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

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Tuberculosis is a common and often deadly infectious disease caused by various strains of myco- bacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air, when people who have the disease cough, sneeze, or spit. The classic symptoms of tuberculosis are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics though antibiotic resistance is a growing problem in multi-drug- resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guerin vaccine.

Malaria is a mosquito-borne infectious disease caused by a eukaryotic protist of the genus Plasmo­dium. It is widespread in tropical and subtropical regions, including parts of America, Asia, and Africa. Malaria is naturally transmitted by the bite of a female Anopheles mosquito. When a mosquito bites an infected person, a small amount of blood is taken, which contains malaria parasites. These develop within the mosquito, and about one week later, when the mosquito takes its next blood meal, the parasites are injected with the mosquito's saliva into the person being bitten. After a period of between two weeks and several months spent in the liver, the malaria parasites start to multiply within red blood cells, causing symptoms that include fever and headache. In severe cases, the disease worsens, leading to coma and death.

Human immunodeficiency virus (HIV) is a lentivirus (a member of the retrovirus family) that causes ^ Acquired Immunodeficiency Syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unsafe sexual contact, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth (vertical transmission). Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.

Such infectious diseases as poliomyelitis, diphtheria, measles and tetanus most commonly occur in childhood.

While discussing the problem of infectious diseases we cannot make round of the topic of epi­demics and their management in hospitals

.^ 18. Describe what cases may be attributed to emergency. What information does an emergency operator ask for? Describe the equipment of an ambulance.

Emergency medicine is a medical specialty in which a physician receives prac­tical training to care for patients with acute illnesses or injuries which require imme­diate medical attention.

An emergency situation is not always easy to determine.

But most Accident and Emergency departments would agree that emergency situation is when a patient has stopped breathing or his heart has stopped, when he suffers severe chest pains or has trouble breathing (possible cardiac arrest).

It is also an emergency when a patient is bleeding severely, is unconscious, has had a serious head injury or has a severe burn.

When a patient has a severe allergic reaction, suffers numbness down one side (possible stroke) or cannot understand what is said to him it is necessary to provide him with immediate help.

If a patient experiences severe stomach pains which do not go away when treated by over-the-counter medicines or has overdosed or poisoned himself it is de­finitely an emergency situation.

You should call an ambulance if there are some incidents such as fall from the height, fire or assault. Also it may be RTA or public transport accident, and, of course, obstetrics.

The Emergency Medical Service can be summoned by people with an emergency telephone number which puts them in contact with a control facility and would then dispatch a suitable resource to deal with the situation.

When a call comes through, an emergency operator asks questions in order to complete an emergency call log.

It includes such data as time of call, code number, caller's name and number, location and type of incident, number and extent of injuries.

Emergency ambulance is a vehicle for transportation of sick or injured people, which provides care to patients with an acute illness or injury.

These can be road-going vans, boats, helicopters or fixed-wing aircrafts.

Ambulances are equipped with everything necessary for giving first aid and making a diagnosis.

The ambulances carry oxygen regulator and cylinders, cardiac monitor, defi- brillator, bags of blood, bag-valve mask, drug box, suction unit, dressings, sets of splints, ambulance chair and stretchers.

All ambulances are radio equipped.

This is very important for# paramedics as it enables them to send the necessary information to the hospital, so that the hospital can prepare beforehand all the neces­sary instruments for an urgent operation, blood transfusion or anything else.20. Discuss the problem of triage dilemmas. Describe main triage categories

Triage is a process of prioritizing patients based on the severity of their condition. It rations patient treatment efficiently when resources are insufficient for all to be treated immediately. Triage originated in World War I by French doctors treating the battlefield wounded at the aid sta­tions behind the front.

^ Simple triage is usually used in a scene of a "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categori­zation of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging.

S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be per­formed by lightly-trained lay and emergency personnel in emergencies.

In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.

Continuous Integrated Triage is an approach to triage in mass casualty situations which is both efficient and sensitive to psychosocial and disaster behavioral health issues that affect the number of patients. Continuous Integrated Triage employs: Group (Global) Triage, Physiologic (In­dividual) Triage and Hospital Triage.

Upon completion of the initial assessment by medical or paramedical personnel, each patient will be labelled with a device called a triage tag. This will identify the patient and any assessment findings and will identify the priority of the patient's need for medical treatment and transport from the emergency scene. Triage tags may take a variety of forms.

The triage categories in different countries are not similar, but traditionally we can define four:

  1. Immediate: The casualty requires immediate medical attention and will not survive if not seen soon. Any compromise to the casualty's respiration, hemorrhage control, or shock control could be fatal.

  2. Delayed: The casualty requires medical attention within 6 hours. Injuries are potentially life- threatening, but can wait until the 'Immediate' casualties are stabilized and evacuated.

  3. Minimal: "Walking wounded," the casualty requires medical attention when all higher priority patients have been evacuated, and may not require stabilization or monitoring.

  4. Expectant: The casualty is expected not to reach higher medical support alive without compro­mising the treatment of higher priority patients. Care should not be abandoned, spare any remaining time and resources after Immediate and Delayed patients have been treated.

In advanced triage systems, secondary (in-hospital) triage is typically implemented by paramedics, battlefield medical personnel or by skilled nurses in the emergency departments of hospitals during disasters, injured people are sorted into several categories, which are similar with the categories of "primary" triage.

As you see, the problem of triage dilemmas is of primary importance today. It represents great in­terest for the whole medical community and has a long way to move forward as it entails a lot of medical problems to discuss

.^ 29. Explain the importance of following hygiene rules at a hospital. What are the re­sults of poor hygiene at a hospital?

Long before lenses made it possible to see microscopic organisms people didn't know any­thing about hygiene. When Anton van Leeuwenhoek developed microscopes, he introduced the world to microorganisms and their role in diseases and prepared the way for the modern germ theory that had formed the basis of such branch of medicine as hygiene. The story of how Flor­ence Nightingale applied knowledge of the existence of microorganisms has become an em­blem for hospital practices. She demonstrated the importance of hygiene rules at a hospital by cleaning sewers and ventilation wards. Her approach to hygiene has formed the basis of modern nursing.

The term "hygiene" is derived from Hygeia, the Greek godless of health, cleanliness and sanitation.

In medicine hygiene practices are determined as preventative measures to reduce the inci­dence and spreading of the disease. The aim of medical hygiene is to do everything necessary to prevent and control infection. Because a lot of infection spreads by hands, a doctor must super­vise everyone from medical staff to follow the cleanliness procedures. For example, hands must be washed before and after patient contact, before and after taking off gloves and after helping the patient to use the toilet.

Also medical hygiene practice include isolation or quarantine of infectious persons or ma­terials to prevent spread of infection, sterilization of instruments used in surgical procedures, use of protective clothing and barriers, such as masks, caps, eyewear and gloves, paper bandag­ing and dressing of injuries.

The wards must also be prepared well for saving the health of patients and medical staff: the door handles should be regularly cleaned, toilets must be washed 3 times a day, floors - twice daily. Because of great risk of contamination from urine and blood the average time for clearing up spillages ofbodily fluids should be 35 minutes.

Medical hygiene practices help to avoid complications after the operations and reduce the risk of widespreading of infectious diseases. That is why hygiene rules are indispensable and require great attention and responsibility of the while medical society.
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