hour of independent student’s work)
THEME:
1. A technique of examination of surgical patients: a head, a neck and a thorax.
2. A technique of inspection of surgical patients: an abdomen, a locomotorium.
3. Examination of the surgical patients.
4. Independent work of students: Prophylaxis of tetanus.
AIM: To be able to carry out clinical examination of surgical patients and to write
the academic case history.
PROFESSIONAL MOTIVATION: Practical class according examination of the
surgical patient and to a spelling of the academic case history is a result training of
the student on faculty of the general surgery. During practical classes according
examination of the surgical patient the student in practice applies practical habits,
knowledge and skill from inspection of the surgical patient with statement of the
clinical diagnosis. Makes algorithm of diagnostic search, determines main
principles of conservative and surgical treatment of the patient.
The case history (medical card of the inpatient) is an official document
which displays the clinical diagnosis, a condition of the patient, dynamics of the
disease, given clinical inspection, additional research receptions, character of
volume conservative and a technique of surgical treatment, and also its result.
It is the registration form of the medical documentation and is object of
clinical and scientific research. Besides the case history has the important legal
value.
Student's, or the academic case history consists practically of the same
sections, as official, however is adapted to the program, in this case - the general
surgery, with precisely outlined by the purpose and tasks. The 3rd year student
should develop the first, basic habits on inspection of the patient with a surgical
pathology and acquire key rules of a spelling of a case history.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
LXXI.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
Theme 1. A technique of examination of surgical patients: a head, a neck and a
thorax.
1. A technique of the collecting of an anamnesis.
2. Objective inspection of a head.
3. Objective inspection of a neck.
4. Objective inspection of a thorax.
Theme 2. A technique of inspection of surgical patients: an abdomen, a
locomotorium.
1. Objective inspection of an abdomen.
2. Objective inspection of a locomotorium.
3. Measuring absolute and relative length of extremities.
Theme 3. Examination of the surgical patients.
1. Collecting complaints, an anamnesis of the disease and life.
2. Objective inspection of the patient.
4. Entering the data in the educational form of a case history.
LXXII.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. The sign of fluctuation specifies presence:
A. An abscess;
B. An infiltrate;
C. Tumours;
D. Air;
E. Inflammations.
2. Complications in an anamnesis during a hemotransfusion concerns to:
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
A. An anamnesis of illness;
B. An anamnesis of life;
C. A transfusion anamnesis;
D. An allergic anamnesis;
E. A passport data.
3. Specify a correct sequence of methods of objective inspection:
A. A percussion, a palpation, physical examination, auscultation;
B. Auscultation, physical examination, a palpation, a percussion;
C. Gaugings, physical examination, a palpation, auscultation;
D. Survey, a palpation, a percussion, auscultation;
E. A percussion, physical examination, auscultation, a palpation.
4. As the hemotransfusion in a case history is documented:
A. A mark in a leaf of assignments;
B. A mark in a narcotic card;
C. Record in a card of observation;
D. In a diary of the doctor;
E. The separate report.
5. As act with a case history after discharge of the patient from a hospital:
A. Give the patient on arms;
B. Destroy;
C. Keep at branch manager;
D. Keep at the head physician;
E. Shelve.
Real-life situations to be solved:
6. The peritoneal cavity has two floors: the upper and lower. What is the border
between them?
LXXIII.
Answers to the Self-Assessment:
1. A;
2. C;
3. D;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
4. E;
5. E;
6. It is mesentery of transverse colon.
LXXIV.
References:
Essential reading:
1. Methods of examination of the surgical patient /Edited by prof. M.A.Lyapis.Ternopil: Ukrmedknyga.-2004.- 167p.
13.
Gostishchev V.K. General surgery /The manual. – M.: GEOTARMED, 2003. – 220p.
14.
Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
Butyrsky A. General surgery /The manual.- Simpheropol: publishers CGMU,
2004.- 478 p.
Further reading:
24.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
LXXV.

Students’ Practical Activities:
9.00 - 12.00
Theme 1. A technique of examination of surgical patients: a head, a neck and a
thorax.
 Work 1. To carry out the collecting of an anamnesis.
 Work 2. To carry out objective inspection of a head and a neck.
 Work 3. To carry out objective inspection of a thorax.
Theme 2. A technique of inspection of surgical patients: an abdomen, a
locomotorium.
 Work 4. To carry out objective inspection of abdomen.
 Work 5. To carry out objective inspection of a locomotorium.
 Work 6. Measuring of absolute and relative length of extremities.
Theme 3. Examination of the surgical patients.
 Work 7. To carry out collecting complaints, an anamnesis of disease and
life.
 Work 8. To carry out objective inspection of the patient.
 Work 9. To bring the data in the educational form of a case history.
LXXVI.
Seminar Discussion Of Theoretical Questions And Practical Work:

12.30 - 14.00
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
LXXVII.
The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 A technique of the collecting of an anamnesis.
 Objective inspection of a head.
 Objective inspection of a neck.
 Objective inspection of a thorax.
 Objective inspection of abdomen.
 Objective inspection of a locomotorium.
 A technique of measuring of absolute and relative length of extremities.
 The collecting of complaints, an anamnesis of disease and life.
 Objective inspection of the patient.
 Rules of entering of the data in the educational form of a case history.
Students should be able to:
 To collect an anamnesis.
 To carry out objective inspection of a head.
 To carry out objective inspection of a neck.
 To carry out objective inspection of a thoracal cell.
 To carry out objective inspection of a stomach.
 To carry out objective inspection of a locomotorium.
 To measure absolute and relative lengths of extremities.
 To collect complaints, an anamnesis of disease and life.
 To carry out objective inspection of the patient.
 To bring the data in educational the form of a case history.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Methodological Instruction to Lesson No 12 for 3rd - year students of the medical
faculty
THEME:
4. Necrosis. The reasons and conditions of development. A clinical picture.
Diagnostics, treatment. Separate kinds of necrosis (a gangrene, ulcers,
fistulas). A clinical picture. Treatment. Prophylaxis.
5. Practical skills in operational block.
6. Protection of a case history.
AIM: To determine the basic clinical, laboratory, roentgenological, endoscopic
attributes of disease; to acquire algorithm and principles of diagnostics, treatment
of necrosis and ways of their prophylaxis.
To learn to behave in operational block and dressing rooms with the purpose
of prophylaxis of occurrence hospital infections.
PROFESSIONAL MOTIVATION: The doctrine about necrosis leaves far for
borders of surgery and finds the display in everyone without exception to clinical
discipline. In an organism of the person constantly there are processes of extinction
of cells and their neogenesis: peeling of skin' cells, an epithelium of the upper
respiratory ways, destruction of blood cells. Their place occupy new cells, and
function of bodies is not broken. Therefore the deep and correct comprehension of
an etiology, a pathogeny, questions of diagnostics and treatment of necrosises is a
key to successful struggle against many difficult diseases and allows in certain to
carry out a measure their prophylaxis.
Work of the medical personnel of a surgery block and dressing rooms should
be directed on prophylaxis of occurrence of an infection and faultless performance
of rules of an asepsis.
BASIC LEVEL:
STUDENTS’ INDEPENDENT STUDY PROGRAM
LXXVIII.
Objectives for Students’ Independent Studies
You should prepare for the practical class using the existing textbooks and
lectures. Special attention should be paid to the following:
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
Theme 1. Necrosis. The reasons and conditions of development. A clinical picture.
Diagnostics, treatment. Separate kinds of necrosis (a gangrene, ulcers, fistulas). A
clinical picture. Treatment. Prophylaxis.
1. To learn an etiology, a pathogeny and kinds of necrosis
2. A clinical picture, principles of diagnostics and treatment of necrosis.
3. An etiology, a pathogeny of separate kinds of necrosises. Clinic, diagnostics
and treatments of gangrenes, ulcers, fistulas.
Theme 2. Practical skills in operational block.
1. Principles of a structure and equipment of a surgery block.
2. The organization of work in operational block.
3. Functional duties of the medical personnel in operational block.
Theme 3. Protection of a case history.
1. Acquaintance with remarks of the teacher from a spelling of a medical card
of the inpatient.
LXXIX.
Tests and Assignments for Self – assessment
Multiple Choices.
Choose the correct answer/statement:
1. The indication to urgent surgical treatment of an acute thrombophlebitis of
superficial veins is:
A. Varicose disease.
B. Posttrombophlebitic syndrome.
C. Young age of patients.
D. Necrotic changes.
E. An acute ascending thrombophlebitis.
2. Trophic ulcers of a medial surface of the lower third of shin arise as
complication:
A. Obliterating atherosclerosis.
B. Obliterating endarteriitis.
C. Elephantiasises.
D. An acute thrombophlebitis.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
E. Varicose disease.
3. Symptoms of a transmissible ischemia is characteristic for:
A. Posttrombophlebitic syndrome.
B. An obliterating aterosclerosis.
C. An osteomyelitis of a femur.
D. Varicose disease.
E. Embolism of a femoral artery.
4. Violation of blood flow, damage of an intima and a hypercoagulation is a
triad of:
A. Bazedov.
B. Pirogov.
C. Virhov.
D. Rokitansky.
E. Erlih
Real-life situations to be solved:
5. Patient E., 56 years old, was operated concerning a fibromyoma of a uterus.
On the fourth day after operation there was a acute pain in a site of the right
lower extremity, a body temperature is 39° С. During examination the
expressed edema of foot, anticnemions and hips. The skin is intense,
morbidity on a course of deep veins.
Your diagnosis?
6. Patient N., 64 years, complains of a pain in gastrocnemius muscles at
walking through everyone of 200 meters. The pain ceases after a short-term
stopping.
How this sign refers to as?
LXXX.
1.
2.
3.
4.
5.
6.
Answers to the Self-Assessment:
E;
E;
B;
С;
Acute right-side ileofemural thrombosis.
Symptom of a transmissible lameness.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
LXXXI.
References:
Essential reading:
51.Gostishchev V.K. General surgery /The manual. – M.: GEOTAR-MED,
2003. – 220p.
52.Lectures prof. B.I. Dmitriev from Odessa State Medical University.
53.Surgery: Text-book for English medium medical students / S.I.
Shevchenko, O.A. Tonkoglas, I.M. Lodyana, R.S. Shevchenko. –
Kharkiv: KSMU, 2001. – 344p.
54.Kushnir R. Ya. General surgery /Lectures.- Ternopil, Ukrmedknyha,
2005.- 308 p.
55.Butyrsky A. General surgery /The manual.- Simpheropol: publishers
CGMU, 2004.- 478 p.
Further reading:
25.Oxford handbook of clinical surgery / Edited by G.R. Mc Latchie, D.J.
Leaper, 2002.- 930 p.
26.Clinical Nursing Skills and Techniques: basic, intermediate and
advanced. The C.V. Mosby Company, 1986.- 1296 p.
LXXXII.

Students’ Practical Activities:
9.00 - 12.00
Theme 1. Necrosis. The reasons and conditions of development. A clinical picture.
Diagnostics, treatment. Separate kinds of necrosis (a gangrene, ulcers, fistulas). A
clinical picture. Treatment. Prophylaxis.
 Work 1. To make the individual circuit of diagnostic search, to analyse
results of objective research. To determine a role and a place of laboratory
and instrumental diagnostics in formation of the diagnosis.

Work 2. To plan and prove the plan of individual treatment;
 Work 3. To offer the basic methods of prophylaxis of occurrence of
necrosis.
Theme 2. Practical skills in operational block.
 Work 4. To familiarize with accommodation, frame and equipment of
operational block.
 Work 5. To familiarize with bases of sanitary - hygienic regimen.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 Work 6. To acquire a complex of the sanitary-hygienic actions directed on
revealing and isolation of a source of an infection and the prevention of its
hit in operational block.
Theme 3. Protection of a case history.
 Work 7. To carry out interpreting the clinical, laboratory and instrumental
data of the supervised patient. To prove his clinical diagnosis and
treatment.
LXXXIII.

Seminar Discussion Of Theoretical Questions And Practical Work:
12.30 - 14.00
LXXXIV. The initial level of knowledge and skills is checked by the decision of
situational problems (tasks) from each theme, answers to tests such as
"Step", constructive questions etc.

14.15 - 15.00
Students must know:
 Concept about necrosis.
 Kind of necrosis.
 Concept about lymphostasis.
 Concept about alternating lameness?
 Classification of acute arterial insufficiency (accorfing to V.S.Saveljev).
 Classification of chronic arterial insufficiency (by V.T.Zajtsev).
 Classification of chronic venous insufficiency (by M.I.Kuzin).
 Classification of lymphostasis accorfing to N.F. Driuk.
 The basic differences of humid and dry gangrene.
 Concept about fistula.
 Concept about stoma.
 Concept about exzogenic decubitus.
Students should be able to:
 to make the individual circuit of diagnostic search;
 to analyse results of objective research;
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc
General Surgery Department
 to determine a role and a place of laboratory-instrumental diagnostics in
formation of the diagnosis;
 to plan and prove the plan of individual treatment;
 to offer the basic methods of prophylaxis of occurrence of necrosises.
 to carry out wet cleaning operational and dressing rooms;
 to carry out the control of quality of cleaning of a surgery block;
 to prepare toolkit for sterilization.
 to prepare a little table for instruments and a dressing material;
 to assist during dressings;
 to perform work of the dressing-room nurse.
© Prof Fedir G Kulachek MD, PhD, Prof Ruslan I Sydorchuk MD, PhD and Dr Ruslan P Knut MD, MSc