"Interview a patient with therapeutic pathology"

Scenario: Peptic ulcer - Algorithm

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 "When did you get sick?"
Asked “How did you get sick?
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": 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:

Superficial palpation of the abdomen revealed pain in the pyloric and

duodenal area and pain during slight finger percussion in the epigastric area.

"Interpretation of laboratory and instrumental research methods, diagnosis,

examination plan"
Scenario: Peptic ulcer - Algorithm

Algorithm
Interpretation of the examination result:
Made a conclusion about the presence of peptic ulcer of the duodenal bulb
Determined the size of the ulcer
Determined the number of ulcers
Determined the presence of H. Pylori infection
Established the diagnosis: peptic ulcer
Formulated the diagnosis: Peptic ulcer of duodenal bulb (single, small), associated
with H. Pylori infection, 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

Algorithm
Outpatient treatment
Recommendations for lifestyle modification:
Smoking cessation is recommended
Recommendation to monitor the effectiveness of Hp eradication no earlier than 4 weeks
Compliance with drug treatment: PPIs + combined antibacterial therapy
Triple therapy: PPI + amoxicillin + clarithromycin.
The correctness of doses and frequency of use of Pantoprazole, 40 mg 2 times a day
The correctness of doses and frequency of use of the drug amoxicillin (Amoxicillin) 1000
mg 2 times a day.
The correctness of doses and the frequency of use of the drug clarithromycin
(Clarithromycin) 500 mg 2 times a day.