Program of Medicine Studies
MODULE
PROFESSIONAL COMPETENCE
Third Year
Six'th Semester
Faculty of Medicine
Kaunas University of Medicine
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Table of Contents
1. General information...............................................................................................................................4
2. General content of the module...............................................................................................................4
3. Aim and objectives of the module..........................................................................................................5
3.1. General surgery...................................................................................................................................5
3.2.Diagnostics of Internal Diseases..........................................................................................................5
4. Departments, aims and objectives of the course....................................................................................7
4.1. Clinic of General Surgery...................................................................................................................7
4.2. Clinics of Internal Diseases...............................................................................................................13
5. Lectures................................................................................................................................................15
5.1. Asepsis and antisepsis (2 hours)........................................................................................................15
5.2. Principles of examination of the surgical patient (2 hours). ............................................................15
5.3. Preoperative period. Operation (2 hours)..........................................................................................15
5.4. Postoperative period (2 hours)..........................................................................................................16
5.5. Nutrition of surgical patients (2 hours).............................................................................................16
5.6. Acute wounds (2 hours)....................................................................................................................17
5.7. Chronic wounds. Fistula. (2 hours)...................................................................................................17
5.8. General examination of the patient (2 hours)....................................................................................17
5.9. Clinical examination of patients with respiratory diseases (2 hours)..............................................17
5.10. Clinical examination of patients with cardiovascular diseases (2 hours).......................................18
5.11. Auscultation of the heart(I) (2 hours)..............................................................................................18
5.12. Auscultation of the heart (II) (3 hours)..........................................................................................18
5.13. Clinical ECG estimation (I) (2 hours).............................................................................................18
5.14. Clinical ECG estimation (II) (2 hours)...........................................................................................18
5.15. Clinical examination of patients with gastrointestinal diseases (2 hours)......................................19
5.16. Clinical examination of patients with diseases of hematopoietic system (2 hours).......................19
5.17. Clinical examination of patients with diseases of endocrine system (2 hours)...............................19
5.12. Auscultation of the heart (II) (3 hours)..........................................................................................19
5.13. Clinical ECG estimation (I) (2 hours).............................................................................................20
5.14. Clinical ECG estimation (II) (2 hours)...........................................................................................20
5.15. Clinical examination of patients with gastrointestinal diseases (2 hours)......................................20
5.16. Clinical examination of patients with diseases of hematopoietic system (2 hours).......................20
5.17. Clinical examination of patients with diseases of endocrine system (2 hours)...............................21
5.18. Preparation of hands for injections. Intradermal, subdermal injections. Injections into muscles,
veins, infusions, taking of blood sample with vacuum system. Heparin injections.................................21
6. Practicals..............................................................................................................................................22
6.1.Medical asepsis (3 hours)...................................................................................................................22
6.2. Surgical asepsis (3 hours)..................................................................................................................23
6.3. Preoperative preparation of surgeon and the operative field (3 hours).............................................24
6.4. Antisepsis. (3 hours)..........................................................................................................................24
6.5. Clinical examination of the surgical patient (3 hours)......................................................................25
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6.6. Laboratory, instrumental, radiological and diagnostic investigation methods in surgery. (3 hours) 25
6.7. Preoperative preparation of the surgical patient (3 hours)................................................................26
6.8. Energy and other requirements of the surgical patients. Nutrition (3 hours)....................................26
6.9. Operation (3 hours)...........................................................................................................................26
6.10. Postoperative period (3 hours)........................................................................................................27
6.11. Wounds (3 hours)............................................................................................................................28
6.12. Trophic ulcers and fistulas. Stomas. (3 hours)................................................................................28
6.13. Modern wound dressings (3 hours).................................................................................................29
6.14. General examination of the patient: interview, general inspection, palpation................................29
6.15. Examination of patients with respiratory diseases: interview, inspection, palpation, percussion,
auscultation..............................................................................................................................................30
6.16. Examination of patients with cardiovascular diseases: interview, inspection, palpation, percussion.
Examination of blood vessels..................................................................................................................30
6.17. Auscultation of the heart (norm).....................................................................................................31
6.18. Murmurs..........................................................................................................................................31
6.19. Clinical ECG estimation (I)...........................................................................................................31
6.20. Examination of patients with diseases of gastrointestinal and hepatobiliary system: interview,
inspection, auscultation, percussion, palpation........................................................................................32
6.21. Clinical ECG estimation (II)..........................................................................................................32
6.22. Examination of patients with diseases of hematopoietic system and urinary system.....................33
6.23. Examination of patients with diseases of endocrine and musculoskeletal system..........................33
6.24. Preparation of hands for injections. Intradermal and subdermal injections. Injections of insulin..33
6.25. Injections into muscles, veins, infusions. Taking of blood samples with vacuum system, bacteplus
system. Calculation of infusion speed......................................................................................................34
7. Seminars...............................................................................................................................................35
8. Examination program...........................................................................................................................36
8.1. General surgery ................................................................................................................................36
8.2. Essentials of Diagnosis in Internal Diseases.....................................................................................39
8.3. General surgery practical skills.........................................................................................................40
8.4. Diagnosis of Syndromes: Practical tasks.........................................................................................41
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1. General information
Supervisors of the module:
Departments
Clinics of Internal Diseases prof.habil.dr.A.Naudžiūnas (vidausligos@kmu.lt)
Clinic of General Surgery prof. Dr. Donatas Venskutonis
(donatas.venskutonis@kmu.lt)
Department of Nursing
Subject matters and teachers in-charge
Diagnostics of Internal Diseases assoc.prof.dr.P.Leišytė (pleisyte@gmail.com)
General Surgery lect. Dr. Juozas Juočas (j.juocas@gmail.com)
Clinical nursing
2. General content of the module
Analyzing the problems of this module the students gain new knowledge and apply it to the following
domains:
1.
Antisepsis and asepsis.
2.
Clinical examination of the surgical patient.
3.
Preoperative period.
4.
Operation.
5.
Postoperative period.
6.
Acute wounds.
7.
Chronic wounds, fistulas.
8.
Modern wound dressings.
9.
Disorders of tissue microcirculation.
10.
Artificial nutrition.
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11.
General examination of the patient.
12.
Examination of the patients with respiratory diseases.
13.
Examination of patients with cardiovascular diseases.
14.
Examination of patients with digestive and hepatobiliary diseases.
15.
Examination of patients with urinary diseases.
16.
Examination of patients with endocrine diseases.
17.
Examination of patients with diseases of hematopoetic system.
18.
Examination of patients with diseases of musculoskeletal system.
3. Aim and objectives of the module
3.1. General surgery
Aim:
The aim is to help the students to get the knowledge of the following items of General surgery:
essentials of General surgery, introduction to clinical and outpatient surgery, clinical signs of main
diseases, principles of diagnostics and management. This knowledge is important for further study of
the clinical modules.
Purposes
Questions which are analyzed in the module of essentials of General surgery are important not only to
the future surgeons but also to the doctors of other specialties. The purposes are to teach the students
the ABC‘s of surgery, to introduce to the general questions of surgery: asepsis and antisepsis, wound
healing and postoperative complications and the ways of solution: examination of the patients,
preoperative preparation, principles of surgical management.
3.2.Diagnostics of Internal Diseases
The aim:
to get the knowledge on main principles of diagnosis of internal diseases.
The purposes:
to teach students interviewing and the main methods of physical examination of patients with
respiratory, cardiovascular, digestive, hepatobiliary, urinary, endocrine, musculoskeletal, hematopoietic
diseases; to get knowledge on laboratory signs of internal diseases.
Clinical skills (physical and laboratory diagnosis of syndromes):
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1.Pulmonary consolidation.
2.Cavity in the lung.
3.Increased airiness in the lung.
4.Fluid accumulation in the pleural cavity.
5.Air accumulation in the lung.
6.Irritation of the airways (bronchitis).
7.Acute respiratory failure.
8.Chronic respiratory failure.
9.Mitral stenosis.
10.Mitral regurgitation.
11.Arrhythmia syndrome.
12.Aortic stenosis.
13.Aortic regurgitation.
14.Arterial hypertension.
15.Pulmonary hypertension.
16.Chronic right heart failure.
17.Chronic left heart failure.
18.Acute heart failure.
19.Syndrome of abdominal pain, dyspepsia and gastrointestinal bleeding.
20.Liver disorder.
21.Hemorrhagic syndrome.
22.Anemia syndrome.
23.Hyperthyroidism.
24.Hypoglycemia, hyperglycemia syndromes.
25.Renal disorder.
26.Arthropathic syndrome.
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4. Departments, aims and objectives of the course
4.1. Clinic of General Surgery
Study content. Herein questions of antisepsis and asepsis are discussed. Principles, ways and methods
of investigation of patient, also endoscopic and ultrasound investigation methods are analyzed.
Questions of the preoperative preparation, preoperative and postoperative period, risk of operation,
postoperative complications, their prevention and principles of management are discussed. Students are
introduced to the soft tissue injury, methods of wound assessment, and principles of treatment. Fistulas,
ulcers, necroses, their causes and principles of surgical management are discussed. Significance of
nutrition of the patient, methods and possibilities of artificial nutrition, indications, contraindications
and complications of artificial nutrition are presented. The focus is put on methodology of
investigation, diagnostics of disorder, principles of management and prevention.
Aim of this issue is to formulate the tasks of General surgery for the students. Questions in the
program are marked differently considering the teaching requirements (can, know or get acquainted):
simple text formatting, bold text or Italian text formatting.
It is very important that students studying the discipline of General surgery learn the correct clinical
examination of patients and develop their practical skills in surgical care and procedures. Therefore
additional tasks of clinical examination and practical skills are created. The learned technique of
clinical examination and ability to assess the obtained results will be evaluated during the practical
examination.
Some main purposes of the program (hemostasis, intensive care, essentials of traumatology, surgical
infection, local anesthesia) and a part of content (causes of bleeding, hemostasis, assessment and
correction of hemostasis, possibilities of use of hemocorrectors, investigation of an injured patient,
surgical infection, local anesthesia) are moved to other second and third year modules.
• Antisepsis and Asepsis
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Medical asepsis: definition, basic principles of medical asepsis. Hand hygiene of the health care
workers. Hygienic hand wash: purpose, methods and ways. Medical gloves: types,
indicatios for use. Types: sterile surgical, single-use examination, utility gloves.
Indications for use.
Use of infection prevention barriers for health care workers and patients: masks, caps, protective eye
and/or facial wear, clothing, footwear. Indications, rules of use.
Cleaning of the surgical department. Conception of “cleaning” and “decontamination”. Cleaning of
common and patient care areas, procedure rooms, nursing devices. Wound dressing rooms: purpose,
equipment requirements, specificity of cleaning.
Methods of infection control. Conceptions of decontamination, disinfection and sterilization. Physical,
chemical ,mechanical and biological methods of infection control.
Disinfection: definition, levels and methods. Disinfection and antiseptic agents. Sterilization:
definition, methods, ways. Conception of sterilization. Methods of sterilization: physical, chemical,
mechanical, biological. Ways of sterilization: dry heat and steam, steam under high pressure, ionizing
and non-ionizing radiation, ultrasound, ethylene oxide gas, germicides, filtration and other. Stages of
disinfection and sterilization. Ways of decontamination and cleaning. Contamination control.
Sterilization of surgical instruments and equipment. Preparation for sterilization. Sterilization of optic
instruments. Ways and principles of sterilization of metallic, rubber, polymeric products, optical
equipment, operating and dressing material, surgical attire and medical devices. Types of currently used
sterilizing agents, principles of action, regimens. Ways of sterility control, storage of sterile items,
sterile shelf life. Perspectives, advantages and disadvantages of disposable medical items. Spaulding‘s
classification.
Methods of sterilization process and sterility control. Mechanical, chemical, biological and combined
methods. Markers of the modern biological sterility control. Transportation and storage of sterile items,
sterile shelf life.
Medical waste: types, hazards, storage and handling.
Surgical asepsis: definition, conception of “sterile” and “aseptic” technique. Basic principles of surgical
asepsis. Operating block. Principles of equipment of the operating theaters. Purposes of rooms of the
operating block. Staff of the operating unit, functions, outfit, work regulations. Combating infection in
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the operating theater. Asepsis in the operating theaters and wound dressing rooms. Principles of
equipment of the operating unit, dressing rooms, movement directions of staff and patients. Work
regulations and responsibility of the staff. Sterility of the outfit of the operating room staff and the
surgical team, gowning regulations. Decontamination of the surgical instruments and linen, preparation
for reprocessing, monitoring the cleaning efficacy. Air quality control in the operating theater.
Ventilation and heating systems. Requirements for outfit of the staff, dressing of the staff. Work and
behavior regulations. Cleaning of the operating theater.
Hand hygiene requirements for the surgeon and the operating room nurse. Ways of hand preparation
before the surgical operation. Principles of hand scrubbing: mechanical, physical and chemical ways,
sterility control. Modern surgical gloves. Purposes of use. Glove types. Gloving procedures.
Masks, caps, footwear, outfit, protective eye and/or facial wear used in the operating theater:
requirements, properties, rules for use. Impregnated outfit. Pinafore.
Preparation and isolation of the operative field. Sterility signs and borders of the draped area.
Preparation principles of the operative field, isolation, antiseptic solutions, protectors.
Asepsis during the operation.
Antiseptic and disinfection agents. Groups and scope of use. Antibiotic groups and agents, activity in
case of different surgical infections. Preventive, impact and maintenance doses.
Principles, aims, routes of administration of antibacterial therapy and possible
complications. Mechanisms of resistance in microorganisms, importance in surgery.
Hospital infection: definition, prevention, clinical forms, ways of contracting, ways of
combating infection. Asepsis and antisepsis in the practice of general practitioner and
surgeon in the outpatient setting.
•
Clinical examination of the surgical patient.
Examination of patients: purpose, ways, sequence.
Subjective examination of the surgical patient: inquiry. Physical examination of the surgical patient:
inspection, auscultation, percussion, superficial and deep palpation, anthropometry, assessment of these
examinations. Specific symptoms. Gynecological examination. Laboratory, radiological and
instrumental investigations. Types of modern ultrasound and endoscopy investigation methods,
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diagnostic possibilities and perspectives in surgical diseases. Invasive and non-invasive examination
methods. Special surgical examination methods, significance of biopsy in surgery.
Principles of examination of patients with abdominal cavity, genitourinary tract, blood vessel and
lymphatic system diseases. Rectal examination: importance in the diagnostics of surgical diseases.
Examination of patient regarding the nature of disease and operation.
Case history of the surgical patient.
•
Preoperative period.
Preoperative period: definition, stages. Tasks of the diagnostic stage. Operative risk, influencing
factors. Assessment of the operative risk: significance for selection of mode of treatment. Preparatory
stage, influence on reduction of the operative risk. Principles and surveillance of the preoperative
preparation. Preoperative patient education: aim and essence.
Specificity of preoperative period in the outpatient setting.
•
Operation.
Operation: conception, classification. Conception of absolute and relative indications to operation.
Operation stages. Contemporary measures and methods of tissue dissection and restoration. Modern
suturing and implant materials: absorbable, non-absorbable, monofilament, braided, stranded synthetic
and natural sutures and meshes. Mechanical suturing devices. Significance of tissue traumatism,
microcirculation disturbances and hemostasis during the operation. Prevention measures of the
operative wound contamination. Drainage of wounds and cavities: indications, ways and complications.
Types of drains. Dangers for the patient in the operating theater, security measures.
•
Postoperative period.
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Postoperative period, body response to operation (trauma), phases. Clinical signs of the postoperative disease. Principles of postoperative management. Pain care. Operative wound care. Operative
wound complications, causes, prevention and principles of management. Prevention of operative
wound suppuration.
Postoperative complications of cardiovascular, pulmonary, urinary tract and digestive tract,
prevention, principles of management. Thromboembolism: prevention, management.
Postoperative care of cardiovascular, pulmonary, urinary tract and digestive tract systems.
Significance of temperature, pulse, body weight changes and diuresis control in the postoperative
period. Care of skin, mucous membranes and mouth in the postoperative period. Prevention of bed
sources.
•
Acute wounds.
Wounds: definition, signs and types. Wound healing: characteristics of stages, ways. First aid for
wounds. Management of fresh contaminated wounds, primary wound closure. Signs of poisonous
wounds and poisonous bites, principles of management. Gun shot wounds. Wound complications and
prevention. Tetanus, rabies: signs, preventive measures.
•
Chronic wounds, fistulas. Disorders of tissue microcirculation.
Chronic wound: conception, etiology. Contemporary principles and methods of chronic wound
healing.
Pressure sources: causes, prevention and management. Trophic ulcers: etiology, classification,
signs, principles of management.
Fistulas: definition, etiology, classification. Fistulas of digestive tract, airways, urinary tract,
artificial stomas. Problems of management and care of patients with fistulas. Specificity of nursing.
Tissue necrosis (gangrene): forms, causes.
Acute causes of arterial and venous occlusion: signs, first aid and management. Causes of chronic
arterial blood flow insufficiency (atherosclerosis, endarteritis, diabetic angiopathy, Raynaud‘s disease):
signs, diagnosis, prevention, nursing, principles of management. Diabetic angiopathies. „Diabetic
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foot“: definition, clinical signs, nursing, principles of management.
Superficial vein varicose, phlebitis and thrombophlebitis. Etiology, pathogenesis, clinical signs and
nursing measures. Deep vein thrombosis: symptoms, complications, prevention, principles of
management, nursing.
•
Modern wound dressings.
Modern wound dressing materials. Requirements of the modern wound dressings. Dressing types and
ways of dressing wounds. Gauze dressings. Non-woven, hydrocolloid, silicone,
polyurethane, alginate dressings. Biological dressings and skin substitutes. Antiseptic
wound dressings. Topical agents for local wound management. Wound dressings
promoting autolysis, granulation and epithelialization.
Special modern wound dressings, wound packs, elastic wound dressings, zinc gelatin wound dressings.
Corsets, suspensors, belts.
•
Artificial nutrition.
Principles of feeding. Energy stores in the body, consumption, catabolism, energy requirements under
normal and pathologic conditions. Nutrition disorders: types, causes, methods of assessment. Enteral
and parenteral feeding: indications, ways of feeding, complications. Nutrients and equipment for
enteral tube feeding. Enteral and parenteral feeding on an outpatient basis and at home.
Clinical skills:
Practical skills:
1.
Surgical hand antisepsis.
2.
Gowning and gloving procedures.
3.
Palpation of peripheral arteries.
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4.
Removal of sutures from a wound.
5.
Dressing an aseptic wound.
6.
Dressing a suppurative wound.
7.
Removal of sutures.
8.
Insertion of gastric tube.
9.
Insertion of the urinary catheter.
4.2. Clinics of Internal Diseases
General examination of the patient:
Subjective examination (complaints, disease history, medical history, family history, social history).
General examination (consciousness, posture,
layer,lymphnodes, anthropometry, thermometry).
gait,
face,
skin,
nails,
hair,
subcutaneous
Respiratory system:
Interview, general inspection, special inspection, palpation, comparative and topographic percussion,
auscultation. Main symptoms, detected during examination and their clinical meanings.
Cardiovascular system:
Interview, general inspection, special inspection, palpation, percussion, auscultation. Blood pressure
measurement, ECG estimation. Main symptoms, detected during examination and their clinical
meanings.
Digestive system:
Interview, general inspection, special inspection, auscultation, percussion, superficial and deep
palpation. Laboratory examination. Main symptoms, detected during examination and their clinical
meanings. Clinical syndromes (abdominal pain, dyspepsia, GERD, irritable bowel).
Hepatobiliary system:
Interview, general inspection, special inspection, percussion (liver, spleen, ascites), palpation (liver,
spleen, ascites). Laboratory examination. Main symptoms, detected during examination and their
clinical meanings. Biochemical syndromes.
Urinary system:
Interview, general inspection, special inspection, percussion, palpation, auscultation. Main symptoms,
detected during examination and their clinical meanings.
Hematopoietic system:
„Interview, general inspection, special inspection, percussion, palpation, auscultation. Main symptoms,
detected during examination and their clinical meanings. Laboratory examination (RBC, WBC,
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hemostasis, biochemical examination, instrumental examination, Rumpel–Leede test).
Endocrine system:
Interview, general inspection, special inspection, palpation, auscultation. Antropometry.
symptoms, detected during examination and their clinical meanings.
Main
Musculoskeletal system:
Interview, general inspection, special inspection, palpation, auscultation. Clinical examination of
different joints, respiratory and cardiovascular systems. Main symptoms, detected during examination
and their clinical meanings.
Allergoses:
Interview, general inspection, special inspection, palpation, auscultation. Main symptoms, detected
during examination and their clinical meanings. Main laboratory tests in vivo and in vitro.
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5. Lectures
5.1. Asepsis and antisepsis (2 hours)
Clinics of General Surgery
In charge: lect. J. Juočas
Description
Introduction. Common traits. History. Types of modern antisepsis. Methods of antisepsis. Hand
antisepsis. Principles of surgical asepsis, behavior rules. Modern requirements for the operating theater,
surgeons and patients. Sterilization and disinfection: ways, methods, action. Chemicals. Assessment of
sterilization.
5.2. Principles of examination of the surgical patient (2 hours).
Clinics of General Surgery
In charge: dr. R. Šiugžda
Description
Aim. Purposes. Subjective examination. Anamnesis. Nonspecific symptoms and syndromes: pain,
dyspepsia, dyschesia and other, specific symptoms. Objective examination. Physical examination:
general examination, abdominal examination, laboratory investigations (morphologic, biochemical,
bacteriological, immunological, tumor markers). Instrumental, endoscopic, radiation diagnostic
investigations: radiologic, ultrasound, CT, MRI. Functional and physical investigation tests.
5.3. Preoperative period. Operation (2 hours).
Clinics of General Surgery
In charge: dr. R. Šiugžda
Description
Diagnostic stage: anamnesis, physical examination, laboratory, radiologic investigations. Preparatory
stage: skin and gastrointestinal preparation, diet, preparation of patient, premedication, prevention of
deep venous and pulmonary artery thrombosis, antibiotic prophylaxis, homeostasis correction.
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Mortality risk factors. Classification of physical status (ASA). Goldman‘s index. Preoperative epicrisis,
informed consent. Operation: stages, dangers, complications. Types of surgery and surgical operations:
urgency, risks, extent, aim, method, radicality, stages. Tissue dissection and restoration. Indications and
contraindications to operation.
5.4. Postoperative period (2 hours).
Clinics of General Surgery
In charge: dr. R. Šiugžda
Description
Postoperative period: purposes, course. Post anesthetic and postoperative ward. Postoperative
monitoring of consciousness, breathing, blood circulation, diuresis, temperature, tubes, catheters and
other means. Potential problems: pain, anxiety, nausea, vomiting, bloating, hiccough, fever, renal
function impairment, injuries related to the confusion of the patient, nutrition disorders and ways of
solution: pain care, anxiety relief, promotion of a normal urinary function, purgation (clean-up of
intestines), restoration of patient mobility, improvement of tissue perfusion and oxygenation,
maintenance of fluid balance. Prevention of operative wound, urogenital tract, blood and respiratory
tract infections. Postoperative complications: shock, bleeding, aspiration, deep vein thrombosis,
pulmonary artery thromboembolism, hypoxemia, fever, atelectasis, pneumonia, urinary retention,
bowel obstruction, wound dehiscence, postoperative psychosis.
5.5. Nutrition of surgical patients (2 hours)
Clinics of General Surgery
In charge: assoc. prof. S. Bradulskis
Description
Body structure and reserves: lipids, carbohydrates, proteins. Energy requirements and sources. Causes
and signs of malnutrition. Nutrition assessment. Artificial nutrition: benefits, indications. Types of
nutrition: oral, enteral, parenteral feeding. Types of feeding tubes, ways of insertion. Enteral feed. Ways
of feeding. Rules and conditions of use of enteral feeding mixtures. Complications of enteral feeding.
Parenteral feeding. Indications for parenteral nutrition. Ways of feeding. Conditions. Principles.
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Assessment of requirements. Parenteral feeding solutions. Monitoring. Complications of parenteral
feeding.
5.6. Acute wounds (2 hours)
Clinics of General Surgery
In charge: assoc. prof. S. Bradulskis
Description
Wound. Definition. Structure and function of the skin. Classification of wounds. Burns. Electric
trauma. First aid. Wound healing. Stages. Wound management. Principles of handling a wound. Moist
wound healing.
5.7. Chronic wounds. Fistula. (2 hours)
Clinics of General Surgery
In charge: assoc. prof. S. Bradulskis
Description
Ulcers (chronic wounds): facts, causes, essentials of examination, classification, principles of
treatment. Fistula: classification, etiology, complications, clinical signs, principles of treatment.
5.8. General examination of the patient (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
Description
Interview: complaints (groups, characteristics), disease history, medical history, family history, social
history, checking the systems. General inspection. Examination of lymhnodes.
5.9. Clinical examination of patients with respiratory diseases (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
17
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings.
5.10. Clinical examination of patients with cardiovascular diseases (2
hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira
Leišytė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion.
Main pathological signs and their clinical meanings.
5.11. Auscultation of the heart(I) (2 hours)
Clinics of Internal Diseases
In charge – Lect. D. E. Rekienė
. Areas of auscultation. Positions of auscultation. Sequence of auscultation. Normal sounds.
5.12. Auscultation of the heart (II) (3 hours)
Clinics of Internal Diseases
In charge – Lect. D. E. Rekienė
Description
Pathological sounds and their clinical meanings.
5.13. Clinical ECG estimation (I) (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Jankauskiene
Description
Pathological ECG: changes in rrhythm and conductance, IHD.
5.14. Clinical ECG estimation (II) (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Kalinauskiene
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Description
Pathological ECG: changes in rrhythm and conductance, IHD.
5.15. Clinical examination of patients with gastrointestinal diseases (2
hours)
Clinics of Internal Diseases
In charge – Asist. Edita Mašanauskienė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings.
5.16. Clinical examination of patients with diseases of hematopoietic
system (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings. Laboratory examination.
5.17. Clinical examination of patients with diseases of endocrine system (2
hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings.
Description
Technical aspects of auscultation. Areas of auscultation. Positions of auscultation. Sequence of
auscultation. Normal sounds.
5.12. Auscultation of the heart (II) (3 hours)
Clinics of Internal Diseases
In charge – Lect. D. E. Rekienė
Description
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Pathological sounds and their clinical meanings.
5.13. Clinical ECG estimation (I) (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Jankauskiene
Description
Pathological ECG: changes in rrhythm and conductance, IHD.
5.14. Clinical ECG estimation (II) (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Kalinauskiene
Description
Pathological ECG: changes in rrhythm and conductance, IHD.
5.15. Clinical examination of patients with gastrointestinal diseases (2
hours)
Clinics of Internal Diseases
In charge – Asist. Edita Mašanauskienė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings.
5.16. Clinical examination of patients with diseases of hematopoietic
system (2 hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings. Laboratory examination.
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5.17. Clinical examination of patients with diseases of endocrine system (2
hours)
Clinics of Internal Diseases
In charge – Assoc.prof. Palmira Leišytė
Description
Complaints, their characteristics, history aspects, general and special inspection, palpation, percussion,
auscultation. Main pathological signs and their clinical meanings.
5.18. Preparation of hands for injections. Intradermal, subdermal
injections. Injections into muscles, veins, infusions, taking of blood
sample with vacuum system. Heparin injections
Department of Nursing
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6. Practicals
6.1.Medical asepsis (3 hours)
Clinics of General Surgery
Definition of asepsis. Background, founders, importance in the surgical management. Viral asepsis.
Asepsis in the practice of general practitioner and surgeon in the outpatient setting.
Medical asepsis: definition, basic principles of medical asepsis. Chain of infection, ways of breaking
the chain of infection.
Hand hygiene of the health care workers. Hygienic hand wash: purpose, methods and ways.
Medical gloves: types, indications for use. Types: sterile surgical, single-use examination, utility
gloves. Indications for use.
Use of infection prevention barriers for health care workers and patients: masks, caps, protective eye
and/or facial wear, clothing, footwear. Indications, rules of use.
Cleaning of the surgical department. Conception of “cleaning” and “decontamination”. Cleaning of
common and patient care areas, procedure rooms, nursing devices. Wound dressing rooms: purpose,
equipment requirements, specificity of cleaning.
Methods of infection control. Conceptions of decontamination, disinfection and sterilization.
Physical, chemical, mechanical and biological methods of infection control.
Disinfection: definition, levels and methods. Disinfection and antiseptic agents. Methods of
sterilization: physical, chemical, mechanical, biological. Ways of sterilization: dry heat and steam,
steam under high pressure, ionizing and non-ionizing radiation, ultrasound, ethylene oxide gas,
germicides, filtration and other. Stages of disinfection and sterilization. Ways of decontamination and
cleaning. Contamination control. Sterilization of surgical instruments and equipment. Preparation for
sterilization. Ways and methods of sterilization. Sterilization of optic instruments. Ways and principles
of sterilization of metallic, rubber, polymeric products, optical equipment, operating and wound
dressing material, surgical attire and medical devices. Types of currently used sterilizing agents,
principles of action, regimens. Ways of sterility control, storage of sterile instruments and equipment,
sterile shelf life. Perspectives, advantages and disadvantages of disposable medical items. Spaulding‘s
22
classification.
Methods of sterilization process and sterility control. Mechanical, chemical, biological and combined
methods. Markers of the modern biological sterility control. Transportation and storage of sterile
materials, sterile shelf life.
Medical waste: types, hazards, storage and handling.
References:
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Textbook. Kaunas
University of Medicine press. 2006. p. 32-185
6.2. Surgical asepsis (3 hours)
Clinics of General Surgery
Surgical asepsis: definition, conception of “sterile” and “aseptic” technique. Basic principles of surgical
asepsis.
Operating block. Principles of equipment of the operating theaters. Purposes of rooms of the
operating block. Staff of the operating unit, functions, outfit, work regulations. Combating infection in
the operating theater. Asepsis in the operating theaters and wound dressing rooms. Principles of
equipment of the operating block, wound dressing rooms, traffic of staff and patients. Work regulations
and responsibility of the staff. Sterility of the outfit of the operating room staff and the surgical team,
gowning regulations. Cleaning of the operating theater. Decontamination of the surgical instruments
and linen, preparation for reprocessing, monitoring the cleaning efficacy.
Air quality control in the operating theater. Ventilation and heating systems. Requirements for outfit of
the staff, dressing of the staff. Work and behavior regulations. Cleaning of the operating theater.
Asepsis during the surgical operation.
References:
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Textbook. Kaunas
University of Medicine press. 2006. p. 250-261.
23
6.3. Preoperative preparation of surgeon and the operative field (3 hours)
Clinics of General Surgery
Masks, caps, footwear, outfit, protective eyewear and face shields used in the operating theater:
requirements, properties, rules for use. Impregnated outfit. Pinafore.
Hand hygiene requirements for the surgeon and the operating room nurse. Ways of hand preparation
before the surgical operation. Principles of hand scrubbing, mechanical, physical and chemical ways,
sterility control.
Modern surgical gloves. Purposes of use. Glove types. Gloving procedures.
Preparation and isolation of the operative field. Sterility signs and borders of the draped area.
Preparation principles of the operative field, isolation, antiseptic solutions, protectors.
References:
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Textbook. Kaunas
University of Medicine press. 2006. p. 185-250.
6.4. Antisepsis. (3 hours)
Clinics of General Surgery
Definition of antisepsis. Background, founders, importance in the surgical management. Types and
ways of antisepsis, historical and modern aspects. Antiseptic and disinfection agents.
Groups and scope of use. Antibiotic groups and agents, activity in case of different
surgical infections. Preventive, impact and maintenance doses. Principles, aims, routes of
administration of antibacterial therapy and possible complications. Mechanisms of
resistance in microorganisms, importance in surgery. Nosocomial infection: definition,
prevention, clinical forms, ways of contracting, ways of combating infection. Antisepsis
in the practice of general practitioner and surgeon in the outpatient setting.
References:
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Textbook. Kaunas
University of Medicine press. 2006. p. 261-331
24
6.5. Clinical examination of the surgical patient (3 hours).
Clinics of General Surgery
Examination of patients: purpose, ways, sequence.
Subjective examination of the surgical patient: inquiry. Physical examination of the surgical patient:
inspection, auscultation, percussion, superficial and deep palpation, anthropometry, assessment of these
examinations. Specific symptoms. Gynecological examination.
Principles of examination of patients with abdominal cavity, genitourinary tract, blood vessel and
lymphatic system diseases. Rectal examination: importance in the diagnostics of surgical diseases.
Examination of patient regarding the nature of disease and operation.
Case history of the surgical patient.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins,
p. 11-43
2.
Clinical Surgery second edition ed by M.M. Henry and J.N. Thomson 2004
6.6. Laboratory, instrumental, radiological and diagnostic investigation
methods in surgery. (3 hours)
Clinics of General Surgery
Laboratory, radiological and instrumental investigations. Types of modern ultrasound and endoscopy
diagnostic investigation methods, possibilities and perspectives in the diagnostics of surgical diseases.
Invasive (penetrative) and non-invasive (non-penetrative) investigation methods. Special surgical
examination methods, significance of biopsy in surgery.
References:
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins, 2006. p.
11-43.
25
6.7. Preoperative preparation of the surgical patient (3 hours)
Clinics of General Surgery
Preoperative period: definition, stages. Tasks of the diagnostic stage. Operative risk, influencing
factors. Assessment of the operative risk: significance for selection of mode of treatment. Preparatory
stage, influence on reduction of the operative risk. Principles and surveillance of the preoperative
preparation of the surgical patient. Preoperative patient education: aim and essence.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins;
p. 11-43
2.
Clinical Surgery second edition ed by M.M. Henry and J.N. Thomson 2004
6.8. Energy and other requirements of the surgical patients. Nutrition (3
hours)
Clinics of General Surgery
Principles of feeding of the patients. Energy stores in the body, consumption, catabolism, energy
requirements under normal and pathologic conditions. Nutrition disorders: types, causes, methods of
assessment. Enteral and parenteral feeding: indications, ways of feeding, complications. Nutrients and
equipment for the enteral tube feeding. Enteral and parenteral feeding on an outpatient basis and at
home.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins,
2006. p. 67-91.
2.
Schwartz S.I., Shires G.T., Spencer F.C. Principles of Surgery. McGraw-Hill, Inc. 1994. p.8092.
6.9. Operation (3 hours)
Clinics of General Surgery
26
Operation: definition, classification. Definition of absolute and relative indications to operation.
Operation stages. Contemporary measures for tissue dissection and restoration. Modern suturing and
implant materials: absorbable, non-absorbable, monofilament, braided, stranded synthetic and natural
sutures and meshes. Mechanical suturing devices. Significance of tissue traumatism, microcirculation
disturbances and hemostasis during the operation. Preventive measures of the operative wound
contamination. Drainage of wounds and cavities: indications, ways and complications. Types of drains.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins;
p. 11-43
2.
Clinical Surgery second edition ed by M.M. Henry and J.N. Thomson 2004
6.10. Postoperative period (3 hours)
Clinics of General Surgery
Postoperative period, body response to operation (trauma), phases. Clinical signs of the postoperative disease. Principles of postoperative management. Anesthesia. Postoperative care of
cardiovascular, pulmonary, urinary tract and digestive tract systems. Significance of temperature, pulse,
body weight changes and diuresis control in the postoperative period. Care of skin, mucous membranes
and mouth in the postoperative period. Prevention of pressure sores.
Operative wound care. Operative wound complications, causes, prevention and principles of
management. Prevention of operative wound infection.
Postoperative cardiovascular, pulmonary, urinary tract and digestive tract complications,
prevention, principles of management. Thromboembolism: prevention, management.
Postoperative period under the conditions of the out patient care.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins,
2006. p. 121-147.
2.
Schwartz S.I., Shires G.T., Spencer F.C. Principles of Surgery. McGraw-Hill, Inc. 1994. p. 455489.
27
6.11. Wounds (3 hours)
Clinics of General Surgery
Wounds: definition, signs and types. Wound healing: characteristics of stages, ways of wound healing.
First aid for wounds. Management of fresh contaminated wounds, primary wound closure. Signs of
poisonous wounds and poisonous bites, principles of management. Gun shot wounds. Wound
complications and prevention. Tetanus, rabies: signs, preventive measures.
References:
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins,
2006. p. 147-157.
2.
Schwartz S.I., Shires G.T., Spencer F.C. Principles of Surgery. McGraw-Hill, Inc.1994. p.279297.
3.
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Kaunas. Kaunas
University of Medicine press. 2006. p. 283-289.
6.12. Trophic ulcers and fistulas. Stomas. (3 hours)
Clinics of General Surgery
Causes of acute arterial and venous occlusion: signs, first aid and management. Causes of chronic
arterial insufficiency (atherosclerosis, endarteritis, diabetic angiopathy, Raynaud‘s disease): signs,
diagnosis, prevention, nursing, principles of management. Diabetic angiopathies. „Diabetic foot“:
definition, clinical signs, nursing, principles of management.
Varicosis of the superficial veins, phlebitis and thrombophlebitis. Etiology, pathogenesis, clinical
signs and measures of nursing. Deep vein thrombosis: symptoms, complications, prevention, principles
of management, nursing.
Tissue necrosis (gangrene): forms, causes. Pressure sores: causes, prevention and treatment.
Trophic ulcers: etiology, classification, signs, principles of management.
Fistulas of the digestive tract, airways, urinary tract, stomas. Specificity of nursing.
References:
28
1.
Lawrence P.F. Essentials of General Surgery. Fourth edition. Lippincott Williams and Wilkins,
2006. p. 157-163.
2.
Schwartz S.I., Shires G.T., Spencer F.C. Principles of Surgery. McGraw-Hill, Inc. 1994. p. 297298.
3.
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Kaunas. Kaunas
University of Medicine press. 2006. p. 289-290.
6.13. Modern wound dressings (3 hours).
Clinics of General Surgery
Modern wound dressing materials. Requirements for the modern wound dressings. Dressing types and
ways of dressing wounds. Gauze dressings. Non-woven, hydrocolloid, silicone, polyurethane, alginate
dressings. Biological wound dressings and skin substitutes. Antiseptic wound dressings. Topical agents
for local wound management. Wound dressings promoting autolysis, granulation and epithelialization.
Special modern wound dressings, wound packs, elastic devices, zinc gelatine wound dressings.
References:
1.
Juočas J., Venskutonis D., Kutkevičius J., Daubaras V. Asepsis and Antisepsis. Kaunas. Kaunas
University of Medicine press. 2006. p. 276-283.
2.
Schwartz S.I., Shires G.T., Spencer F.C. Principles of Surgery. McGraw-Hill, Inc. 1994. p. 298.
3.
Surgical Wound healing and management ed by M.S. Granick and R.L. Gamelli; 2007.
6.14. General examination of the patient: interview, general inspection,
palpation
Clinics of Internal Diseases
The main parts and sequence of interview. Practical interviewing of patients. The main aspects of
general inspection. Practical examination of lymphatic system.
References:
29
1. Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone, 2001.
2. Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.5-20.
3. Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition. Lippincott, Williams&Wilkins, 2007.
4. James Thomas, Tanya Monagham. Oxford Handbook of Clinical Examination and Practicall Skills.
Oxford University Press, 2007.
5. The Merck Manual of Diagnosis and Therapy, 18th edition. Merck Publications, 2006.
6.15. Examination of patients with respiratory diseases: interview,
inspection, palpation, percussion, auscultation
Clinics of Internal Diseases
Examination of respiratory system by interview, inspection, palpation, percussion, auscultation. Getting
practical skills.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.21-44.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
4.
James Thomas, Tanya Monagham. Oxford Handbook of Clinical Examination and Practicall
Skills. Oxford University Press, 2007.
5.
The Merck Manual of Diagnosis and Therapy, 18th edition. Merck Publications, 2006.
6.16. Examination of patients with cardiovascular diseases: interview,
inspection, palpation, percussion. Examination of blood vessels
Clinics of Internal Diseases
Examination of cardiovascular system by interview, inspection, palpation, percussion. Blood pressure
measuring. Getting practical skills.
References:
30
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.59-72, 96-108.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
4.
James Thomas, Tanya Monagham. Oxford Handbook of Clinical Examination and Practicall
Skills. Oxford University Press, 2007.
6.17. Auscultation of the heart (norm)
Clinics of Internal Diseases
Technique of auscultation. Normal findings. Getting practical skills in auscultation.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.73-77.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
6.18. Murmurs
Clinics of Internal Diseases
Classification. Clinical meanings. Practical auscultation of patients.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.87-95.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
6.19. Clinical ECG estimation (I)
Clinics of Internal Diseases
31
Practical interpretation of ECG.
References:
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.113-136.
6.20. Examination of patients with diseases of gastrointestinal and
hepatobiliary system: interview, inspection, auscultation, percussion,
palpation
Clinics of Internal Diseases
Examination gastrointestinal and hepatobiliary system by interview, inspection, auscultation,
percussion, palpation. Getting practical skills.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.167-214.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
4.
James Thomas, Tanya Monagham. Oxford Handbook of Clinical Examination and Practicall
Skills. Oxford University Press, 2007.
5.
The Merck Manual of Diagnosis and Therapy, 18th edition. Merck Publications, 2006.
6.21. Clinical ECG estimation (II)
Clinics of Internal Diseases
Practical interpretation of ECG.
References:
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.113-136.
32
6.22. Examination of patients with diseases of hematopoietic system and
urinary system
Clinics of Internal Diseases
Examination of hematopoietic and urinary system by interview, inspection, palpation, percussion,
auscultation. Getting practical skills .Interpretation of laboratory findings.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.215-222, 241-268.
3.
The Merck Manual of Diagnosis and Therapy, 18th edition. Merck Publications, 2006.
6.23. Examination of patients with diseases of endocrine and
musculoskeletal system
Clinics of Internal Diseases
Examination of endocrine and musculoskeletal system by interview, inspection, palpation, percussion,
auscultation. Examination of joint motion. Getting practical skills.
References:
1.
Munro J., Campbell J.W. Macleods‘ Clinical Examination. 10th ed. Churchill Livingstone,
2001.
2.
Bacevicius E. Propedeutics to Internal Medicine. Kaunas, 1998, p.268-295.
3.
Lynn S., Bickley MD. Bates’ Guide to Physical Examination and History Taking, 9th edition.
Lippincott, Williams&Wilkins, 2007.
4.
James Thomas, Tanya Monagham. Oxford Handbook of Clinical Examination and Practicall
Skills. Oxford University Press, 2007.
5.
The Merck Manual of Diagnosis and Therapy, 18th edition. Merck Publications, 2006.
6.24. Preparation of hands for injections. Intradermal and subdermal
injections. Injections of insulin
Department of Nursing
33
6.25. Injections into muscles, veins, infusions. Taking of blood samples
with vacuum system, bacteplus system. Calculation of infusion
speed.
Department of Nursing
34
7. Seminars
35
8. Examination program
8.1. General surgery
Asepsis and antisepsis
1. Chain of infection spread.
2. Factors influencing the spread of infection.
3. Universal and standard precautions for prevention of infection of patients and health care workers.
4. Asepsis: definition, background and founders.
5. Medical asepsis: definition, basic principles of medical asepsis.
6. Hand hygiene of health care workers.
7. Hygienic hand washing: purpose, methods and ways.
8. Medical gloves: types, indications for use.
9. Measures of protection against infection of patients and health care workers.
10. Cleaning of the surgical department.
11. Methods of infection control.
12. Disinfection: definition, levels and methods.
13. Disinfecting and antiseptic agents.
14. Sterilization: definition, methods, ways.
15. Most popular ways of sterilization, characterization, purpose.
16. Stages of disinfection and sterilization.
17. Spaulding’s classification.
18. Sterilization of surgical instruments and equipment.
19. Wound dressing material, sterilization.
20. Sterilization of gowns, masks, caps, operative field, draping.
21. Single use medical items: advantages and disadvantages.
22. Methods of sterilization process and sterility control.
23. Transportation and storage of sterile materials, sterile shelf life.
24. Medical waste: types, hazards, storage and handling.
25. Surgical asepsis: definition, conception of “sterile” and “aseptic” technique.
26. Basic principles of surgical asepsis.
27. Operating block. Principles of equipment of the operating theaters.
28. Staff of the operating block, functions, outfit, work regulations.
36
29. Combating infection in the operating theater. Cleaning of the operating theater.
30. Surgical hand disinfection procedures (surgical hand washing).
31. Modern surgical gloves.
32. Indications for washing and changing gloves.
33. Masks, caps, footwear, outfit, protective eye wear and face shields used in the operating theater.
34. Preparation and isolation of the operative field.
35. Asepsis during operation.
36. Antisepsis: definition, background, founders.
37. Types and methods of antisepsis.
38. Antiseptics: classification, fields of application.
39. Modern antisepsis.
40. Currently used antiseptic agents.
Feeding of patient
41. Protein and energy stores in the body. Energy requirements of healthy and ill subjects.
42. Malnutrition: causes, main clinical signs: anamnesis, anthropometric, laboratory tests.
43. Principles of nutrition of patients. Enteral nutrition.
44. Parenteral feeding: indications, principles, complications, advantages.
Examination of patient
45. Diagnostic stage: duration, purposes, preoperative preparation.
46. Subjective examination of the surgical patient.
47. Physical examination of the patient.
48. Laboratory investigation of patient.
49. Instrumental investigation of surgical patient: endoscopy, biopsy (classification, methods,
purposes).
50. Radiological investigation methods: x-rays, CT, MRI, radioisotope, ultrasound.
51. Examination of patient with the peritoneal cavity diseases.
52. Examination of patient with blood vessel diseases.
53. Methods of rectal examination.
Operation
54. Preoperative period: stages, duration. Preoperative epicrisis.
55. General and local preparation for elective and urgent surgery.
56. Operation: indications, contraindications, classification.
37
57. Operative risk: main factors increasing operative risk, assessment (ASA classification of physical
state, cardiac and thromboembolism risk factors).
58. Surgical tissue dissection. Devices for tissue approximation (restoration), characteristics, use.
59. Factors influencing wound healing: tissue injury, microcirculation disturbances, and hemostasis.
60. Drainage of wounds and cavities: indications, types, possible complications.
61. Postoperative period: stages, prevention of complications.
62. Post-operative disease, phases, signs (adaptation syndrome).
63. Operative wound care, possible complications, prevention.
64. Postoperative care of respiratory system, possible complications, prevention.
65. Postoperative functional disorders in gastrointestinal tract, prevention and management.
66. Postoperative urination disorders, prevention, principles of management.
67. Postoperative thrombosis and thromboembolism, prevention.
68. Pressure sores.
69. Postoperative fever, causes, prevention.
70. Postoperative period: assessment of changes of body temperature, pulse, body weight, urine output
(diuresis).
Wound
71. Wound: signs, types.
72. Classification of wounds.
73. First aid for wound. Wound associated dangers.
74. Gunshot wound: types, specific features.
75. Infected wounds and bites: signs, first aid, principles of management.
76. Surgical wound.
77. Wound healing: characterization of phases, ways of wound healing (by primary, by secondary and
by tertiary intension).
78. Healing of purulent wound: periods, phases.
79. Microbial wound complications: tetanus, rabies.
Tissue vascularization disturbances and tissue necroses
80. Acute artery and vein occlusion: causes, symptoms, diagnosis, first aid and principles of treatment.
81. Obliterative endarteritis: etiology, causes, signs, diagnostics, principles of treatment. Morbus
Raynaud. Intermittent claudication (claudicatio intermittens).
82. Diseases causing occlusion of leg arteries: causes, signs, diagnostics and principles of treatment.
83. Diabetic angiopathies. “Diabetic foot”: signs, diagnostics, principles of treatment.
84. Superficial leg vein varicosis: etiology, pathogenesis, signs, diagnostics, principles of treatment.
38
85. Superficial phlebitis and thrombophlebitis: etiology, signs, diagnostics, principles of treatment,
prevention.
86. Phlebothrombosis: etiology, pathogenesis, signs, diagnostics, principles of treatment, prevention.
87. Microcirculatory changes in tissues: necrosis, gangrene.
88. Ulcers: classification, causes, signs, diagnostics, principles of treatment.
89. Fistulas: classification, causes, signs, diagnostics, principles of treatment.
8.2. Essentials of Diagnosis in Internal Diseases
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Complaints, their types, characterization.
The levels of altered consciousness; diagnostic criteria.
Main causes of altered consciousness.
Cyanosis; mechanism of development; types, clinical meanings.
Edema, its classification; mechanisms of development, clinical meanings.
Examination of the peripheral lymph nodes: norm, types of enlargement, causes.
Changes of skin pigmentation; causes.
Types of eruption, causes.
Body mass index (BMI); normal values, abnormal meanings.
Characterization of cough and sputum production in patients with respiratory diseases; their
clinical meanings.
11.
Dyspnea in patients with respiratory diseases: types; clinical meanings.
12.
Chest pain in patients with respiratory diseases: characterization, clinical meanings.
13.
General inspection of patients with respiratory diseases; possible changes and their clinical
meanings.
14.
Special inspection of patients with respiratory diseases; possible changes and their clinical
meanings.
15.
Pathological changes of tactile fremitus, causes.
16.
Comparative percussion of the lungs; pathological changes and their causes.
17.
The lower borders of the lungs: norm and pathological changes, causes. Active mobility of the
lungs: norm and pathological changes, causes.
18.
Auscultation of the lungs: breath sounds that are heard over the normal lungs, their pathological
changes and clinical meanings.
19.
Wheezes and rales; mechanism of generation of these adventitious sounds, types and causes.
20.
Crepitation and pleural friction rub: mechanism of generation of these adventitious sounds,
causes.
21.
Types of chest pain in patients with cardiac diseases; their characterization and clinical
meanings.
22.
Dyspnea and palpitation in patients with cardiac diseases: characterization, clinical meanings.
23.
General inspection of the patients with cardiac diseases: possible pathological changes and their
clinical meanings.
24.
Special inspection of patients with cardiac diseases, possible pathologic changes and their clinic
meanings.
25.
Apex beat, cardiac beat: normal values, pathological changes and their clinical meanings.
39
26.
Percussion of the heart: relative cardiac dullness, normal and pathological changes of the area
of cardiac dullness, clinical meanings.
27.
Normal auscultation of the heart.
28.
Accentuated heart sounds, clinical meanings.
29.
Diminished heart sounds, clinical meanings.
30.
Splitting of the first heart sound (S1); clinical meanings.
31.
Splitting of the second heart sound (S2); clinical meanings.
32.
Gallop rhythm, OS, and physiological third sound (S3); their characterization and clinical
meanings.
33.
Mechanism of generation of cardiac murmurs; classification of cardiac murmurs.
34.
Characterization of cardiac murmurs.
35.
Measurement of arterial blood pressure; normal values and pathological meanings.
36.
Examination of blood vessels: evaluation of radial pulse, normal values, pathological changes,
their clinical meanings.
37.
Abdominal pain in patients with gastrointestinal diseases, types of pain, characterization,
clinical meanings.
38.
Functional complaints in patients with gastrointestinal diseases: their characterization, clinical
meanings.
39.
Stool examination: norm, pathological findings, clinical meanings.
40.
Main complaints of the patients with hepatobiliary diseases, their clinical meanings.
41.
Inspection of hepatobiliary patients.
42.
Main biochemical laboratory tests in hepatobiliary diseases: normal and pathological values,
their clinical meanings.
43.
Main complaints of patients with hematologic diseases: characterization, causes, clinical
meanings.
44.
Inspection of patients with hematologic diseases; the meanings of pathological findings.
45.
Examination of red blood cells: normal and pathological findings, their clinical meanings.
46.
Examination of white blood cells (differential white blood cell count): normal and pathological
findings, their clinical meanings.
47.
The laboratory tests of hemostasis; normal and pathological findings, their clinical meanings.
48.
Anemia syndrome: definition, causes, main clinical and laboratory findings, their clinical
meanings.
49.
Inspection of patients with endocrine disease; clinical meanings of the pathological findings.
50.
Oral glucose tolerance test: indications, contraindications, method of performance, evaluation,
clinical meanings of pathological changes.
51.
Main complaints of patients with musculoskeletal diseases, their clinical meanings.
52.
Main complaints, inspection, clinical signs of allergic patients.
8.3. General surgery practical skills
1. Surgical hand antisepsis.
2. Wearing the gown and gloving procedure.
3. Palpation of peripheral arteries.
4. Removal of stitches from a wound.
40
5. Dressing an aseptic wound.
6. Dressing an infected wound.
7. Removal of stitches.
8. Insertion of the gastric tube.
9. Insertion of the urinary catheter.
10. Interviewing the patient.
11. Assessment of the abdominal inspection findings.
12. Assessment of the abdominal auscultation findings.
13. Assessment of the abdominal percussion findings.
14. Light abdominal palpation.
15. Deep abdominal palpation.
16. Palpation of the liver, spleen, cecum, the sigmoid colon.
17. Assessment of the peritoneal irritation signs.
18. Detection of fluid accumulation (ascites) in the peritoneal cavity.
19. Technique and assessment of the digital examination of the rectum.
20. Palpation an assessment of hernia opening.
21. Examination of the deep leg veins.
22. Examination of the superficial leg veins.
23. Evaluation of the peripheral arterial blood flow.
24. Palpation of the peripheral lymph nodes.
25. Assessment of the superficial abscess signs.
26. Breast palpation.
8.4. Diagnosis of Syndromes: Practical tasks
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Pulmonary consolidation.
Cavity in the lung.
Increased airiness in the lung.
Fluid accumulation in the pleural cavity.
Air accumulation in the lung.
Irritation of the airways (bronchitis).
Acute respiratory failure.
Chronic respiratory failure.
Mitral stenosis.
Mitral regurgitation.
Arrhythmia syndrome.
Aortic stenosis.
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13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Aortic regurgitation.
Arterial hypertension.
Pulmonary hypertension.
Chronic right heart failure.
Chronic left heart failure.
Acute heart failure.
Syndrome of abdominal pain, dyspepsia and gastrointestinal bleeding.
Liver disorder.
Hemorrhagic syndrome.
Anemia syndrome.
Hyperthyroidism.
Hypoglycemia, hyperglycemia syndromes.
Renal disorder.
Arthropathic syndrome.
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