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Tosolvetheproblem, what tactic should keep GP in the cases of epistaxis

Tashkent – 2015





prorector of educational work

prof. Teshaev O.R.
_____________ 201


SUBJECT: «Endoscopic METHODS OF ENT.Tactic of General Practitioner »

Author: Prof. Khakimov A.M

Pedagogical annotation

Subject: «Otorhinolaryngology»

Theme: «Endoscopic METHODS ENT. Tactic of General Practitioner. ».

Aim of the case:

To introduce students to the working conditions and methods of investigation ENT. Students should become familiar with inspection equipment frontal reflector and otoscope. Learn practical rhinoscopy, pharyngoscope, indirect laryngoscopy, otoscopes

Planningresult –as a result of this case students gain next skills:

  • Assessment and analysis of the situation and the general condition of the patient with epistaxis.

  • Choosing the right algorithm for the diagnosis of action.

  • Independently provide emergency assistance if needed

  • Refer to hospital for treatment

  • To be able to provide qualified rehabilitation measures

For successful decision of this case student must know :

- Be familiar with normal endoscopic picture of the nose, pharynx, larynx, ear.

- Be familiar with the typical pathological in the endoscopic picture.

- Know the procedure and method of examination ENT patient.

- Know the value of visual inspection with ENT diagnosis of various diseases.

- To know the methods of the esophagus and bronchi (esophagoscopy, bronchoscopy).

- Know the additional research methods ENT (CT, MRI, Ultrasound, clinical and laboratory studies).

Thegivencase reflects real situation in the conditions of primary unit channels of information

Main literature

  1. Quloq, burun, halqum va hiqildoq kasalliklari I –II qism Toshkent 2011 yil.

  2. А. М. Хакимов , ва бошқ. “Умумий амалиёт шифокори тайёрлашда оториноларингология” Бухоро 2008 й.

  3. А. Н. Дадамуҳамедов, Ш. Э. Омонов “Болалар оториноларингологияси” Тошкент 2005й.

4. Е.С. Козорез ЛОР заболевания Москва 2005 г..

5. А. И. Лопотко, М.Ю. Бобошко, С. Г. Журавский, Г. В. Лавренова “фармакотерапевтический справочник” Санкт Петербург 2004 г.

6. Солдатов И. Б. , Гофман. «Руководство по оториноларингологии» Москва. 2002г. стр. 3-6, 236-263

7. Богмильский М. Р. , Чистякова В. Р. «Детская оториноларингология» Москва. 2002г. стр. 5-13.

8. Мартин Бартон « Болезни уха, горла и носа». 2002 год..

9. Б. В. Шеврыгин, Б. И. Керчев “Болезни уха, горла и носа” Москва 2002 г.

10. “Оториноларингология”, В.Т. Пальчун, А.И. Крюков, М., “Литера”, 1997г.

11.“Болезни уха, горла и носа”, В.Т. Пальчун, Н.А. Преображенский, М., Медицина, 1980г.

12. “Оториноларингология для медицинских ВУЗов”, Овчинников, М., Медицина, 1997г.


1.“Детская оториноларингология”, Ю.Б. Исхаки, Л.И. Кальштейн, Душанбе, Маораф, 1977г.

  1. “Оториноларингологический атлас”, В.А. Гапанович, В.М. Александров, Минск, 1989г.

  2. “Клиническая оториноларингология”. Учебное пособие. Н.В. Мишенькин, А.И. Драчук, Л.И. Иванова, Ю.М. Дашкевич, А.Л. Носков, М.П. Лисовская, Омск, 1990г.

  3. “Детская оториноларингология”, Б.В. Шеврыгин, М., Медицина, 1996г.

  4. “Оториноларингология для врачей общей практики”, В.В. Дискаленко, Г.В. Лавренова, Е.Ю. Глухова (под редакцией М.С. Плужникова). СПб, Манускрипт, 1997г.

  5. Тарасов Д. И. , Федрова О. К. , Быкова В. К. «Заболевания среднего ухо» Москва, 1988г.

  6. Солдатов И. Б. «Лекция по оториноларингологии» Москва. 1990г. стр. 3-6, 107-131, 131-149.

  7. Муминов А. И. «Кулок, томок ва бурун касалликлари» Тошкент 1994й. бет. 3-8, 79-84.

  8. Шевригин Б. В. «Справочник по оториноларингологии» Москва. 1996г.

  9. Атлас по оториноларингологии Москва. 1997г. стр.

  10. Дадамухамедов А.Н., Мирзарасулов М.М. «Болалар оториноларингологияси» Тошкент. 1999й. бет. 155-157, 162.

12. Пискунов Г.З с авт. «Заболевания носа и околоносовых пазух».Москва, 2003 г.

13.Тамаз Мчедлидзе «Оториноларингологический словарь» 2007г Санкт – Петербур

14. Н. Х. Воҳидов, СА. Ҳасанов “ Болаларда ўткир ларинготрахеит Тошкент 2007”

  1. Интернет сайтлари: www.audiology.ru, www.otolar.ru, www.rmj.ru,

www.lor_tma.uz, www.med-lib.ru

Case characteristics

Thegivencasebelongstotheoreticalandplotline category it is volumetric and structured. This is case -question.

By didactic aims this case is appear to be training, mind stimulating.

This case can be used in the next disciplines : anatomy, histology, normal and abnormal physiology, pathology, microbiology end emergency conditions.

«The methodology of endoscopic methods ENT. Tactic of General Practitioner»


To draw attention to the need to study patients with ENT position study of the whole organism. Keep in mind the importance of the need to study the history state of internal organs and nervous system, and the application in practice of the GP laboratory research methods and X-ray examination ENT (X-ray, CT, MRI, multidetector computed tomography).

Clinical anatomy and physiology of the nasal mucosa of the respiratory and olfactory regions. Function of the nose (respiratory, olfactory, security, voice, cosmetic). The structure and topography of the paranasal sinuses. Clinical anatomy and physiology of the pharynx, pharyngeal ring (6 tonsils), barriers to infection: the mucosa, the follicles and the vascular endothelium, capsule, regional lymph nodes, tonsils functions: protective, blood, excretory, endocrine.

Clinical anatomy and physiology of the larynx, bronchi, and esophagus (laryngeal tonsil, throat muscles), breathing, voice and protective functions of the larynx. Structure and function in relation to age.

Survey methodology ENT. Research methods ear (otoscopy). Familiarity with the technique of otoscopy and tools. Methods of investigation of the nose and paranasal sinuses (rhinoscopy, olfactometer, transillumination, radiology and endoscopy). Research methods pharynx, larynx, bronchi, and esophagus. Familiarity with the technique of rhinoscopy, stomofaringoskopii, laryngoscopy, and esophagoscopy traheobronhoskopii. Familiarity with the endoscopy room and tools to study the functions of ENT organs.

For ENT endoscopy in a single room (office), or at least part of the room should be equipped workplace otolaryngologist. It is desirable that the room was at least 5 m, isolated from the noise, because it is the study of hearing. The room should be a table to place the tools needed to examine the patient, two chairs, a couch, a desk

Decisionofgivencasewillallowstudentstoreachthenext educational results:

  • Toevaluateandanalysethesituation, and general condition of patients with tonsillitis

  • To choose the algorithm of actions for correct tonsillitis

  • If needed to provide first aid

  • If needed send to hospital for treatment

  • To be able to provide qualified rehabilitation measures

Situation. №1. Situation. Number 1. In SVP doctor delivered to GPs sick 63 years, complaining of headaches, noise in the ears and nose bleeding, occurring after exercise. The patient tried to stop the bleeding on their own, but to no avail.

At home, she has received 10 ml of a 10% solution of calcium chloride and 3 ml of 1% - of the solution vikasol, but bleeding to be continued.

Objectively: skin pale , pulse 98 beats. In a moment, weak filling, regular, BP 210/110 mm Hg, at the apex of the heart auscultated systolic murmur. From the right half nose bleeding. On the part of the left side of the nose and throat revealed no pathology. At right is determined rhinoscopy bleeding from both departments septum. Blood tests:

hemoglobin 157 g / L, erythrocyte - 5.5 x 10 ¹ ² / L, white blood cells - 6.1h10 ^ 9, stiks nuklear- 1%, segment nuclear- 65%, eosinophils -2%, lymphocytes- 28%, monocytes - 2%, ESR-11 mm / h.

Questions and tasks

  1. What is your diagnosis with foundation?

  2. How do you think with which disease it should be differentiated ?

  3. What is the tactic of GP.

Task:on the basis of analyses should be given primary diagnose, carry out necessary methods of diagnostics to make a right decision for the further management of patient with epistaxis
II. Methodical indications for students

2.1 Problem :

Choose the tactics of GP and defining the necessity of hospitalization of patients with epistaxis in conditions of rural medical point

2.2. Problems

  1. To analyse the appearance

  2. To analyse anamnesis, to find out the etiological factor

  3. To carry out examinations

  4. Necessary methods of diagnostics

  5. To analyse the results and provide differential diagnose

  6. To make a decision in the conditions of rural medical point

2.3. Decisionalgorithm

1. To analyse of appearance includes :

- examination of skin and mucous membranes

- face (eyes, tongue)

2. To analyse the anamnesis

- adoptive diseases

- social and family anamnesis

- duration and character of disease

3. Analysis of examination

- Ps, blood pressure

-body temperature

- Palpation of the submandibular and cervical lymph nodes

4. Selecting the appropriate diagnostic methods

- anterior rhinoscopy

- front rhinoscopy

- orofaringoskopy

- blood and urine test

- biochemical blood test

-determination of blood coagulation time

  1. To analyse the results and provide differential diagnose with:

-a blood disease

- a bleeding polyp of the nasal septum

- endocrine disease

6. To make a decision in the conditions of rural medical point

- treatment if needed

- emergency hospitalization

- to provide first aid

Instruction for decision of practical situation

List of situation analyses

Stages of work

Recommendations and advices

1. examination of the case

А cursory examination of the case. Read it , do not attempt to analyse the situation immediately

2. Examination with the given situation

Read it one more time and underline the main data.

Try to characterize the situation. Define what is important and what is not.

3. Revelationandfoundationofthemainproblem


Choose the tactics of GP and defining the necessity of hospitalization of patients with epistaxis in conditions of rural medical point .

4. Analysis of the situation

Answer next questions:

What range of common and dangerous diseases are accompanied by nasal bleeding?

What nosologies to make a differential diagnosis and determine the most likely causes nasal bleeding ?

Which diagnostic methods must be applied, make a plan and justify the level survey SVP and CRH.

What additional advice specialists needed for a final diagnosis?

Determine the degree of need for follow-up (medical and non-medical treatment.)

What kind of diagnostic methods should be made in rural medical point and in hospital.

Consultation of what doctors do you need to made a final diagnosis?

Define the further management of these patients

5. Choose and give a foundation for the methods of solving this problem.

List all the possible methods of solving this problem on this occasion.

6. Developing and solving the problem

Diagnose and solve the problem in the conditions of rural medical point.

Instruction for team work in solving the practical situation and its’ analyses.

Stages of the work

Recommendations and advices

Coordinate the opinions about the situation and opinion.

Discussand coordinate concepts of team members according to this situation and problem.

Analyzeandevaluateoffered methods for solving the problem and chose the best one .

Discuss and evaluate offered variants and methods to solve the problem, chose the priority way of solving the problem.

Developmutuallyacceptablevariantofsolvingtheproblem and elaborate its’ further realization.

Developmutuallyacceptablevariantofsolvingtheproblem and elaborate its’ further realization..

Prove your diagnosis;

Prove your further actions.

Prepare the presentation

Formalizetheresultsoftheworkinverbalformonthebehalfofthegroup. Discussanddecidewhowillpresenttheresultsofthework: leaderorthewholeteamdividing the functions between the participants. Prepare hand out data in the form illustrations, slides and multimedia

List of situation analyses



examination with problem given in the case

А cursory examination of the case. Finding out important data

Analysis of the situation

Answer next questions:

Analysis of the anamnesis , finding out etiological agent

Analysis of the examination of the patient.

chose of necessary methods of diagnostics.

To analyze the results and provide differential diagnose.

To make a decision in the conditions of rural medical point

Problem foundation

Foundation of the main problem and its’ constituents

The ways of alternative decisions

Form the possible alternatives in this case.

Developing and solving the problem

Elaboration and foundation of concrete decision in this case

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