In 2020 and 2021, according to RPN "polyclinic", the city's polyclinic

will serve 35035 residents.

Incidence of myocardial infarction (2020)
men 50-60 years-20. 60-70 years -7, total-27
women 50-60 years-4, 60-70 years-12, total-16
incidence of myocardial infarction (2021)
men 50-60 years-24, 60-70 years-13, total-37
women 50-60 years-10, 60-70
The mortality rate for myocardial infarction in 2020 was 7 people-3 years, a total of 13.
In 2021, the death rate was 10 people.
In the polyclinic registered "D": 1020 people, according to the myocardial infarction
suffered in 2020-300 people, in 2021-310 people.
Questions
:
1. to analyze the primary morbidity from myocardial infarction of the attached population of the polyclinic
.
2. analysis of mortality, calculation of total mortality rates from myocardial infarction of the attached population
of the polyclinic
.
3. make recommendations for long-term treatment after STEMI in accordance with the regulatory legal acts of
the Republic of Kazakhstan
.
You must have a calculator with you.
In 2020 and 2021, according to RPN "polyclinic", the city's polyclinic
will serve a total population of 36,540 people.
The number of patients with diabetes mellitus in 2020 is 126 people and in 2021-177 people.
In the polyclinic registered "D": 1020 people, according to the database 2020 -500 people, 2021 -510 people
in 2020 for registration"D " in polyclinic No. 1, 126 people were taken, in 2021-177 people.
In 2020, the death rate from diabetes was 5 people.
In 2021, the death rate was 7 people.
Questions
:
1. to analyze the primary incidence of diabetes mellitus in the attached population of the polyclinic
.
2. analysis of mortality, calculation of total mortality rates from diabetes mellitus of the attached population of
the polyclinic
.
3. make recommendations on the management of patients with diabetes mellitus (dynamic
monitoring and performance indicators) in accordance with the regulatory legal acts of the Republic of
Kazakhstan.
You must have a calculator with you.
Patient V., 38 years old,went to the clinic complaining of a choking attack,
dry cough, weakness, rapid heartbeat, a feeling of fear that does not stop taking 10 doses of salbutamol.
Medical history: in recent years, the frequency of daytime seizures is not more than 1 time per month, night
seizures were not observed. According to the patient, the day before the house
was renovated, old wallpaper was removed from the walls. Suffocation occurred during the night.
I tried to stop taking salbutamol on my own, but no positive results were observed. In connection with the
deterioration of the condition
, the husband brought the car to the clinic.
Behavioral features: characterized by anxiety, nervousness, a tendency to consolidate any thoughts,
but he doesn't have the strength to finish the whole thing.
Tasks:
1. What skills are included in the doctor-patient communication process?
2. what is the group of doctor-patient interaction skills?
3. What skills are needed to effectively complete doctor-patient contact?
Patient S., student, 24 years old. My friends and I were taken to a general practitioner.
Patients complained of sudden pain on the outer surface of the left ankle, increased pain
during movement (flexion and recording, removal and delivery),
swelling and a small bruise that spread to the heel in the lateral area of the left ankle.
Medical history: when he got off the bus about 1 hour ago, he went down the stairs
and leaned on his left leg, bent under the weight of his whole body. He immediately
noted the appearance of acute pain in the area of the external ankle, the appearance and growth of edema in this
area. My friends
and I were taken to the clinic.
Features of behavior: indifferent to clinicians, considers them "non-specialists"
, is convinced that good doctors work in paid medicine, for "other" money.
Questions:
1. What communication skills should the doctor use first and define?
2. Stages of the communication process between patient and doctor in accordance with the Calgary-

Cambridge model 3. R. VICH (R. VICH, 1972) stages of the communication process between patient and doctor
, give a brief description
Patient V., 44 years old,has pain in her chest,left arm,
shoulder blade, and collarbone while receiving GTD. Pain duration 3-5 min. The pain occurs when walking and
climbing to the floor, subsides at rest. It has been bothering you for 3 months. I haven
't seen a doctor before.
Objectively: the temperature is 36.6 C. The general condition is satisfactory. The skin is clean. The subcutaneous
fat
layer is excessively developed.. Height-173 cm, weight -89, girth of the abdomen-95 cm . Vesicular respiration,
TAC 16 times per minute. Heart sounds are rhythmic, clear, HRE 84 times per minute, blood pressure 120/80
mm Hg.
Abdominal pathology was not detected.
Bad habits-10 cigarettes a day for 20 years, weekends with friends drink a lot
of beer, work is connected with business trips, food is chaotic, often
eat fast food.
Questions:
1. Make and justify the intended diagnosis
2. Do you need to name additional arguments, what document approved them, and when they were adopted?
3. list the planned activities depending on the patient, who conducts them ,and when.
Patient K., 35 years old, complains of pain in the left breast, pain before
menstruation. In the Lower-inner quadrant in the right mammary gland in an upright position, a tumor-like
volume formation of 2x2 cm
, painless, mobile, is detected. Local lymph nodes did not increase.
There is no pathology on the part of the internal organs. From the anamnesis of 3 pregnancies, 2 births, 1
premature
spontaneous abortion. Does not live on the register. Relatives are healthy.
Questions:
1. what clinical symptoms should be checked in the patient? Make a preliminary diagnosis
and conduct a differential diagnosis
2. What special tests do you need to go through to justify the diagnosis ?
3. What document approves cancer care in the Republic of Kazakhstan? In which
clinical group of dynamic observation is the patient monitored? Scope of research in accordance with the order .
A 2-day-old child was diagnosed with congenital pneumonia
, depending on the state of health, food was replaced with milked breast milk, birth weight 2800.0, height 48
cm.
1. Calculate your daily and unit food intake:
a) the Filkenstein formula;
c) the Zaitsev formula;
c) the unit volume formula.
2. How many times a day the child should eat.
3. what formula of nutrition allows you to determine the physiological daily rate
? Why?
Alima is 5 years old, the child goes to kindergarten. According to the mother, she became acutely ill,
her body temperature rose to 38 °C, coughing, nasal congestion. Over the next 3 days, the fever is feverish
, catarrhal manifestations increase. Cough strong, frequent, eyelids swollen, conjunctivitis,
fear of light. On the 3rd day, white spots with a diameter of 1-2 mm appeared in the mouth on the mucous
membrane,on the 4th day of the disease, the body temperature rose to 39.5 C and a spotty-papular rash appeared
on the face and behind the ears
. Over the next two days, it spread through the body and pity departments.
Questions:
1. make a clinical diagnosis in accordance with the clinical protocol of the Ministry of Health of the Republic of
Kazakhstan
2. Identify leading clinical syndromes
3. Non-specific preventive health measures in accordance with the clinical protocol of the Ministry of Health of
the Republic of Kazakhstan
The city's polyclinic serves a total population of 35035 people in 2020 and 2021, according to the Regional
Public Health Organization "Polyclinic"
.
MI incidence (2020)
Men 50-60 years-20. 60-70 years -7, Total-27
Women 50-60 years-4, 60-70 years-12, Total-16
MI incidence (2021)
Men 50-60 years-24, 60-70 years-13, Total-37
Women 50-60 years - 10, 60-70 years-3, Total-13
The death rate from MI in 2020 was 7 people.
The death rate in 2021 was 10 people.
In the polyclinic on the" D " account consists of: 1020 people, according to the PIM for 2020 -300 people, 2021
-310 people
Question:
1. To analyze the primary morbidity from myocardial infarction of the attached population
of Polyclinic
2. Conduct a mortality analysis , calculate the total mortality rates from myocardial
infarction of the attached population of Polyclinic
3. Make recommendations for long-term treatment after STEMI, according to the following criteria:
regulatory legal acts of the Republic of Kazakhstan.
Have a calculator with you
The city's polyclinic serves a total population of 36,540 people in 2020 and 2021, according to the Regional
Public Health Organization "Polyclinic"
.
The number of patients with diabetes in 2020 - 126 people and
2021-177 patients In the polyclinic on" D " is registered: 1020 people, for DIABETES in 2020-500 people, 2021
- 510 people
In 2020, 126 people were registered in Polyclinic No. 1 on "D", for 2021 177 patients.
The death rate from diabetes in 2020 was 5 people.
The death rate in 2021 was 7 people.
Question
:
1. To analyze the primary morbidity from diabetes of the attached population of Polyclinic
2. Conduct a mortality analysis , calculate the total mortality rates from diabetes
of the attached population of Polyclinic
3. Give recommendations on the management of patients with DM (dynamic monitoring and
performance indicators), in accordance with the regulatory legal acts of the Republic of Kazakhstan.
Have a calculator with you
Patient V., 38 years old, went to the clinic complaining of a choking attack that could not be stopped
by taking 10 doses of salbutamol, an unproductive cough, weakness, palpitations, and a feeling of fear.
Anamnesis of this disease: In recent years, the frequency of daytime attacks is not more than 1
time per month, night did not notice. The day before, I made repairs at home, removed old wallpaper from the
walls.
During the night, suffocation appeared. I tried to stop it by taking salbutamol on my own
,but there was no positive effect. Her condition continued to deteriorate,
and her husband drove her to the clinic.
Behavioral features: anxiety, suspiciousness, a tendency to fixate on
any thought is characteristic, but there is no strength to bring all the cases to the end.
Tasks:
1. What skills are included in the process of establishing contact between a doctor and a patient?
2. What is the group of doctor-patient interaction skills?
3. What skills are needed to effectively complete doctor
-patient contact?
Patient S., student, 24 years old. Delivered by friends to the general medical practice.
Complaints of sharp pain in the area of the left ankle joint, from the outside,
which increases with attempts to move in it (flexion and extension, abduction and adduction
of the foot), edema and moderate cyanosis in the area of the lateral (external) ankle of the left lower
limb with spread to the foot.
Anamnesis of this disease: about 1 hour ago, when leaving the bus, she stumbled off
a step and leaned her entire body weight on her bent left foot. Immediately noted the appearance
of sharp pain in the area of the external ankle, the appearance and increase of edema in this area.
Friends delivered to the clinic.
Behavioral characteristics: demonstrates a dismissive attitude towards
polyclinic doctors, considering them "under-specialists", is convinced that good doctors work in paid
medicine, for "other" money.
Tasks:
1. What is the first communication skill that a doctor should use, please define?
2. What stages does the structure of the doctor-patient communication process include
according to the Calgary-Cambridge model?
3. Indicate the models of doctor-patient interaction identified by R. VICH (1972) and give
a brief description of them
Patient V., 44 years old, went to the GP with complaints of compressive pain attacks
that occur behind the sternum, radiating to the left arm, under the left shoulder blade, and in the left collarbone.
The duration of pain is 3-5 minutes. Pain occurs when walking and climbing two floors,
and passes at rest. Bothered for about 3 months. I haven't seen a doctor before.
Objectively: the temperature is 36.6 C. The general condition is satisfactory. The skin is clean. Subcutaneous
fat is excessively developed. Height-173 cm, weight -89, waist size-95.
Vesicular respiration, BPD 16 per min. Heart sounds are rhythmic, clear, heart rate 84 per minute, blood pressure
120/80 mm Hg.
Abdominal pathology was not detected.
Bad habits – smokes about 10 cigarettes a day for 20 years,
drinks large quantities of beer on weekends with friends, work is associated with business trips, does not eat
regularly, often
eats fast food.
Tasks
1. Formulate and justify the presumed diagnosis.
2. What are the necessary additional studies, what document regulates
the scope of research, and when it was adopted?
3. Determine the activities that you plan to perform in relation to the patient, who
will perform them and in what time frame
Patient K., 35 years old, complains of pain in the right breast, which increases in
the premenstrual period. In the lower-inner quadrant of the right breast in
an upright position, a tumor-like formation of 2x2 cm in size is detected,
painless, mobile. Regional lymph nodes are not enlarged. There is no pathology from the
internal organs. From the anamnesis – 3 pregnancies, 2 births, 1-spontaneous miscarriage
at an early stage. Not registered. Close relatives are healthy.
Questions:
1. What clinical symptoms should be checked in this patient? Formulate
a preliminary diagnosis and make a differential diagnosis.
2. What special research methods should be performed to confirm
the diagnosis?
3. What order of the Ministry of Health of the Republic of Kazakhstan regulates the provision of cancer care in
the Republic of Kazakhstan? In which
clinical group of dynamic observation will this patient be observed? Scope
of the survey in accordance with this order.
A two-day-old child was diagnosed with congenital pneumonia, transferred
to expressed milk for health reasons, birth weight 2800.0, height 48 cm.
1. Calculate daily and one-time feeding volumes:
a) the Filkenstein formula;
c) the Zaitseva formula;
c) the one-time volume formula.
2. How many times a day should the baby be fed?
3. What formula allows you to calculate a more physiological daily volume of breast milk?
milk? Why?
Alima is 5 years old, attending kindergarten. According to my mother, I became acutely ill, with the temperature
rising to 38
°C, cough, runny nose. In the next three days, the temperature remained at febrile figures,
catarrhal phenomena increased. Cough is rough, frequent, puffy eyelids, conjunctivitis,
photophobia. On day 3, white spots with a diameter of 1-2 mm appeared on the cheek mucosa opposite
the small molars. On the 4th day of the disease, the body temperature rose to 39.5 °C,
a spotty-papular rash appeared on the face, behind the ears, which spread
to the torso and limbs in the next two days.
questions:
1. Clinical diagnosis in accordance with the CP of the Ministry of Health of the Republic of Kazakhstan?
3. Evaluate the leading clinical syndromes.
2. Non-specific preventive measures in this case in accordance with the KP of the Ministry of Health of the
Republic of Kazakhstan?