Formation of practical skills on the theme «The subject, purposes and methods of pathological physiology”.

The purpose of the office hour:
• Development of skills for experimental work
• Formation of communicative skills for group work

• Formation of skills for pathophysiological analysis of cases

Tasks of study:
• To master the technique of functional studies of the respiratory and cardiovascular systems in load tests (Martine, Genche, Shtange)
• To analyze and evaluate the results of the experiment

Methods of teaching
Work in groups: experimental work, pathophysiological analysis of case study

 

The task № 1.

To study the reaction of cardiovascular system in physical loading test (Martine) with the purpose of diagnose predisease

Technique: For performance of practical work students share on some working groups. In each group should be not less than four person:

1 - tested (student - volunteer)

2 - the student who measures arterial blood pressure

3 - the student who measures pulse 

4 - the student who registers data into table.

Arterial blood pressure (BP) is measured in sitting position, the average size of pulse for 10 seconds is measered. For this purpose pulse for 10 seconds is measured six times, received data are summarized and deviced by six, so we receive average pulse.

Further the examinee, without taking off cuff of tonometer from a shoulder, does 20 deep squattings within 30 seconds. Just after loading the BP and number of heart beats for 10 seconds is registered. The further counting of pulse and BP measurement are fulfilled every minute after loading until there is restoration of parameters to initial sizes. The received data are written in the table:

 

Researched parameters	before loading	Just after loading	Every other minute after loading
			1	2	3	4	5
1. Pulse for 10 sec.   2. The arterial blood pressure: systolic dyastolic pulse

 

Criteria of test estimation:

- The analysis of heart beat:

1. Time of pulse restoration after loading is 3 – 4 minutes.

2. Increase of pulse rate after loading is 50 – 70 %, is count by formula:

(pulse after loading – initial pulse) х 100

initial pulse

- The analysis of arterial blood pressure changes

1. At once after physical loading systolic pressure usually raises on 10-20 mm of hg, dyastolic pressure is reduced on 10 – 20 mm of Hg, pulse pressure increases for 20-40 mm of Hg.

2. The BP is restored after loading through 4 – 5 minutes.

It is NORMOTONIC REACTION of cardiovascular system response to physical loading and is peculiar to healthy unexercised people with a normal function of heart and vessels and sufficient adaptive abilities.

There are pathological (inadequate) types of response:

 

1. HYPERTONIC REACTION 

Systolic pressure considerably grows – up to 180-200 mm of a hg, diastolic – does not vary or raises. The gain of pulse rate increases, pulse and the BP return to initial figures in a longer time after loading, than in norm.

Such type of reaction is observed at persons with atherosclerotic changes of vessels, at sportsmen during high training loading.

 

2. DISTONIC REACTION

  Systolic pressure after loading sharply raises sometimes up to 225 mm of hg and higher, and diastolic pressure is defined on zero – a phenomenon of "infinite" tone.

 

3. ASTHENIC REACTION

It is observed at decreased heart function. Systolic pressure after loading goes down. The gain of a pulse rate is increased. Normalization of pulse and BP occurs later.

 

The task № 3.

To study the reaction of respiratory system to physical loading.

Technique: Volunteer in standing position does inspiration, expiration, then deep inspiration and holds the breath (a nose is clamped by fingers). The time of breath holding is marked by a timer (Shtange’ test). After minute rest in sitting position the examinee does a deep inspiration, the maximal expiration and holds the breath. The time of breath holding is marked by timer (Genche’s test).

Further similar tests are carried out just after physical loading (20 deep squattings for 30 seconds). The received data is written down in the table:

 

Researched parameters	before loading	right after loading
Shtange’s test
Henche’s test

 

The estimation of the tests is made by comparison of the received data with normal:

At healthy unexercised people:

Shtange’s test is 30-40 сек.

Henche’s test is 20-30 сек.

After physical loading duration of both tests is shortened on 10-15 sec.

Case study

Case № 1

    Patient A., aged 45, arrived for a spa treatment with complaints of weakness and pain in the muscles of the right shin while walking. Five years ago on the basis of vascular disease (endarteritis), he developed dry gangrene of the left foot. It had been amputated. The patient was treated with warm hydrogen sulfide baths. Soon, however, the procedure had to be canceled because of development of inflammation in the veins (phlebitis). In addition, the patient was poorly tolerated to treatment: while taking baths he showed raised blood pressure and headaches.
Questions:
1. Find out the  disease. Define disease, select disease criteria.
2. Find out the pathological reaction, give the definition
3. Find out the pathological processes, give the definition
4. Find out the pathological state, give the definition
         

Case 2

A child of 3 years old complained of sore throat, abdominal pain and headache. Body temperature was 38.5⁰ C, there was a single vomiting. After 12 hours a doctor revealed rash on the cheeks the chest, back, around the underarms and elbows, enlarged hyperemic tonsils, enlarged submandibular lymph nodes. A week ago, the child had contact with sick person with scarlet fever. The doctor diagnosed scarlet fever and prescribed antibiotics.
A week later the rash faded, but the affected skin begin to peel.
1. Call the stages of infectious disease, describe each stage, justify answer.
Case 3

A musician (pianist) injured a finger. Inflammation developed.

Does he have a disease? Justify the answer.

 

THE LIST OF LITERATURE:

The basic

5. Lectures. Handouts

6. Textbook of pathology. Harsh Mohan 3rd edition, Delhi, 1998, P 3-13.

Additional

7. Патофизиология в схемах и таблицах: Курс лекций: Учебное пособие. Под ред. А.Н.Нурмухамбетова. – Алматы: Кітап, 2004. – С. 12-17.

 

Control – conclusions on the tasks

 

2. THEME:

«GENERAL ETIOLOGY AND PATHOGENESIS. EFFECTS  OF LOW BAROMETRIC PRESSURE ON AN ORGANISM»

The purposes of the class:

· Formation of knowledge of the main issues of the theme

· Formation of skills to use the knowledge of the theoretical material for pathogenetic schemes and pathophysiological analysis of clinical cases

· Formation of communicative skills for discussion of the problem

Tasks of study:
• To learn the main issues of the theme
• To develop the skills to use the glossary in three languages for discussion of the theoretical material
• To Learn how to make pathogenetic schemes, to allocate the leading link and  vicious circles
• To  apply the theoretical knowledge in solving of clinical cases

• To form communicative skills for discussion of the theoretical material

 Questions for the theme

1. Etiology, definition. Role of causes and conditions in occurrence of diseases Etiotropic principle of preventive maintenance and treatment of illnesses.

2. Classification of etiological factors and their characteristic. Role of environmental factors and organism’s peculiarities in occurrence of illnesses.

3. Pathogenesis, definition. Primary lesion as an initial factor of pathogenesis. Levels of damage. Cause and effect relations in pathogenesis. The main (leading) pathogenetic factor, "vicious circles", definitions, examples.

4. Effects on an organism of low barometric pressure. Mountain sickness, the main symptoms, pathogenesis.

Methods of teaching

Discussion the major issues under the supervision of a teacher, discussion of video film “Modeling of mountain sickness”, pathogenetic schemes analysis

Methods of control

Oral questioning, checking conclusions of experiment, testing