Demonstrate and explain the method of

breastfeeding.

Demonstrate and tell the first (A) step of the

primary resuscitation of newborns. Explain Apgar
score for newborns. Show and explain what tools
are needed for primary resuscitation of newborns.

Show the methods of palpation, percussion of the

kidneys in children.

Show the methods of palpation of the endocrine

system in children.

Show the methods determining the main symptoms

of acute appendicitis in children.

Show the technique of anthropometric

measurements in children.

Show the methods determining of the pulse on the

arteries in children.

Show the methods of palpation, percussion,

auscultation of the cardiovascular system in
children.

Show and explain the second step (B) of primary

neonatal resuscitation. Explain Apgar score for
newborns.

Show and explain the third (C) step of primary

neonatal resuscitation. Explain Apgar score for
newborns.

Demonstrate and explain the primary toilet of

newborns.

Show the method of palpation, percussion,

auscultation of the abdominal cavity in children.

Demonstrate and explain percussion of liver sizes

according to Kurlov in children.

Demonstrate and explain heart rate estimation

techniques in children.

Show the techniques for auscultation of pulmonary,

cardiac and intestinal sounds.

Demonstrate and explain conditioned and

unconditioned reflexes research techniques.
Show and explain dental hygiene in children.

You are a local pediatrician at a local polyclinic. In

the office, a mother with a child is waiting for you,
who came for a preventive examination before
vaccination. It is necessary, having received consent
from the legal representatives for the examination,
to conduct a physical examination of the child, to
evaluate the data of anthropometry. Give an opinion
on the health status of the child. During the
inspection, voice all necessary actions.
You are a district pediatrician at a children's polyclinic, you
were urgently called to the filter box for a child who has an
obsessive cough with a small amount of mucous sputum and
nasal breathing is difficult. On examination: temperature
37.6°C, slight cyanosis of the nasolabial triangle, respiratory
rate - 34 per minute, expiratory dyspnea, during auscultation -
the exhalation is lengthened, against the background of hard
breathing, whistling dry and mild medium bubbling wet rales
are heard. Your task is to assess the clinical picture and
conduct inhalation therapy for a patient with an obstructive
syndrome. All actions that you will perform must be voiced.

You are a local pediatrician. You have a patient in front of you. You
need to conduct a physical examination of the child's respiratory
system. Introductory information about the complaints made by the
child, the history of life and the history of the disease is presented in
writing. Say whatever you think is necessary when communicating
with the patient.
Girl, 10 years old. Complaints of a wet cough, fever up to 39oC,
general weakness, loss of appetite, lethargy, fatigue. Anamnesis: fell
ill 5 days ago, when a rare dry cough appeared. After 2 days the body
temperature rose to 39oC, the cough became wet.
According to the results of a physical examination of the respiratory
organs formulate the expected (preliminary) diagnosis.

You are a local pediatrician. You have a patient in front of you. You
need to conduct a physical examination of the child's digestive
system. Introductory information about the complaints made by the
child, the history of life and the history of the disease is presented in
writing. Say whatever you think is necessary when communicating
with the patient.
Boy, 13 years old. He complained of headaches, lethargy, loss of
appetite, nausea, abdominal pain, localized in the upper abdomen,
occurring on an empty stomach and at night. Pain is relieved by
eating, antisecretory drugs. The pain has been bothering me for
several years. Episodes of pain syndrome for 3-4 weeks with a
frequency of 3-4 times a year. During the last week, the pain has
intensified.
Based on the results of a physical examination of the digestive
system, formulate a proposed (preliminary) diagnosis.
You are a district pediatrician at a children's polyclinic, you were
urgently called to the filter box, where there is a child suffering from
bronchial asthma with a dry paroxysmal cough that started while
walking in the park and continues to this day. On examination: the
temperature is 36.8°C, cyanosis of the nasolabial triangle is
pronounced, the respiratory rate is 30 per minute, expiratory dyspnea,
during auscultation, the exhalation is elongated, harsh breathing and a
large number of wheezing rales are heard above the symmetrical parts
of the chest. With peak flowmetry, PEF (peak expiratory flow rate) is
60%. Your task is to assess the clinical picture and conduct inhalation
therapy for a patient with an obstructive syndrome. All actions that
you will perform must be voiced.

You are a local pediatrician. You have a patient in front of you. You
need to conduct a physical examination of the child's respiratory
system. Introductory information about the complaints made by the
child, the history of life and the history of the disease is presented in
writing. Say whatever you think is necessary when communicating
with the patient.
Girl, 4 years old. Mother's complaints about paroxysmal dry cough,
shortness of breath, fever to febrile numbers, weakness, loss of
appetite, restless sleep. Anamnesis: I fell ill 3 days ago, when the
above complaints appeared.
According to the results of a physical examination of the respiratory
organs formulate the expected (preliminary) diagnosis.

You are a local pediatrician. You have a patient in front of you. You
need to have a physical examination of your child's thyroid gland.
Say whatever you think is necessary when communicating with the
patient.
A 13-year-old girl complains of weight loss, increasing muscle
weakness, sweating, fatigue, fussiness, sometimes abdominal pain,
subfebrile body temperature, and a tendency to loose stools. Over the
past two months, school performance has declined. Body length - 167
cm (a year ago it was 157 cm), body weight - 48 kg.
Based on the results of a physical examination of the thyroid gland,
formulate a proposed (preliminary) diagnosis.

You are a local pediatrician. You have a patient. You need to conduct
a physical examination of the child's blood system. Introductory
information about the complaints made by the child, the history of
life, the history of the disease is presented in writing. Voice whatever
you feel is necessary when communicating with the patient.
Girl, 1 year old. When addressing complaints of fatigue, hair loss,
loss of appetite, pallor of the skin. From the anamnesis it is known
that during the medical examination, the child showed a decrease in
hemoglobin to 76 g/l and a color index to 0.53. Anamnesis of life: the
child was born from the first, normally proceeding pregnancy and
childbirth. Body weight at birth 3300 g, length - 51 cm. From 2
weeks of age is on artificial feeding. From 4 months feeding with
cow's milk, juices, vegetables. Meat was very rare. Often ate earth,
chalk.
Based on the results of a physical examination of the blood system,
formulate a proposed (preliminary) diagnosis.

Characterize Bishop score, show on the

Virtugin dilation, effacement of cervix in
different stage of labor. Define position,
attitude, presentation, moulding and
sinclitism of the fetal head during descent to
the pelvic cavity.

M., 28 years old, parity 2. Full term of pregnancy. Initiation

of labor was 8 hours ago. Uterine contractions are every 3
minutes and lasts 35-40 seconds. The membranes ruptured
20 minutes ago. Pelvic sizes: 25,28,31,20. Fetal head rate
132 per minute with satisfactory characteristics. Probable
fetal weight is 3000 g. Vaginal results: the cervix is
completely dilated. The amniotic sac is absent. Fetal head is
in 0 station. Sagittal suture is in the right oblique diameter of
pelvic inlet. Anterior fontanel is located to the right side
anteriorly and posterior fontanel is near sacral region to the
left side. What is the diagnosis? Demonstrate on the
Virtugin fetal station and cervical dilatation and
presentation?

You are the obstetrician-gynecologist on duty at the

maternity hospital, you were called to the delivery
department to examine a woman in early postpartum period.
Patient a 29-year-old woman had normal vaginal delivery at
the gestational age 40 weeks. She gave birth a girl 3500
grams. From the anamnesis she doesn’t have any somatic
diseases. This pregnancy is the 2, proceeded without
complications. Labor last 6 hours, without complications.
The uterus is firm, above umbilicus on the right side. No
signs of postpartum bleeding. Explain and demonstrate on
the model active management of III stage of labor.

A 31-year-old G2P1 woman at 24 weeks' gestation presents for a routine prenatal visit. She reports
an uneventful pregnancy other than early morning nausea and vomiting, which has subsided since
her last visit. She denies vaginal bleeding or contractions. Blood pressure and routine laboratory
values at previous visits had been normal. Today her temperature is 37°C (98.6°F), pulse is 74/min,
blood pressure is 162/114 mm Hg, and respiratory rate is 14/min. Her uterine size is consistent with
her dates, and her physical examination is unremarkable.

Laboratory tests show:

• WBC count: 9000/mm3

• Hemoglobin: 13 g/mL

• Hematocrit: 39%

• Platelet count: 240,000/mm3

• Blood urea nitrogen: 11 mg/dL

• Creatinine: 1.0 mg/dL

• Aspartate aminotransferase: 20 U/L Alanine aminotransferase: 12 U/L.

• Urinalysis reveals 3+ protein but no blood, bilirubin, bacteria, leukocyte esterase, or nitrites. The
patient is sent directly from the clinic for a nonstress test and an ultrasound. Six hours later her
blood pressure is rechecked, and it is 162/110 mm Hg. What is your diagnosis and actions?
Demonstrate management of preeclampsia according to WHO protocols on Dimedus.

A 37-week pregnant women came to

emergency department with complaining
headache, nausea, vomiting, pain in the upper
abdomen, she lost consciousness in the
emergency room. Select an action according
to the management of eclampsia on
Dimedus.
You are the obstetrician-gynecologist on duty
at the maternity hospital. A 28-year-old
parturient female presents with spontaneous
vaginal delivery. Placenta self-separated
within 30 minute and intact during
examination. Postpartum period without
complication.2 hours later after separation of
placenta patient loss 500 ml of blood from
uterine cavity. Tell the diagnosis and
demonstrate the management according to
WHO protocol on the Dimedus?

Demonstrate and characterize digital and

bimanual vaginal examination and speculum
examination in gynecology.
Demonstrate insertion of IUCD (Intrauterine
contraceptive device).

Demonstrate mechanism of labor (cardinal

movements of the fetus) and management in
the face presentation.

Demonstrate mechanism of labor (cardinal

movements of the fetus) and management in
the brow presentation.
Demonstrate mechanism of labor (cardinal
movements) and management in breech
presentation.

Identify true and false pelvis. Measure

external size of pelvis (distancia spinarum,
distancia cristarum, distancia trochanterica,
external conjugate). Find Index Salovyova.
Find out the true conjugate with formula.

Demonstrate external cephalic version in

breech presentation. Tell prerequisites,
indication and contraindications.

Characterize fetal skull (fontanelles and

sutures) and diameters (suboccipito frontal,
suboccipito bregmatic, submento bregmatic,
mento vertical, submento bregmatic).

Demonstrate manual assistance in breech

presentation (Burns- Marshall technique,
Pinard maneuver, Malar flexion, Savage
technique, Wigand-Martin technique).

Demonstrate mechanism of labor (cardinal

movements) occipito posterior and occipito
anterior presentation on the models.
Demonstrate principles of management and
maneuvers in shoulder dystocia.

Demonstrate the internal diameters

(anteroposterior, transverse, oblique) of true
pelvis (inlet, cavity, outlet).

Demonstrate abdominal examination of

pregnant women (Leopold maneuvers).
Explain and draw parts of partogram.

Explain active management of III stage of

labor. Demonstrate delivery of placenta by
controlled cord traction.
Demonstrate management of retained
placenta (manual removal of placenta).

Demonstrate forceps delivery and vacuum

extraction of the fetus during obstructed
labor.
You are the obstetrician-gynecologist on duty at the maternity hospital, you
were called to the delivery department to examine a woman in labor who had
gone amniotic fluid at home, the woman in labor forgot the pregnancy history
card at home.

Patient a 29-year-old woman in labor in the delivery room. From the

anamnesis she doesn’t have any somatic diseases. This pregnancy is the first,
according to the woman, proceeded without complications, the gestational age
40 weeks, the first period of labor lasted 9 hours. The second period of labor
lasts 2 hours. Contractions-attempts for 40 seconds, after 2-3 minutes. Blood
pressure 130/80 mm Hg. art. Amniotic fluid poured out 8 hours ago – light in
moderate amounts. According to CTG, there are no signs of fetal suffering.
Heart rate (fetal heart rate) 150 per minute. The height of the uterine fundus is
34 cm, the circumference of the abdomen is 88 cm. The size of the pelvis is
normal, the Solovyov index is 14 cm. On examination, the opening of the
cervix is complete, the fetal head is on the pelvic floor, the sagittal suture is in
an antero-posterior diameter, a small fontanel on the pubis symphysis.

1. Find the diagnosis

2. Demonstrate manual assistance and management of labor.

General observation

Measure pulse in radial artery, noting: rate,

rhythm and volume

Measure blood pressure, both arms (for

practice), using stethoscope
Confirm by measuring systolic blood pressure
by palpation (special test)

Measure blood pressure and pulse after

positional changes (orthostatic)

Measure respiratory rate

Examine hands, nails, fingers

Thyroid: Observation, palpation

Palpation lymph node, parotid and salivary

gland regions
 Observe & inspect abdomen .Shape, scars,
color, symmetry, unusual protrusions
Auscultation

Percuss all quadrants of abdomen

Percuss liver span

Percuss area of spleen, stomach Palpation

Palpate all abdomen quadrants superficially

Palpate all abdomen quadrants deeply

Try to identify liver edge (w/inspiration)

Palpate region of spleen

Assess costo-vertebral angle for tenderness

(*special test: if concern for pyelonephritis)
Inspect precordium

Palpation of RV and LV; Determination of

PMI Auscultation

S1 and S2 in 4 valvular areas w/diaphragm

Try to identify physiologic splitting S2

Assess for heart murmurs

Assess for extra heart sounds (S3, S4) w/bell

over LV Carotid artery .Palpation

Check for edema

measure respiratory rate Observe & inspect
chest

General observation, note using accessory

muscles/general respiratory effort

Assess chest excursion

Assess for fremitus (*special test: if concern
for effusion or consolidation)

Percuss posterior lung fields, top to

bottom→comparing side to side

Identify amount of diaphragmatic descent with

inhalation (*special test: if concern for
diaphragmatic paralysis)
Percuss right antero-lateral chest (middle lobe)
and anterior lobes (bilateral)

Auscultation of lungs

Interpret diagnostic laboratory and

instrumentally studies for pulmonary
pathologies
Interpret diagnostic laboratory and
instrumentally studies for cardio vascular
disorder

Interpret diagnostic laboratory and

instrumentally studies for GIT pathologies

Interpret diagnostic laboratory and

instrumentally studies for kidneys pathologies
Interpret diagnostic laboratory and
instrumentally studies for rheumatology
pathologies

Interpret diagnostic laboratory and

instrumentally studies for endocrinology
pathologies

Interpret diagnostic laboratory and

instrumentally studies for hematological
disorders

Algorithm of pharmacological management in

Acute Respiratory Failure

Differentiated approach to the treatment of

patients with complicated hypertonic crises

Algorithm of emergency care in hypoglycemic

coma

Algorithm of emergency care in ketoacidotic

coma

Algorithm of emergency care in hyperosmolar

coma

Algorithm of emergency care in ACS(acute

coronary syndrome), Cardiogenic shock

Algorithm of emergency care in anaphylactic

shock

Algorithm of emergency care in Bleeding of

Gastro intestinal tract

Algorithm of emergency care in bronco

obstructive syndrome with bronchial asthma

Algorithm of emergency care in pulmonary

embolism

Acute Respiratory Failure algorithm of

emergency care

Algorithm of emergency care in spontaneous

pneumothorax
Examination of abdomen

Examination of thyroid swelling

Clinical examination of types of scar.

How to stop bleeding

How to help patient with trauma. ATLS

protocol.

How to perform blood grouping.

How to perform endotracheal intubation.

how to perform injections( Im,Iv,Sc)

Explain steps of hand washing.Aseptic

techniques
How to check Glasgow coma scale.

Examination of patients with chest trauma.

Examination of patients with abdominal trauma.

How to perform spinal and epidural anesthesia.

Airway evaluation.

How to perform parenteral and enteral nutrion.

Examination of patient with hernia.

Examination of breast.

Examination of patient with varicose veins.

Examination of patient with burn injury.

Examination of patient with shock,