"Interview a patient with therapeutic pathology"

Scenario: Peptic ulcer associated with NSAIDs

Algorithm Necessary questions
Greeted and introduced himself
Identified the patient
Asked permission to conduct the survey
Asked complaints
Singled out the main complaint - abdominal pain
Asked " What is the nature of abdominal pain?”
Clarified the localization of abdominal pain
Asked "How long does the abdominal pain last?"
Asked “What relieves pain?”
Asked if vomiting brings relief
Asked about recent weight loss
Asked about the recent change in the color and character of the stool
Asked "When did you get sick?"
Asked “How did you get sick? What do you associate your illness with?”
Asked “Were there periods of exacerbation of the disease and when?”
Asked about the hereditary predisposition to same diseases in the family
Asked "Have you had concomitant diseases?"
Asked “Do you take drugs for concomitant diseases regularly? If so, which
ones?”
Asked "Have you noticed any side effects?"
Asked "Have you had bad habits?"
Asked "Does the patient have a question?", thanked for the information
provided.
 ALGORITHM FOR PERFORMING PRACTICAL SKILLS
at the OSCЕ-2 station
"Physical examination of the patient"
Scenario " Peptic ulcer associated with NSAIDs ": superficial palpation of the
abdomen and determination of Mendel's symptom.

1. Say hello, introduce yourself to the patient.

2. Obtain consent for the examination.
3. Offer the patient to undress to the waist and lie down on the couch, ask if the
patient is comfortable.
4. Take a classical (academic) position by the patient's bed: sit to the right of the
patient at the level of the patient's pelvis, facing the patient.
Superficial palpation of the abdomen
5. Place the palm of the right hand on the abdomen, slightly bending the fingers, and
make light pressure on the abdominal wall with the tips of II, III, IV and V fingers,
getting a tactile impression of the degree of tension of the anterior abdominal wall.
In this way, the entire anterior abdominal wall is palpated, including the epigastric
region, the pyloroduodenal region, the left and right hypochondrium, etc.
Definition of Mendel's symptom
6. With the fingers of the right hand, perform light finger percussion in the epigastric
area
Сontrol questions
Obtaining consent to the survey
The student washed hands or treated with antiseptic
It is suggested to undress to the waist
It is suggested to lie down on a couch
Provide instructions on the position on the couch
Classical (academic) position at the patient's bedside
Superficial palpation of the abdomen
The hands are positioned correctly
Correct performance of palpation movements with appropriate pressure on
the abdominal wall
Correct execution of the palpation sequence algorithm
The hands are correctly topographically located when determining the
Mendelian symptom
Correctly performed light finger percussion in the epigastric area
(identification of Mendel's symptom)
Report the results of superficial palpation of the abdomen
Report the results of determination of Mendel's symptom
Make conclusions
Thank the patient
Analyze the proposed results of superficial palpation of the abdomen and
determination of Mendel's symptom
ANALYZE THE DATA OF SUPERFICIAL PALPATION OF THE ABDOMEN AND THE
DETERMINATION OF MENDEL'S SYMPTOM: (EXAMPLE)

Superficial palpation of the abdomen revealed pain under the xiphoid

process and pain with slight finger percussion in the epigastric region.
 "Interpretation of laboratory and instrumental research methods, diagnosis,
examination plan"
Scenario: "Peptic ulcer associated with NSAIDs "

ALGORITHM
Interpretation of laboratory/instrumental research results
1. To determine the presence/absence of endoscopic changes in the mucous
membrane of the stomach, the bulb of the duodenum, extrabulbar sections,
deformation of the corresponding sections. Draw a conclusion: the presence/absence
of signs of inflammation in the relevant departments.
2. Determine the presence of ulcer defects. To draw a conclusion about peptic
ulcer.
3. Determine the localization of ulcer defects. To draw a conclusion about peptic
ulcer based on the small curvature of the stomach.
4. Determine the size of ulcer defects. To draw a conclusion about a medium-sized
peptic ulcer.
5. Determine the number of ulcer defects. Make a conclusion about a single peptic
ulcer.
6. Determine the absence of malignancy of the ulcer based on the biopsy data.

When analyzing the data of laboratory/instrumental studies, it is important to draw

and voice conclusions, because in connection with the limitation of time for
interpretation to 5 minutes, the assessment of the performance of practical skills will
be carried out precisely taking into account the intermediate conclusions.
Сontrol questions
Interpretation of the examination result:
Made a conclusion about the presence of peptic ulcer of the stomach
Determined the size of the ulcer
Determined the number of ulcers
Determined the absence of H. Pylori infection
Determined the absence of malignancy of the ulcer
Established the diagnosis: peptic ulcer
Formulated the diagnosis: Peptic ulcer of the stomach (single, medium-
sized), associated with taking NSAIDs, active phase.
Appointed mandatory laboratory and instrumental methods of examination
to confirm the diagnosis:
CBC (common blood count)
Definition of H. Pylori infection
Fecal occult blood analysis
Ultrasound examination of abdominal organs
The student did not choose inappropriate research methods
 "Treatment of a patient with therapeutic pathology"
Scenario: Peptic ulcer associated with NSAIDs
Algorithm
Outpatient treatment
Recommendations for lifestyle modification:
Smoking cessation is recommended
Clarification of the need for strict adherence to the rules for taking NSAIDs
for the patients to whom they are prescribed (after taking food, in the doses
indicated by the doctor), the need to prioritize COX2-selective NSAIDs and
prevent uncontrolled use of NSAIDs.
Recommendation of EGDS monitoring of ulcer healing after 6 months with
mandatory biopsy.
Compliance with drug treatment: PPI + gastroprotector.
Correctly made the appointment, for example, pantoprazole - Pantoprazolum
(or another PPI).
Correctly prescribed, for example, sucralfate (Sucralfatum) or bismuth
subcitrate (Vismuthi subcitras).
The correctness of doses and frequency of use of Pantoprazol
Pantoprazolum, 40 mg 2 times a day (or another PPI in a standard dosage).
Correctness of doses and frequency of use of Sucralfate (Sucralfatum) 1000
mg 4 times a day OR bismuth subcitrate (Vismuthi subcitras) 120 mg 1 tab.
4 times.
Appropriate duration of PPI prescription (from 4 to 8 weeks).