THE MINISTRY OF PUBLIC HEALTH OF UKRAINE



Theme 1: "SUBJECT AND TASKS OF PAHOPHYSIOLOGY. METHODS OF PATHOPHYSIOLOGICAL INVESTIGATIONS. MAIN STAGES OF PATHOPHYSIOLOGY AS A SCIENCE DEVELOPMENT".

Actuality of the theme.

The question of regulation of function at diseased organism – it is one of central questions in the general pathology. It serves the base to study and understanding the mechanism of disorders of function at different type of pathology. The knowledge of these mechanisms is of great importance for physician at choice of the methods of the diagnostics and pathogenic therapy of diseases.

General purpose of the lesson.

Learn the principles of modeling of the pathological processes. Show the regulation of breathing in condition of pathology.

For this it is necessary to know (the concrete purposes):

1. To master the elementary skills of planning and carrying out the experiments on laboratory animals.

2. To be able to draw up a protocol of study, analyze, process, summarize extracted results and make the conclusions.

3. To fall into a, what is the subject of pathophysiology, pathophysiology tasks, significance of pathophysiology for the future specialist.

4. To know, what is the physiological regulation of functions, what are the mechanisms of it.

For realization of purposes of lesson it is necessary to have the base knowledges-skills.

1. To know the methods of the empirical cognition: scientific observation, scientific experiment, empirical modeling (the department of the social sciences - discipline - philosophy).

2. To have a notion about the main rules of bioethics (the department of the social sciences - discipline - philosophy).

3. To reveal the mechanisms of neuro-reflector regulation of the external breathing (the department of normal physiology).

4. To explain at concrete examples the mechanisms of humoral regulation of external breathing (the department of normal physiology).

5. To reveal the mechanisms neurohumoral regulation of external breathing (the department of normal physiology).

6. To reveal the role a reflexes from the receptors of the mucous shell of the upper respiratory ways at regulation of the external breathing (the department of normal physiology).

The checking of primary level of knowledges.

Give the answers to the following questions:

1. How is realized the mechanisms of neuro-reflector regulation of external breathing?

2. How is realized the mechanisms of humoral regulation of external breathing.

3. How is realized the mechanisms of neuro-humoral regulation of external breathing.

4. Significance of the reflexes from receptors of the mucous shell of the upper respiratory ways at regulation of the external breathing.

5. The modern beliefs about respiratory centre.

6. The role of hydrogen at regulation of the external breathing.

7. The role CO2 at regulation of the external breathing.

8. The direct indexes of efficiency of the external breathing.

Theoretical questions, at the base of which the execution of purpose types of activity is possible.

1. Pathophysiology as a science. Place of the pathophysiology at the system of medical knowledge.

2. Role of the achievements of molecular biology, genetics, biochemistry, physiology, immunology and other sciences in the development of modern pathophysiology.

3. History of the pathophysiology. The value of scientific works of K.Bernar, R.Virhov, J.Konheym, I.Mechnikov, V.Pashutin, G. Selje and other prominent researchers.

4. Schools of the pathophysiologists (H.A.Hrzhonschevskyy, V.V.Pidvysotskyy, V.K.Lindeman, A.A.Bogomolec, M.M.Syrotynin, A.V.Reprov, D.O.Alpern, V.V.Voronin, M.N.Zaiko).

5. Scientific schools of the pathophysiologists, main directions of their activities.

6. Pathophysiology as educational discipline and its components.

7. Subject of pathophysiology, purposes and tasks. Connection of pathophysiology with other disciplines.

8. Methods of pathophysiology.

9. Experimental modeling of pathological processes. Types of experiments. Modern methods of the experiment, the rules of working with experimental animals.

10. Place of pathophysiology in the training of physician. Methods of clinical pathophysiology.

11. Regulation of functions in the health and diseases.

12. Values of clinical pathophysiology and preventive medicine. Clinical pathophysiology.

Literature is necessary for studying of the theoretical questions.

1. Handbook of general and Clinical Pathophysiology/ Edited by prof.A.V.Kubyshkin, CSMU, 2005. – P.5-7.

2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.3-10.

After adopting the theoretical questions students learn the practical part of lesson.

Practical work: «REGULATION OF FUNCTIONS IN PATHOLOGICAL PROCESSES».

Object of work: to show how respiratory regulation occurs in the case of the stricture of the airways and effect of the chemical irritans.

Description of experiment:The work is of demonstration type with the assistance of the students.

Each subgroup carries out an acute experiment with a rabit. The rabit is tied to the bench. The graphic recording of the initial respiration is performed on the tape measure of the kimograph with the help of the cuff applied to the thoracic cavity and connected by means of a rubber tube with a capcule of Mareae.

Experiment 1. Cause incomplete asphyxia by partial clamping of the trachea lumen. The recording of respiration and its analysis are carried out in this condition.

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Conclusion:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Experiment 2. For 15 sec to allow the rabit to breath with ammonia vapour and repeat the procedure in some minutes. To record respiration in this condition.

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Conclusion:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Experiment 3. Inject 0,5 ml of 0,1n solution of lactic acid into the lateral vein of the rabbit's ear. To record respiration in this condition. To make the analysis. To make the conclusions.

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Conclusion:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Experiment 4. Cause a full asphyxia claming the trachea. To study the development of the stages of asphyxia averting the animal from death.

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Looked after development of stages of asphyxia:

1. Stage of excitation:

1) inspiratory dyspnea

2) expiratory dyspnea

2. Stage of braking:

3) Gasping-breathing, apnoea

Conclusion:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Theme 2: " GENERAL STUDY ABOUT NOSOLOGY, ETIOLOGY AND PATHOGENESIS (the SEMINAR)".

Actuality of the theme.

Teaching about disease, or the general nosology (from greek “nosos” - a disease), belongs to belongs to the most old problem of medicine since. States of health and disease, as a rule, are interleaved and go one in another often without observable borders. For physician it is important to have general criteria, which gave him possibility faultless to distinguish health from disease.

Study about etiology or reason and condition of the development of the diseases, belongs to the oldest problem of medicine since because the first question, with which the physician is confronted at examination of sick, concerns its reasons. Find the reason a disease – it means to find the way to its treatment and preventive maintenance. However, this question is not from lights often. Special etiology studies the concrete reasons and condition of the arising the separate diseases.

Thereby, teaching about reason of the origin disease (etiology) is natural-scientific base one of the most important principle of medicine - its preventive directivity.

Studies about pathogenesis belong to the most actual problems of modern medicine. In fact only understanding general mechanism of development, motion and outcomes of diseases, it is possible to consider one a «thinking» doctor.

The sequence of changes is determined in an organism for every disease, cause-effective relations appear between different structural, metabolic and functional changes are determined at the same time. In other words factors which assist subsequent development of illness are determined.

The analysis of pathogenesis requires the clear understanding of role of etiologic factor in pathogenesis, and also correlation between general and local, structural and functional. Understanding of cause-effect relations and ability to see and select the «main link» of pathogenesis will allow the doctor of any profession to liquidate a pathological process and accelerate the offensive of favorable consequences of illness.

General purpose of the lesson.

1. To know how to define biological and social essence of disease, the general regularities of dynamic of its development.

2. To learn the role of the reasons and conditions in development of disease.

3. To learn the general conceptions of pathogenesis, to interpret the mechanisms of development of pathological processes correctly.

For this it is necessary to know (the concrete purposes):

1. Explain the basic concepts of general nosology: health, disease, pathological process, typical pathological process, pathological reaction, pathological condition, etiology, pathogenesis.

2. Explain the basic concepts of etiology: causal factors, risk factors, and conditions of disease development.

3. Analyze various options for the cause-effective relationships in pathogenesis.

4. Analyze of pathological phenomena in the pathogenesis: adaptive-compensatory, general and local, specific and nonspecific, leading to main link of pathogenesis.

5. Evaluate the importance of modern methods of research (experimental and clinical) for the pathophysiology.

For realization of purposes of lesson it is necessary to have the base knowledges-skills.

1. To have a notion about correlation the weltanschauung and philosophy (the world, its structure, types) (department of the social sciences - discipline – philosophy).

2. To know philosophy of the Ancient East, China, Greece, Rome, Middle Ages and Renaissance (department of the social sciences - discipline – philosophy).

3. To be aware of the teaching of dialectical materialism. Have a notion about dialectics and its alternative (department of the social sciences - discipline – philosophy).

4. To know the philosophical conception of Z. Freud (department of the social sciences - discipline – philosophy).

5. To know the main philosophical categories: thing, characteristic, attitude, reason and effect, single and the general, necessities and casual, reality and possibility, contents and the form, essence and phenomena, system, element, structure and function (department of the social sciences - discipline – philosophy).

6. To have a conception about problem of the person in philosophy (the psyche and consciousness; biological, social and spiritual at person) (department of the social sciences - discipline – philosophy).

7. To have a notion about such philosophical conceptions, as: matter, motion, space and time (department of the social sciences - discipline – philosophy).

8. To have a notion about general-logical methods: abstracting, analysis and syntheses, induction and deduction, comparison and analogy (department of the social sciences - discipline – philosophy).

9. To know the methods of the empirical cognition: scientific observation, scientific experiment, empirical modeling (department of the social sciences - discipline – philosophy).

10. To have a conception about relationship of philosophy and medicine (the theories of the diseases to civilizations, ecological concepts) (department of the social sciences - discipline – philosophy).

11. To have a notion about philosophical problem of the life and death (department of the social sciences - discipline – philosophy).

12. To have a notion about the main rule of bioethics (department of the social sciences - discipline – philosophy).

Information required for renewing the base knowledges it is possible to find at the following textbook:

1. Lectures from the philosophy course.

Check primary level of knowledge.

Give the answers to the following questions:

1. Name the main history directions of development of the teaching about disease.

2. Name the factors, from which the different looks at disease on different stage of mankind development are depending on.

3. Hippocrates contribution at development of the general teaching about a disease.

4. Characterize the humoral and the solidary direction.

5. Galen contribution at development of the general teaching about disease.

6. Avicenna contribution at development of the general teaching about disease.

7. Paracelsus contribution at development of the general teaching about disease.

8. Characterize the jatrochemical and the jatrophysical direction.

9. R. Virhov contribution at development of the general teaching about disease.

10. Formulate the main positions of cellular pathology of Virhov.

11. Name positive and negative importance of cellular pathology of Virhov.

12. Give definition of the conception "health".

13. Give definition of the conception "disease".

14. Give the definition of the conception "pathological process" (cite an example).

15. Give the definition of the conception "pathological reaction" (cite an example).

16. Give the definition of the conception "pathological state".

17. Give the definition of the conception "typical pathological process" (cite an example).

18. Principles of classifications of the diseases (cite an example).

19. Name the periods of disease and give the feature of each period.

20. Name the outcomes of the diseases.

21. Give the definition of the conception "clinical death".

22. Give the definition of the conception "biological death".

23. Give the definition of the conception "social death".

24. Give pathophysiologycal characteristic of the terminal states.

25. Name the factors, from which duration of clinical death depends.

26. Name the pathophysiologycal principles of reanimations

27. Give the definition of conception "etiology".

28. Name the main stages of the development of the teaching about etiology at pathology.

29. What is the monocausalism? Explain the reasons of origin this direction in medicine?

30. Significance of monocausalism in the development of the general studying about etiology.

31. What is the conditionalism?

32. Significance of conditionalism in the development of the general studying about etiology.

33. What is the constitutionalism?

34. Significance of constitutionalism in the development of the general studying about etiology.

35. Give the definition of psychosomatic direction.

36. 1Significance of psychosomatic direction in the development of the general studying about etiology.

37. What is the philosophical base of general etiology?

38. 1What is a methodological base of general etiology?

39. Name the main positions of dialectics-materialistic determinism.

40. Modern understanding of causality at pathology.

41. Role of the conditions at arising of the diseases. Classification of conditions.

42. Notion about mono- and polyetiologic diseases.

43. Classification of etiological factor.

44. What is the "risk factors"? Cite an example.

45. Significance of "risk factors" at development of the diseases.

46. Significance of the general studying about etiology for theoretical and practical medicine.

47. Give definition of concept «pathogenesis».

48. Explain the role of etiologic factor in pathogenesis (to make examples).

49. Name the variants of interaction factor with an organism in time.

50. Give description of role of structural and functional changes in pathogenesis.

51. Give description correlation between “general” and “local” in a pathological process.

52. What is “main link” of pathogenesis?

53. Name the types of cause-effect relations.

54. Give definition of conception «Vicious circle» in pathogenesis.

55. Make an example of direct type of cause-effect relations.

56. Make an example of cause-effect relations on the type of «convergence».

57. Make an example of cause-effect relations on the type of «divergence».

58. Make an example of cause-effect relations on the type of «vicious circle».

59. Significance of common studies about pathogenesis.

Theoretical questions, at the base of which the execution of purpose types of activity is possible.

1. Basic concepts of nosology: norm, health, disease, pathological process, typical pathological process, pathological reaction, pathological condition.

2. Main directions of the study about the disease: humoral (Hippocrates), solidary (Democritus), cellular (R.Virchov). Development of these areas today.

3. Principles of diseases classification.

4. Basic periods of illness. Outcomes of diseases.

5. Concept of terminal states (agony, preagony, clinical death) and biological death.

6. Pathophysiological basis of reanimation.

7. Definition of etiology.

8. Main directions of the study about the etiology.

9. Modern conceptions of the causal factors, risk factors, conditions and development of disease.

10. Classification of etiological factors.

11. Environmental, genetic, accumulative and ontogenetic concept of human diseases.

12. Ethiotropic principle of treatment and prevention of disease.

13. Definition of pathogenesis. Manifestations of damage at the different levels: molecular, cellular, tissue, organ, organism.

14. Protective adaptative reactions. Adaptation, compensation. Mechanisms of immediate and long-term adaptation. Role of nerve and humoral factors in their implementation.

15. Cause-effective relationships, their variants and “vicious circle".

16. Concept of the "main link" in pathogenesis.

17. Local and general, specific and nonspecific manifestations in the pathogenesis.

18. Unity of the structural and functional changes of the disease.

Theme of reports:

1. Hyperbaric oxygenation, it’s using in medicine.

2. Social death as physician-social problem of mankind.

3. Adaptation, compensation. Mechanisms of immediate and long duration adaptation.

4. Role of Virchov in development of study about pathogenesis. Positive and negative value of cellular theory.

5. Adaptation, compensation. Mechanisms of immediate and long duration adaptation.

6. Role of Virchov in development of study about pathogenesis. Positive and negative value of cellular theory.

Literature is necessary for studying of the theoretical questions.

1. General nosology. Manuals for the students. – Vinnitsia, 2007.

2. Handbook of general and Clinical Pathophysiology/ Edited by prof. A.V.Kubyshkin, CSMU, 2005. - P. 7-11.

3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.10-12

4. Lecture’s materials.

Checking of the final level of knowleges.

“KROK-1” open database 2010

1. A patient with gastric ulcer underwent a course of treatment, wich led to digestion normalization, pain relief, better mood. However in a few weeks the epigastric pain as well as heartburn and sour eructation reccurred. Such course of the disease can be characterized as:

A. Remission period

B. Relapse

C. Complication

D. Latent period

E. Prodromal period

2009 -

2008 – 2004

1. Atrophy of the alveolar processes of the jaw after tooth extraction marked in the patient. This is an example of:

A. Pathological condition

B. Pathological reaction

C. Pathological process

D. Norm

E. Diseases

2. In women, aged 55, a dentist discovered a number of teeth affected by caries. How can you call this disorder?

A. Pathological process

B. Pathological conditions.

C. Pathological response

D. Disease.

E. The reaction device.

3. Man, aged 60, lost many teeth on the upper and lower jaws as result of paradontitis. What occurs as a consequence in the body?

A. Pathological condition

B. Pathological process.

C. Latent period

D. Relaps

E. Remission.

4. In patients suffering from caries that was complicated by acute purulent inflammation of periodont, the tooth extraction was made. Which of the pathological phenomena in this patient should be referred to the term "pathological condition"?

A. The absence of this tooth

B. Caries

C. Fever

D. Inflammation of periodont

E. Periodontitis

5. Boy V., 12, returned from the school, he began to complain of headache, nausea, chills, intermittent pain in muscles, loss of appetite, fatigue. What period of illness is characterized by such symptoms?

A. Prodromal

B. Latent

C. Incubation

D. Manifestation of disease

E. Outcome

6. Man, 49 years old, who 12 years ago suffered from rheumatic myocarditis and endocarditis, has mitral valve insufficiency. Examination have shown that inflammation is absent, minute volume of blood circulation is sufficient. What notion of general nosology this requirement is characteristic for?

A. Pathological condition

B. Pathological reaction.

C. Pathological process

D. Typical pathological process

E. Compensatory reaction.

7. Stenosis of the pylorus was revealed at radiographic examination of the patients with peptic ulcer disease. This violation is:

A. Pathological conditions

B. Pathological process

C. Disease

D. Pathological reaction

E. Outcome

8. Patient K., age 39, was suffering from a stomach ulcer for the last 4 years. Especially his condition worsened in the spring: there is pain in the epigastrium, heartburn, nausea, constipation. How to name the state of the patient between of relapsing?

A. Pathological process

B. Pathological conditions.

C. Pathological response

D. Compensatory reaction.

E. Health.

9. Man, 50 years, lost many teeth as result of trauma. What will occurs as a result?

A. Pathological condition

B. Latent period.

C. Relapse.

D. Remission.

E. Pathological process.

10. Female, 55 years, 10 years ago suffered from myocarditis with mitral valve insufficiency. Currently, no complaints. Hemodynamics in the norm. What notion of general nosology this requirement is characteristic for?

A. Pathological condition

B. Pathological process

C. Typical pathological process

D. Pathological reaction.

E. Compensatory reaction.

11. Ulcer scar were found at the fibrogastroscopy after the treatment of gastric ulcer. Which pathophysiological categories can be attributed to this phenomenon?

A. Pathological condition

B. Pathological processes

C. Pathological reflex

D. Defensive reaction

E. Pathological response

12. Lack of the upper left bicuspid was founded at the dental examination at the patient, 37 years. The tooth was removed two years ago because of paradontosis. This is:

A. Pathological condition

B. Pathological response

C. Pathological process

D. Chronic process

E. Complications

13. Man, 32 years, came to a dentist, six months after the tooth extraction. Color of mucous membrane in the place of extraction is not differ from other parts of the mouth. What is this phenomenon?

A. Pathological condition

B. Pathological reaction.

C. Pathological process.

D. Typical pathological process.

E. Compensatory reaction.

14. The aseptic inflammation was modeled in the experiment by the introduction of irritating solution into the abdominal cavity. How to consider the concept of disease in this case?

A. As a typical pathological process

B. As the disease on this patient.

C. As a nosologic unit.

D. As a philosophical generalization.

E. As a pathological condition.

15. Patient, 60 years, appealed to the dentist. The doctor found a caries of the 3 teeth. This is?

A. Pathological process

B. Pathological conditions.

C. Relapse.

D. Latent period.

E. Prodromal period.

16. A woman who treated teeth because of caries agreed to remove the tooth due to complications. What pathological phenomena in women can be attributed to the term "pathological condition"?

A. Lack of teeth

B. Fever

C. Redness

D. Swelling

E. Caries

17. Rhinitis, dermatitis, bronchial asthma was marked at the workers of the carpet marked. According to which classification these diseases can be attributed to one group?

A. Pathogenic

B. Topography - anatomical

C. Environmental

D. According to the age

E. According to the sex

18. Patient with the complaints of pain in the right subcosteal area, general weakness, yellowness of the skin, discolored feces entered in the infectious department. Objective: yellow skin and sclera, t-39 ° C, enlarged liver, feces is acholic. He was diagnosed with infectious hepatitis. Which stage of disease is described?

A. Manifestation of disease

B. Incubation period

C. Latent period

D. Prodromal period

E. Recovery

19. Gum papillae and gingival margin mucosa is hyperemic, swollen, bleeding in two weeks after the placing of the crowns of teeth. What is the founded gingivitis?

A. Nosologic unit

B. Typical pathological process

C. Pathological condition

D. Pathological reaction

E. Syndrome.

20. Gum papillae and gingival margin mucosa is hyperemic, swollen, bleeding in two weeks after the placing of the crowns of teeth. Gingivitis was diagnosed. What is the hyperemia at gingivitis?

A. Symptom

B. Syndrome.

C. Nosologic unit.

D. Typical pathological process.

E. Pathological conditions.

Situation tasks:

1. As a result of voltage swing the equipment of a dental office became out of service. When the doctor was trying to repair dental equipment by himself he accidentally grabbed his hand on the wire with voltage 220 V. He wasn’t able to disconnect because of convulsions of the muscle. He quickly lost consciousness. Within minutes he was disconnected by the other cabinet officers, who called an ambulance. The ambulance doctor stated the stop of breathing at kept heart. On hands and both feet there are small and deep wounds with slightly charred edges. The artificial respiration was carried out to the victim during 2.5 hours (till appearance of spontaneous breathing).

1. Can we say that the victim was in a state of clinical death?

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2. Explain your conclusion.

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2. Patient S., 28, delivered in a hospital intensive care unit in serious condition. He was foundedon the street with a trauma of the maxillofacial area and massive bleeding. Objective: unconscious, skin and visible mucous membranes are pale with cianosis, the pupils are dilated, blood pressure - 0. Pulse has been determined, breathing and reflexes are reduced, pain sensitivity is absent.

1. What terminal condition these violations are characteristic for?

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2. What reanimation measures should be used?

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3. A. The patient applied to dental clinic with complaints of pain in the tooth pulsating character, increases with the closing of jaws. The pain lasts a few days. For relief of pain patient puts pad with ice on the area of the sick tooth. Condition became better fol shot time, but one day before suddenly fever to 38-390C, general weakness, sweating, sore throat when swallowing and speaking developed. The doctor diagnosed periodontitis, which was complicated by phlegmon of the bottom of the mouth.

1. What is the direct cause of disease ?_________________________________________

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2. What is the role of overcooling in this case ?_______________________________

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4. Patient S., 37, who suffered from the accident, was taken to the admission department of the hospital in serious condition. The fracture of facial bone, profuse bleeding was observed in the patient. Objective: unconscious, skin and visible mucous membranes are pale with cianosis, the pupils are dilated, blood pressure - systolic 40mm.Hg. (Diastole is not determined). Pulse 30 beats / min, Gasping-breathing, reflexes are reduced, pain sensitivity is absent.

1. What terminal condition these violations are characteristic for?

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2. What reanimation measures should be used?

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5. Patient A., age 22, entered the dental clinic with extensive trauma of maxillofacial area. During the operation, carried out under the endotracheal anesthesia, there was a blockage of endotracheal tube by the mucus. The breathing is stopped, pulse disappeared soon. After 2 min. after onset of clinical death suction of mucus from the trachea was made and artificial respiration started. Injection into the right brachial artery 300 ml of blood with 1 ml of adrenaline (1:1000) under pressure 220 mm Hg was conducted simultaneously. In the absence of effect thorax revealed and direct cardiac massage made. After 1 min. after the massage heart beat and breathing were resumed. Postoperative condition is satisfactory.

1. What are the basic principles of reanimation?

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2. Is it justified the transition from indirect to direct cardiac massage during ventricular fibrillation without prior defibrillation?

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6. Patient M., aged 14, entered the dental clinic with complaints of severe pain in the tooth, aggravated while taking of sweets. He linked the disease with excessive consumption of carbohydrates as food, sweets, sugar, sugary carbonated drinks. After investigating the patient was diagnosed: "caries".

1. What is the direct cause of disease in this case?

____________________________________________________________________________________________________________________________________________

2. What factors contribute to the development of this disease?

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7. Patient S., 40, entered the dental clinic complaining of pain in the region of the lower jaw of pulsating nature, pain of throat and tongue root in time of swallowing and speaking, headaches, general weakness, loss of appetite. Objective: the gum at the area of the left mandibular molars swollen, red with a cianosis, the pus exuds from the gingival pockets ander the compression; purulent infiltrare is palpate in the area of root of the tongue. Body temperature - 38.5°C. The number of leukocytes in the blood – 18x109/l, ESR - 20mm/hour. It is known that patient is suffering from chronic periodontitis.

1. What is the connection between described local and general changes?

____________________________________________________________________________________________________________________________________________

2. Name local and general signs.

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8. Patient, 34 years old, was operated because of phlegmon of mouth floor. In the postoperative period he was appointed to strict bed rest and antibiotic therapy, to prevent septic complications. However, the patient was not following prescribed treatment, and therefore three days after the operation a postoperative wound infection developed again.

1. What is the significance of etiological factor in the pathogenesis?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. From what characteristics of the etiological factor the consequences in this case depend on?

________________________________________________________________________________________________________________________________________________

9. In patients with untreated caries of tooth pulpitis developed, which was complicated by osteomyelitis of the mandible. Objective: body temperature 39,5°C, leukocytosis, shift of leukogram to the left, ESR increase.

1. List separately the local and general signs of inflammation.

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2. Does it possible to say that inflammation is purely local process?

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10. At the child, 1 year, with decompensate violation of phosphoric-calcium metabolism rickets developed, which was complicated by deformation of the jaws and the development of malocclusion.

1. Name local and general signs in this case?

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2. What is the relationship between described local and general changes?

____________________________________________________________________________________________________________________________________________

11. At children, 1.5 years old, malocclusion and disturbance of dentition were founded by a dentist. After detailed examination disorders of parathyroid glands function that accompanied with violation of phosphoric-calcium metabolism was founded, in the pathogenesis of which the main link is reducing of PTH production by parathyroid gland and development of hypocalcemia.

1. What is the main link of pathogenesis?

________________________________________________________________________________________________________________________________________________

2. Why do we need to identify the main link of pathogenesis?

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12. A child, 4 years old, entered to the dental clinic with frequently recurrent aphthous stomatitis. After careful examination of the patient diabetes mellitus 1st type was diagnosed.

1. What is the relationship between described local and general changes?

____________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Do the general changes have the leading part in the development of pathological process all the time?___________________________________________________________

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13. Patient M, 32 years old, came to the dental clinic with complaints of pain within the same tooth, pulsating character, increases with the closing of the jaws and touch. Objective: signs of inflammation of periapical tissues.

1. What period of disease is characterized by described symptoms?

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2. Give the characteristic of all periods of the disease.

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14. Patient M., aged 14, entered the dental clinic with complaints of severe pain in the tooth, aggravated while taking of sweets. He linked the disease with excessive consumption of carbohydrates as food, sweets, sugar, sugary carbonated drinks. After investigating the patient was diagnosed: "caries".

1. What is the direct cause of disease in this case?

____________________________________________________________________________________________________________________________________________

2. Give the definition of “risk factors”. Give an example of risk factor and disease.

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15. In the patient P., 54 years, there is a lack of teeth after suffering a periodontitis, accompanied by progressive destruction of the alveolar processes.

1. What period of disease is characterized by described symptoms?

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2. Name the variants of given period of disease.

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Theme 3: PATHOGENIC EFFECT OF THE ENVIRONMENTAL FACTORS (mechanical factor, ionizing radiation, barometric pressure, high and low temperatures, chemical, biological, social and psyhical).

Actuality of the theme.

Ionizing radiation is radiation, which interaction with the environment results in ionization with the formation of electric charges with different signs. Ionization and accompanying it excitement of atoms and molecules is a starting mechanism of processes that results in the development of the radial damage of biological structures of cells, tissues, organs, systems of the whole organism.

Mechanical trauma is one of the main reasons of hospitalization and before the proper time disability. According to the data of the World Organization of Health 250 thousands of peoples perish from incidents on the roads and more than 10 millions get injuries every year.

A man feels the influence of diminished barometric pressure at climbing in mountains or at flight in aircrafts (at decompression of airplane cabin). The influence of the high barometric pressure at immersion into water.

Thermal factor is of great importance in the development of pathologic processes. Overheating and super cooling result in changing of thermoregulation, disorders of different organs and systems of the organism.

Knowledges of the mechanisms of hyper and hypothermia are necessary for working out the methods of treatment and prophylaxis of these pathological processes.

Electric current is one of the most dangerous environmental factors that has a pathogenic influence and results in the development of the extreme states. The wide use of the latter in industry in everyday life in natural conditions with diagnostic and therapeutically purpose. The possibility of emergency situations bring about the necessity of deep study of electric current effect on the organism

Among the pathological environment factors chemical substances take one of leading places. Constant decreasing of their number is observed. Now more than five million different chemical substances have been registered in the world and about two thousand new ones are synthesized every year. A man widely enough contacts with 60 – 70 thousand chemical substances. Scientific and technical progress is associated with steady decrease of mass of chemical substances that get in an environment.

In basis of mechanisms of pathogenic effect of chemical factors there lies their ability to react with normal components of the organism and change their structure, and, consequently, and functional properties.

General purpose of the studies - to learn the mechanisms of pathogenic action of mechanical factors and ionizing radiation on the organism, to learn pathogenic influence of barometric pressure, high and low temperatures on an organism; to learn the mechanisms of pathogenic action of electric current on the organism, to learn the mechanisms of pathogenic action of chemical, biological, psychical and social factors on the organism.

For this purpose it is necessary to be able (concrete aims):

1. To analyze the role of environmental factors in causing of disease;

2. To analyze general laws of the pathogenic mechanisms of environmental factors on the organism; to explain pathogenic mechanisms of physical, chemical and biological environmental factors;

3. To explain the cause-effective relationships, with separate local and general changes, pathological and adaptive-compensatory reactions in the pathogenesis of the manifestations of environmental factors action (overheating, cooling, burns, freezing, radiation sickness, disease, compression and decompression);

For realization of aims of study base knowledge-abilities are needed.

1. Physical essence of the mechanical force (the department of physics).

2. Physical nature of different types of ionizing radiation (the department of physics).

3. Biological nature of different types of ionizing radiation (the department of physics).

4. Blood cells and methods of their counting (the department of normal physiology).

5. Gas composition of the blood and partial pressure of oxygen in the atmospheric air (normal physiology department).

6 Dependence of degree of hemoglobin saturation with oxygen on its partial pressure (normal physiology department).

7. Dependence of physic and chemical properties of gases in liquids on barometric pressure (department of physics).

8. Dependence of physic and chemical properties of proteins on the temperature of environment (department of physics).

9. Regulation of heat exchange is an organism (normal physiology department).

10. Basic physical parameters of electric current (department of physics).

11. Electric properties of living tissue (physical department).

12. Types of reactions of chemical factors with the most important biological substances (biochemistry department ).

13. Products of ethanol oxidization (biochemistry department).

Information, necessary for addition to base knowledges-abilities on these questions, can be found in the followings textbooks:

1. Medical Physiology, Arthur C. Guyton, M.D.John E.Hall, Ph.D., W.B. Saunders company, 1996.

Testing of primary level of knowledge.

Give answers on the followings questions:

1. What structures have the greatest stability to breaking?

2. What tissues are the most stable to compression?

3. The dysfunction of what organs and systems is leading at the “crush” syndrome?

4. What changes in the picture of blood are characteristic of the first period of osteo-cerebral form of radiation sickness?

5. What changes in the blood picture are the characteristic of the second period of osteo-cerebral form of radiation sickness?

6. What changes in the blood picture are the characteristic of the third period of osteo-cerebral form of radiation sickness?

7. What do we call the first period of osseocranial form of radiation sickness?

8. What do we call the second period of osseocranial form of radiation sickness?

9. What do we call the third period of osseocranial form of radiation sickness?

10. What do we call the 4th period of osseocranial form of radiation sickness?

11. What forms of radiation sickness do you know?

12. Radiation sickness complications.

13. What do the radiation sickness complications depend on?

14. What do the mechanisms of pathogenic action of ionizing radiation consist of?

15. What is radiolysis of water? What is its significance in the mechanisms of pathogenic action of ionizing radiation?

16. What types of radiation do you know?

17. What are radiotoxins? What radiotoxins do you know? What is their significance in the mechanisms of pathogenic action of ionizing radiation?

18. What system is most sensible to radiation? Motivate you answer.

19. What does the sensitivity of tissues to the action of ionizing radiation depend on?

20. What are the stages of traumatic shock?

21. Call the main the mechanisms of the pathogenic action of the mechanical factor?

22. What mechanisms of the pathogenic action of ionizing radiation consist of?

23. When does a man undergo the action of high barometric pressure?

24. When does a man undergo the action of diminished barometric pressure ?

25. What is euphoria?

26. What is saturation?

27. What is desaturation?

28. What changes of gas composition of blood characterize mountain sickness?

29. How does solubility of gases change at the elevation of barometric pressure?

30. How does solubility of gases change at the diminishing of barometric pressure?

31. At what altitude does boiling of biologic liquids at the body temperature take place?

32. What is explosive decompression?

33. What is gas embolism? How does the change of barometric pressure influence on its development?

34. What is bleeding from the nose and ears at the diminishing of barometric pressure associated with?

35. What is hyperoxia? What is the manifestation of toxic action of oxygen?

36. Why in removing of СО2 disturbed at hyperoxia?

37. What is burn disease?

38. Stages of burn disease.

39. When does heat stroke develop?

40. When does sunstroke develop?

41. What conditions are favorable for the pathogenic effect of high temperature of the environment?

42. What properties does the pathogenic action of electric current depend from (to enumerate)?

43. What is the significance of pathway of electric current in the organism? Ground.

44. What is the significance of physiological state of organism at the action of the electric current?

45. What forms the base of the electrochemical effect of the electric current?

46. What forms the base of the electro thermal effect of the electric current?

47. What does the electromechanical effect of the electric current consist of?

48. What local disorders develop in the tissues at passing of the electric current?

49. What is teratogenic effect? What environment factors is it inherent to?

50. What does mutagenous effect of chemical factors consist of?

51. What is „ the effect of adaptation”? What environmental factors is it inherent to?

52. Mention the biological effects that appear due to the action of chemical environmental factors.

53. What is a psychical effect?

54. What pathology may develop under the influence of the psychical factors?

55. What are social factors?

56. What are jatrogenic diseases?

Abstinence (Lat. abstinentia - retention) is the state that develops when some substances that cause narcotic dependence stop getting into the organism.

Abstinence is characterized by the vegetosomatic, psychical, neurological disorders.

Theoretical questions on the basis of which implementation of purpose types of activity is possible.

1. Classification of pathogenic environmental factors.

2. Pathogenic effect of mechanical factors.

3. Laws of mechanical trauma, crush-syndrome, traumatic shock.

4. Pathogenic effect of ionizing radiation. Types of ionizing radiation. Radiosensitive tissues.

5. Mechanisms of direct and indirect radiation damage of biological structures. Radiolysis of water. Radiotoxins.

6. Manifestations of radiation injury at the molecular, cellular, tissue, organ and systemic levels.

7. Pathogenesis of radiation disease, its basic forms and syndromes.

8. Nearest and long-term consequences of large and small doses of ionizing radiation. Stochastic and non-stochastic effects.

9. Natural mechanisms of radiation protection. Pathophysiological basis of radioprotection.

10. Pathogenic effect of thermal factors.

11. Protective, reactions and pathological changes in hyperthermia.

12. Heat- and sunstroke.

13. Burns, burn disease.

14. Hypothermia. Protective, reactions and pathological changes in hypothermia.

15. Mechanisms of long-term adaptation to cold.

16. Artificial hypothermia and its use in medicine.

17. Pathogenic effects of infrared and ultraviolet rays.

18. Photosensitization. Risk of insufficient insulation.

19. Injury caused by electromagnetic radio waves of high frequency.

20. Pathogenic effect of electrical current. Factors that determine the nature of injuries at that.

21. Effects on the body of high and low atmospheric pressure.

22. Cause-effective relationships in the pathogenesis of compression and decompression syndromes. Explosive decompression.

23. Effects on the body of space flight factors - acceleration, weightlessness.

24. Chemical pathogenic factors as a problem of ecology and medicine.

25. The concept of toxicity, carcinogenicity and teratogenicity of chemical compounds.

26. Exo-and endointoxications.

27. General laws of poisons, specific and nonspecific mechanisms of intoxication.

28. Natural mechanisms of protection against toxins and poisons.

29. Pathophysiological aspects of alcoholism, drug addiction, substance abuse.

30. Infectious process, the general patterns of development.

31. Classification of infectious agents.

32. Protective barriers against infection, the conditions to overcome them.

33. Distribution and dissemination of infectious agents in the body.

34. Sepsis.

35. The role of pathogen properties and reactivity in the development of infectious diseases.

Literature.

1. Handbook of general and Clinical Pathophysiology/ Edited by prof. A.V. Kubyshkin, CSMU, 2005. - P.12-18.

2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. - p. 14-29.

3. Manual of the department “General nosology”, Vinnitsia, 2010. – p. 18-36

Themes of reports for individual work of students:

1. Remote results of the ionizing radiation influence.

2. Pathogenic effect of infra-red rays.

3. Pathogenic effect of ultraviolet rays.

4. Medical aspects of consequences of the accident in Chernobyl atomic station..

5. Hypothermia. Its application in medicine.

6. Application of hypothermia in modern medicine.

Testing for checking of final level of knowledge

“KROK-1” open database 2010

1. As a result of a trauma a patient has developed traumatic shock. The patient is fussy, talkative, pale. AP-140/90 mm Hg, Ps-120 bpm. This condition is consistent with following shock phase:

A. Terminal

B. Latent

C. –

D. Erectile

E. Torpid

2. 30 minutes after a road accident a 35-year-old man was found to have a massive trauma of his lower extremities without significant external haemorrhage. The injured is in excited state. What is the leading component of traumatic shock pathogenesis that requires immediate correction?

A. Pain

B. Internal organs dysfunction

C. Internal plasm loss

D. Intoxication

E. Internal haemorrhage

3. A patient was delivered to hospital after having been exposed to ionizing radiation. He presents with vomiting, anorexia, pain in different region of abdomen, bloody feces, elevation of body temperature, inertness. Such clinical presentations are typical for the following form of acute radiation disease:

A. Intestinal

B. Toxemic

C. Bone-marrow

D. Cerebral

E. Combined

2009 –

1. A patient with the cancer of the mandible, 52 years, have passed radiotherapy. Tumor size decreased. Which of the mechanisms of cell damage causes the most effectiveness of radiation therapy?

A. Mutagenesis

B. NK-cell lysis

C. Thrombosis

D. Hyperthermia

E. Formation of free radicals

2. In the long term while climbing in the mountains there is an increase of erythrocytes number from 5.0 x 1012/l to 6,0 x1012/l. What was the reason of erythropoiesis stimulation?

A. Increase in pO2 in arterial blood

B. Increase in pO2 in venous blood

C. Reduction of pO2 in venous blood

D. Reduction of pO2 in arterial blood

E. Increase in pO2 in cells

2008 – 2004

1. Hydrocyanic acid and cyanides are the most violent poisons. According to the dose the death follows after a few seconds or minutes. The death is caused by the inhibited activity of the following enzyme:

A. ATP- synthetase

B. Catalase

С Acetylcholinesterase

D. Cytochrome oxidase

E. Methgemoglobin reductase

2. During the work with radioactive substances as result of accident worker got dose of radiation 4Gr. He complains of headache, nausea, dizziness. What changes in the blood can be expected in a patient within 10 hours after exposure?

A. Neutrophilic leukocytosis

B. Neutropenia

C. Leukopenia

D. Lymphocytosis

E. Agranulocytosis

3. Man, 30 years, received radiation dose of 3 Gr. What change in blood will be 8 hours after exposure?

A. Lymphopenia

B. Granulocytopenia

C. Anemia

D. Leukopenia

E. Thrombocytopenia

4. The man on the street raised electric wire that was under high voltage with both hands. Instantaneous death occurred on:

A. Fibrillation of heart

B. Stopping of breathing

C. Hemorrhage in the brain

D. Burns

E. Extremity avulsion

5. Instantaneous death of pilots occurred at aircraft cabin depressurization at altitudes of 19 km. What is the cause of death?

A. Boiling of blood

B. Hemorrhage in the brain

C. Gas embolism of heart vessels

D. Bleeding

E. Paralysis of respiratory center

6. The patient suffering from osseo-cranial form of radiation sickness. What sprouts of hematopoiesis will be affected in this disease?

A. All

B. Corpuscular.

C. Mehakariotsytarnyy.

D. Granulocyte.

E. Ahranulotsytarnyy.

7. Passenger of aircraft, which partially dehermetization, have deteriorated condition: pain in the ears, frontal sinuses, meteorism, bleeding from the nose. What disorder of peripheral blood circulation caused this serious situation?

A. Gas embolism

B. Ischemia

C. Venous hyperemia

D. Thromboembolism

E. Stasis

8. In patients with burns 40% body surface burn shock developed. Which factor should be allocated a main role in the development of burn shock?

A. Pain

B. Dehydration

C. Violation of mineral metabolism

D. Autoimunisation

E. Violation of protein metabolism

9. After the forced rapid rise from the depths of a diver on the surface he had the signs of decompression sickness: joint pain, itching of skin, twinkling in the eyes, disorder of consciousness. What kind of embolism this changes caused by?

A. Gas

B. Air

C. Fatty

D. Tissue

E. Thromboembolism

10. When a diver dives to a depth of 60 m the symptoms of CNS dysfunction developed in him - excitation, euphoria, relaxation of attention, professional errors. These symptoms are associated with toxicity in neurons:

A. Nitrogen

B. Oxygen

C. Carbon dioxide

D. Ammonia

E. Lactate

11. Rapid dehermetization of airplane developed in the pilot at an altitude of 14000m. What type of embolismt developed?

A. Gas

B. Tissue

C. Thromboembolism

D. Air

E. Fatty

12. As a result of damage of a nuclear reactor radioactive products was leaking. People who were in the zone of increased radiation, received approximately 250-300R. They were immediately hospitalized. What will be the leading symptom in an affected?

A. Lymphopenia

B. Leukopenia

C. Anemia

D. Thrombocytopenia

E. Neutropenia

13. convulsions with loss of consciousness developed in diver at accidental rise from the depths. What is the main mechanism in the development of these disorders?

A. Gas embolism

B. Hypoxia

C. Toxic effects of oxygen

D. Toxic effect of nitrogen

E. Toxic effects of CO2.

14. Decompression disease developed in a diver, who long time was at a depth of 40m. The main pathogenic mechanism was embolism:

A. Gas

B. Air

C. Fatty

D. Paradoxal

E. Tissue

15. In patients 64 years, cancer of oral mucosa was founded. Objective: substantial destruction of molar teeth, poor hygienic condition of the mouth. He smoks for 50 years, in anamnesis - work at Chernobyl. Most likely cause of cancer was:

A. Ionizing radiation

B. Stimulation of mucosa by food

C. Alcohol

D. Smoking

E. Poor hygienic condition of the oral cavity

Situational tasks

1. During examination of a patient, who works at the nuclear power plant, dentist revealed signs of glossitis: hyperkeratosis of tongue mucosa, moderate hyperemia, erosive-ulcerous changes. After the questioning of the patient doctor find out that recently as result of leak of radioactive products patient received a dose of 2 Gr.

1. What other effects can be expected in affected?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Explain the pathogenic mechanisms of ionizing radiation.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. The patient asked the dentist about increased bleeding of the gums. During the medical examination doctor revealed the hyperemia of gums, bleeding of them at slight damage, hyperkeratosis oral mucous membrane, mucosal erosions covered with fibrinous plaque. In history it is known that the patient was radiotherapy on tumors in maxillofacial area.

1. What is radiation sickness. What forms do you know?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Explain the mechanism of hemorrhagic syndrome at radiation disease.

____________________________________________________________________________________________________________________________________________________________________________________________________________________

3. The patient came to the dentist with suffering on a swollen of tongue on, pain in time of eating and talking, increased bleeding of gums. After examination and blood analysis revealed: erythrocytes - 2.8 x 1012 / l, leucocytes - 3,2 x 109 / l, platelets - 100 x 109 / l. From anamnesis it is known that the patient is working on the nuclear power plant.

1. What period of osseo-cranial form of radiation disease occurs in a patient?

________________________________________________________________

2. Describe hematological changes in different periods of osseo-cranial form of radiation disease.

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. The patient came to the dentist with complaints about tooth crown fracture. At survey observed a broken crown with sharp edges, swelling and hyperemia of the tissues around the broken tooth crown, the presence of ulcers with infiltration of tissues in the periphery. Doctor was diagnosed: "traumatic stomatitis.

1. Name the pathogenic mechanisms of mechanical factors.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. From what properties of the tissue the action of mechanical factor depend on?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Patient S., 28, delivered in a hospital intensive care unit in serious condition. He was founded in the street with extensive trauma of maxillofacial area and massive bleeding. Objective: impairment of consciousness, he doesn’t answer on the questions, skin and visible mucous membranes are pale, blood pressure - 80/50 mm Hg, thready pulse, superficial breathing, reflexes are decreased, nociception is reduced.

1. What stage of traumatic shock is described?

________________________________________________________________________

2. Explain the mechanism of the described changes.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. As a result of damage to the container of a nuclear reactor leak of radioactive products developed. In the area of increased radioactivity workers received approximately 100 Gr. They were immediately taken to the clinic.

1. What form of radiation sickness occurred in affected?

________________________________________________________________________

2. Give a description of this form

________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. As a result of damage to the container of a nuclear reactor leak of radioactive products developed. In the area of increased radioactivity workers received approximately 30 Gr. They were immediately taken to the clinic.

1. What form of radiation sickness occurred in affected?

________________________________________________________________________

2. Give a description of this form

________________________________________________________________________________________________________________________________________________________________________________________________________________________

8. During examination of oral cavity of a child, who accidentally drank a solution of concentrated acetic acid, superficial necrosis of oral mucous membrane revealed.

1. What type of necrosis occurs as a result of acids action?

________________________________________________________________

2. Explain the basic mechanisms of chemicals action.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

9. During examination of the patient, who is working in production with the use of heavy metals, dentist revealed signs of catarrhal stomatitis: edema and hyperemia of the mucosa, pigmentation of gum edge type “gingival sulcus”.

1. Name the biological effects of chemical factors.

________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What are the ways of chemicals detoxication?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

10. As a result of change of voltage the of equipment dental office became out of service. In time of attempt to repair the dental equipment by himself the doctor accidentally grabbed the wire through which current was 220 V by both of hand. As a result of convulsions he wasn’t able to disconnect the wire by himself. He quickly lost consciousness.

1. What led to loss of consciousness?

________________________________________________________________________

2. What are the physical parameters of the current carry harmful impact?

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

11. As a result of change of voltage the of equipment dental office became out of service. In time of attempt to repair the dental equipment by himself the doctor accidentally grabbed the wire through which current was 220 V by both of hand. As a result of convulsions he wasn’t able to disconnect the wire by himself. He quickly lost consciousness.

1. What directions of an electric current passing is most dangerous ?

___________________________________________________________________________________________________________________________________________________________________________________________________________________

2. What is first help to affected?

____________________________________________________________________________________________________________________________________________________________________________________________________________________

3. What safety rules were violated?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Practical work:

“Pathogenic action of chemical factors”

Object of work: to study the pathogenic action of chemical factors on the organism of animals.

EXPERIMENT № 1. Induction of coagulative necrosis.

Inflict the drop of phenol by a glass stick on the area of membrane. Examine and sketch the picture of coagulative necrosis. Make the conclusions.

EXPERIMENT № 2. Induction of colliquative [liquefactive] necrosis.

Inflict the drop of the concentrated alkali (caustic potash solution).

Examine and sketch the picture of colliquative necrosis.

Blood stream in norm Coagulative necrosis Colliquative necrosis

[pic] [pic] [pic]

Conclusions:_____________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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