Устные экзаменационные темы для лечебного и педиатрического факультетов 2011-2012 уч год

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^ Clinical trials are conducted to allow safety and efficacy data to be collected for health interven­tions, for example, drugs, devices and therapy protocols.

Depending on the type of product and the stage of its development investigators enroll healthy volunteers or patients into small pilot studies initially, followed by larger scale studies in patients that often compare the new product with the currently prescribed treatment. As positive safety and efficacy data are gathered, the number of patients is typically increased. Clinical trials can vary in size from a single center in one country to multicenter trials in multiple countries.

During the clinical drug trial the investigators recruit patients with the predetermined characteris­tics, administer the treatment, and collect data on the patients' health for a defined time period. These data include measurements like vital signs, concentration of the study drug in the blood, and whether the patient's health improves or not. The researchers send the data to the trial spon­sor who then analyzes the pooled data using statistical tests.

While performing a drug trial the investigators should compose a clinical trial protocol, which is a document used to gain confirmation of the trial design by a panel of experts and adherence by all study investigators, even if conducted in various countries.

The biggest barrier to completing studies is the shortage of people who take part. All drug and many device trials target a subset of the population, meaning not everyone can participate. Some drug trials require patients to have unusual combinations of disease characteristics. It is a chal­lenge to find the appropriate patients and obtain their consent, especially when they may receive no direct benefit. In the case of cancer patients, fewer than 5% of adults with cancer will partici­pate in drug trials.

The other problem concerning clinical drug trials is high frequency of accidents during it. In March 2006 the drug TGN14 caused catastrophic systemic organ failure in the individuals re­ceiving the drug during its first human clinical trials in Great Britain.

Potential drugs first have to be discovered, purified, characterized and tested in labs with the help of specific animal studies before undergoing clinical trials. The problem of involving animals in the process of drug trial has always been discussed in scientific circles. There may be a lot of ar­guments for and against it. However, in some severe cases it becomes necessary to test the drug on animals in order to secure the patient's life.

The World Medical Association's Declaration of Helsinki requires researchers to take special care with consent involving vulnerable subject populations which have barriers to informed con­sent. These groups include minors, prisoners, and the mentally ill.

To approve the trial for such groups of people it must meet all of the following conditions:

  • The trial must involve no more than a minor increase over minimal risk.

  • The treatments must be appropriate to the condition or to medical care that the patient would otherwise receive.

The treatment must either yield "generalizable knowledge" about the specific condition that is vital for understanding or treatment

.9. Discuss what people should/shouldn't do to lead healthy lifestyle

Duration and effectiveness of our life fully depends on our lifestyle. From this point it is only our decision, how long and how joyful our life can be.

One the one hand, if we watch out for our diet, take care of health, including mental one, go in for sports or fitness, our chances of enjoying prolonged life are increases. On the other hand, people who smoke and drink have a lot of lung, heart and vascular problems. They could also suffer from obesity. Those who live under stress are also unlikely to live long. But in this case there is a way out to extend efficiency of life.

Any doctor will advise you to:

  • lose your weight by cutting down sweets, reducing calories

  • eat as much low-fat food as possible (chicken, fish and yogurt)

  • eat at least five portions of fruit and vegetables a day to ensure vitamins and minerals

  • give up smoking

  • avoid snacks

  • avoid stress

  • lead an active lifestyle and stay in shape with exercise that give of benefit

  • not to go to bed late

  • not to be a fitness or diet fanatic

This advice is not difficult at all, but unfortunately very few people follow it. So it is important for a patient how you with doctor can prove them the importance of these simple rules. Attempts to change patients' behavior is a matter of negotiation. Right strategy is that which involves the patients themselves. This is achieved not through forcing opinion or ordering to do something, but by coaxing and encouraging patients. Patients should know the benefits of following the rules of healthy lifestyle and harmful effects of bad habbits.

Also a health adviser should provide the patient wide options from which the patient can make a choice. Options need to be patient-centered, taking into account the patient's way of life. For example, no need to say to a patient who doesn't use buses, to exercise by getting off one stop early when going to work.

you a lot
Effective negotiation requires sympathy and empathy. Doctor must be kind, patient and responsive. Otherwise, patient might begin to lose faith in the doctor's attempts to help him.
^ 10. Discuss the importance of keyhole surgery. What complications and risks does it reduce?

Surgery is a repairing body with knives and stitches. For thousands of years it was limited to amputations which were performed very fast, without anesthetic and knowledge of hygiene. Success rates were low and many patients died from shock or post-operative infections.

Even with modern anesthetics and antiseptics pa tients still suffer from the consequences of the operations. Open surgery still remains a bloody busi ness. However, the invention of the laparoscope - a tube for looking inside the body - has led to the development of the "keyhole" surgery. It is highly appreciated because it means less pain and less scarring. For example, in conventional by-pass surgery the surgeon has to open the patient's chest with a 30 cm long incision whereas keyhole surgery involves just three one-centimeter cuts. Now complex operations are done through small inci sions. While performing such a procedure surgeons see images on screens made by a tiny video camera at the end of laparoscope. Keyhole surgery demands a lot of practice in hand-eye coordination in order to accurately navigate around the internal organs.

The next stage of development of the keyhole surgery is involving robots in operative proc ess. Robot's hands have a greater range of movement and don't shake.

As you see, keyhole surgery opens a great variety of opportunities for surgical manipulations. But nowadays it is exactly determined that it helps to avoid such complications as hematomas, hernias, fewer wound complications like infection. That's why keyhole surgery is a new stage of surgery development providing a pretty huge field for further scientific investigations.11.Discuss the importance of pre-operative procedures. List them. What are the benefits of pre-op patient education, both for patient and for the healthcare system?

Surgery has always been risky and even with modern anesthetics, bloods transfusion and antiseptics patients still suffer from the consequences of the operations. Patient usually worry about such things as pain after and during the op­eration, searing, MRSA and dying during surgery. That is why it is twice important for the surgeon to inform his patient what procedure is going to be, and the surgeon must do all his best to be prepared well for the operation and to prepare his patient.

But the operation is not performed only by a surgeon. It is performed by the group of experts in operative proce­dure, pain management and specific patient care, which is called "surgical team". The basic surgical team includes sur­geon, anesthetist, anesthetist nurse and operating nurse. In teaching hospitals attached to medical schools the team may be enlarged by interns, residents and nursing students. A surgical team during surgery is led by one surgeon performing most clinical work himself while directing his team to assist with or to overtake less clinical parts. Anesthetists is a physician who is directly or indirectly involved in all three stages of surgery (pre-operative, operative and post-operative) due to his focus on pain management and patient safety. The anaesthetist nurse supports the anaesthetist and takes full control of anaesthesia during the operation. Operating nurse is the general assistant to surgeon during the actual operation phase. The nursing staff performs comprehensive care, assistance and pain management during each surgical phase.

Pre-operative management contains a lot of different manipulations which are performed by members of surgical team and include preparation of patient, surgeon and operating room.

The patient should be admitted to the hospital some day before operation. It is necessary to make some preparations for operation such as evacuation of the bowel. If evacuation of the bowel has been regular a water enema on the morning of the operation is adequate. As a rule the skin receives its first preparation on the evening before the surgical manipula­tions. The operative area is first washed with soap and also must be painted with antiseptic.

As for surgeon's hands he should wash his hands thoroughly with soap and hot water for 3-5 minutes. Special care should be taken with the grooves round the nails. The hands and arms should be immersed in alcohol rubbed with a piece of gauze for a few minutes and then dried. Finally the cleaned and sterilized rubber gloves are drawn on. All these prepa­rations should be done immediate by before the operation, just before the patient is anaesthetized.

The operating room should be well lighted, well heated, well ventilated. It must also contain all the necessary sup­plies such as: instrument basing, sutures, needles, syringes, drains, tubes, gauze and others. There are the instruments used during the operation: scalpels, scissors, dissecting forceps, tissue forceps, sponges, curette, tourniquet and bandages. All the instruments should be sterilized by boiling for 15 to 20 minutes in water containing 1 or 2 per-cent of carbonate of soda. The operating nurse must also prepare the apparatuses for blood transfusion and artificial respiration. The surgical instruments and supplies are counted before the operation in order to avoid forgetting them in the patient's body.

Before the operation the anesthetist nurse may give a pre-med to a patient. It is a liquid sedative which makes pa­tient feel relaxed and sleepy. The anesthetist connects patient to the monitoring equipment and then gives some drugs that will send patient to sleep. Then anesthetist asks the patient to count backwards from 100.... And the next thing the patient sees is the recovery room.

All these pre-operative procedures help to avoid complications after the operation and reduce the risk of wide spreading of infectious diseases. That is why they are indispensable and very useful both for patients and for the health­care system on the whole.

^ 12. Describe the procedure of conventional surgery. What personnel are involved? What instruments are necessary? What documents does the orderly take into thea­ter?

Conventional or open surgery still remains a bloody business which involves cut­ting open the body, holding it open with retractors and putting both hands into the hole.

Conventional surgery is carried out in an operating theatre. It involves a surgeon and his assistant, an anaesthetist and his assistant, theatre and scrub nurses. Theatre nurse makes sure the table's set up, that they have everything they need such as gowns, gloves, soaps and brushes, waste bags, and stocks of swabs.

The orderly usually takes into the theatre such documents as notes, test results and consent form. The surgeon and his or her assistant wash or scrub up, and put on surgical gowns, masks and gloves. By the moment the patient is lying on the operating-table the anaesthetists gives him intratracheal anaesthesia and when the patient falls asleep the op­eration begins.

The surgeon treats the operative area with an antiseptic solution three times and sur­rounds it by a sterile cloth. Then he makes an incision with a scalpel. Bleeding is stopped with the clamps and then the surgeon performs all necessary manipulations in the opera­tion area. Next the surgeon cleanses the operative wound from exudates. Then the surgeon closes the abdominal wound in layers with drainage. A patch is stuck and an ice-bag is put on the wound for several hours.

When the operation is over the patient is taken on a stretcher cart to the post­operative room. In about two hours the patient comes round. If the patient survives the operation well, his general state is satisfactory. Thereafter the doctor in charge examines the patient every day to make sure the patient's post-operative course is uneventful. If no complications are noted and the wound is healing well the patient is usually discharged from the hospital in a fortnight.

Keyhole surgery is highly appreciated because it means less pain and less scarring - things that patients are mostly afraid of. For example, in conventional by-pass surgery the surgeon has to open the patient's chest with a 30 cm long incision whereas keyhole sur­gery involves just three one-centimetre cuts

.^ 13.Discuss the importance of post-operative monitoring. What complications may occur? Explain how to rate and manage pain.

The fear of being in pain makes some patients unable to cope with idea of surgery. But the efforts of anesthetists are aimed to prevent feeling of pain during and after the operation because of their involving in all stages of surgery (pre-operative, operative and post-operative). Before the operation anesthetist connect patient to the monitoring equipment, then he gives some drugs that send patient to sleep, asks the patient sees is recovery room.

The following procedures are devoted to post-operative monitoring, the integral part of which is pain management. The procedure of pain management contains giving a pain relief while patient's waking up. Also there is a special apparatus PCA machine (patient-controlled analgesia) which is run through the pump. The medication goes into patient's bloodstream whenever he pushes the button. Even if patient keeps pushing the button the opportunity of giving overdose expelled: the pump is programmed so that the machine automatically blocks medication carrying out through line. It is called "a lock-out time" of giving medication. Patients are usually asked to assess their own pain level on a pain scale, in which "0" means absence of pain at all and "10" means the unbearable pain. This evaluation is quite subjective. That is why it is important to be clear about pain threshold and pain tolerance. The pain threshold is the point at which we all feel pain. Pain tolerance is more individual sensing of pain and can be affected by several things like cultural factors for instance. Some patients have a high tolerance and some - low tolerance for pain.

There are some analgesics which are used in acute post-operative pain. Analgesics act on different sites of the body and are therefore useful for the various types of post-operative pain: localized and referred. Localized pain is a fast pain which is felt at the site of surgical incision. Anti-inflammatory drugs are useful for this type of pain. For example opioids can be used to modify or change the transmission of nerve impulses in the dorsal horn. In this way, the opioid pre-empt painful nerve impulses before they cause discomfort. Paracetamol is used as a background drug to opioids. That is why pain management is about using several drugs together to obtain the best outcome.

Except for the procedures of pain management there are the other procedures strongly connected with post-operative monitoring. For example, taking patient's observations: temperature, pulse, blood pressure. It is usually performed by nurse. After the operation patients may be given an incentive spirometer-atri-ball to blow into. It is important to wait to prevent lung collapse by making sure the patient's lungs inflate as much as possible. This procedure is used to get lung function back after the anesthetic.

AH these post-operative procedures help to avoid a lot of complications in dangerous post-operative period. That is why they are indispensable and very useful both for patients and for the healthcare system

.^ 14. Describe Great Britain: geographical position, political situation, populations, nations, history and the main sights.

The United Kingdom of Great Britain and Northern Ireland occupies territory of the British Isles which are situated to the north-west of Europe. They consist of two main islands: Great Britain and Ireland and 4 sub-countries: England, Scotland, Wales & Northern. Its washed by the Atlantic Ocean, by the North Sea. The Irish Sea, the North Channel and the St. George's Channel. Great Britain is separated from France by the English Channel, which is 32 km wide in its narrowest part. In everyday speech "Great Britain" is used to mean the UK.

Weather changes very often. The climate of Britain is mild, humid and changeable. The most characteristic feature of Britain's weather is its variability. Summers are not hot and winters are not cold in Britain. The snow never lies for long on the ground. As a rule there is no ice on the waters of rivers and lakes.

English is the official, but not the only language used in the country.

Britain has been many centuries in the making. The Romans conquered most part of Britain, but were unable to subdue the fiercely independent tribes in the West and in the North. Further waves of invaders followed: Angels, Saxons, Jutes, Vikings and Normans. All these contributed to the mixture we call English. For many centuries this country was known simply as England. It had a strong army and navy. It waged numerous colonial wars. England, once the "work shop of the world", was the first to become a highly industrial country.

There are no big rivers in Great Britain. The biggest are Severn and Thames. The Severn in England is the longest river. It is 350 kilometers long. There are a lot of mountains in Great Britain, but they are nit high. The highest mountain - Ben Nevis - is in Scotland. The flora of the British Isles is much varied and the fauna is similar to that of the north-west of Europe. The country is not veiy rich in natural resources but there were enough for the Industrial Revolution to start.

Great Britain is highly industrialized, this was the country in which the earliest developments of modem industry.

The Great Britain is a parliamentary monarchy. British laws are made in the House of Lords and the House of Commons.

London is the capital of the Great Britain. It was founded by the Romans. It is veiy old city. It is two thousand years old. London is only the capital of the countiy; it is also a huge port.

^ 15.Voronezh N.N. Burdenko State Medical Academy

I State Institution of Graduate and Postgraduate Professional Education «Voronezh N. N. Burdenko State Medical Academy» is known as one of the country's leading research and teaching institutions with the total student enrollment of 5 500 people.

It is one of the oldest educational institutions of Russia. Its history goes back to 1802 — the date of Derpt University foundation, which in 1918 moved to Voronezh. In December, 1930 the Medical Faculty of the Voronezh University became an independent medical institute consisting of two Faculties: the Faculty of General Medicine and the Faculty of Health. The Institute acquired an Academy status in 1994.

There are 6 departments at the Voronezh State Medical Academy: The Faculty of General Medicine, The Pediatric Faculty, The Faculty of Stomatology, The Faculty of Pharmacy, Medico-prophylactic Faculty (The Faculty of Preventive Medicine), The Faculty of Advanced NursingAThe department of in-service doctors' training and post-graduate courses are also availableAThere are more than 50 chairs at the Academy which one can find in several buildingsArThe largest multy-field medical and healthcare establishments of Voronezh serve as clinical bases for students' practical trainings/various kinds of well-equipped laboratories are at the disposal of the Academy. The Academy has an extensive library possessing about 580 000 items ./Hew information technologies are introduced successfully in the work of the library.

AThe Academy has a well-established reputation for providing high quality medical teaching, learning and research. The quality of its performance is reflected in the rating system, where the Academy was placed in the top ten higher medical schools of Russia. Since the foundation year it has prepared above 40 thousand medical specialists, including foreign specialists from 28 countries of Europe, Asia and Africa. Medical degrees received at VSMA are recognized worldwide

.^ 16. Discuss the problem of infectious diseases transmission. What are the main transmis­sion routes? What are the ways of its prevention?

Ал infectious disease is a clinically evident illness resulting from the presence of patho­genic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, mul­ticellular parasites, and aberrant proteins known as prions. Infectious pathologies are also called communicable diseases or transmissible diseases due to their potential of transmission from one person or species to another by a replicating agent.

An infectious disease is transmitted from some source. Defining the means of transmission plays an important part in understanding the biology of an infectious agent, and in addressing the disease it causes. Transmission may occur through several different mechanisms. Respiratory diseases and meningitis are commonly acquired by contact with aerosolized droplets, spread by sneezing, coughing, talking, kissing or even singing. Gastrointestinal diseases are often acquired by ingesting contaminated food and water. Sexually transmitted diseases are acquired through contact with bodily fluids, generally as a result of sexual activity. Some infectious agents may be spread as a result of contact with a contaminated, inanimate object (known as a fomite), such as a coin passed from one person to another, while other diseases penetrate the skin directly.

Transmission of infectious diseases may also involve a vector. Vectors may be mechanical or biological. A mechanical vector picks up an infectious agent on the outside of its body and transmits it in a passive manner. An example of a mechanical vector is a housefly, which lands on cow dung, contaminating its appendages with bacteria from the feces, and then lands on food prior to consumption. The pathogen never enters the body of the fly.

In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new hosts in an active manner, usually a bite. Biological vectors are often responsible for serious blood-borne diseases, such as malaria, viral encephalitis, Chagas disease, Lyme disease and Af­rican sleeping sickness. Biological vectors are usually, though not exclusively, arthropods, such as mosquitoes, ticks, fleas and lice. Vectors are often required in the life cycle of a pathogen. A common strategy used to control vector borne infectious diseases is to interrupt the life cycle of a pathogen by killing the vector.

General methods to prevent transmission of pathogens may include disinfection and follow­ing common hygiene rules. In medicine hygiene practices are determined as preventative meas­ures to reduce the incidence and spreading of the disease. That is why medical hygiene practice includes cleanliness procedures, isolation or quarantine of infectious persons and sterilization or disinfection of instruments used in surgical procedures.

One of the ways to prevent or slow down the transmission of infectious diseases is to rec­ognize the different characteristics of various diseases. Some critical disease characteristics that should be evaluated include virulence, distance traveled by victims, and level of contagiousness. The human strains of Ebola virus, for example, incapacitate its victims extremely quickly and kills them soon after. As a result, the victims of this disease do not have the opportunity to travel very far from the initial infection zone.

So, the spread of Ebola is very rapid and usually stays within a relatively confined geo­graphical area. In contrast, Human Immunodeficiency Virus (HIV) kills its victims very slowly by attacking their immune system. As a result, many of its victims transmit the virus to other in­dividuals before even realizing that they are carrying the disease. Also, the relatively low viru­lence allows its victims to travel long distances, increasing the likelihood of an epidemic

.^ 17. Describe some of the infectious diseases (causes, symptoms, detection and treatment). Dis­cuss how epidemics in hospitals may be managed.

An infectious disease is a clinically evident illness resulting from the presence of pathogenic mi- crobial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions. Infectious pathologies are also called communicable diseases or transmissible diseases due to their potential of transmission from one person to another by a replicating agent.

Transmission of an infectious disease may occur through one or more of diverse pathways includ­ing physical contact with infected individuals. These infecting agents may also be transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread. Transmissible diseases which occur through contact with an ill person or their secretions, or objects touched by them, are especially infective, and are sometimes referred to as contagious diseases.

Because of great variety of agents causing the disease, and routes of its transmission we can define a lot of types of infectious diseases. I'd like to describe some of them, which are mostly wide-spread.
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