Data of RPN " Clinic " in 2020 and 2021 according to of the city in the clinic of the people

for a total of
35,035 inhabitants service is displayed .
Myocardial infarction incidence (2020)
men aged 50-60-20 . 60-70 years old - 7, total - 27 women
50-60 years old - 4, 60-70 years old - 12, total - 16
Myocardial infarction incidence (2021) men
aged 50-60-24, aged 60-70-13 , total-37
aged 50-60 women - 10, 60-70 years old - 3, all - 13 with
myocardial infarction in 2020 7 people died formed _
in 2021 10 people died formed _ In the
clinic "D" report : 1020 people , from the beginning previous myocardial infarction in 2020 - 300 people ,
in 2021 - 310 people .

Questions :
1. The clinic fixed residents from myocardial infarction first morbidity analysis driving _
2. To death analysis conduct of the clinic fixed residents from myocardial infarction was death general
coefficients calculation .
3. Normative and legal regulations of the Republic of Kazakhstan to acts according to from the beginning
passed ОКСбпЅТ after long periodic treatment according to make suggestions .
With yourself have a calculator together need _

Data of RPN " Clinic " in 2020 and 2021 according to city in the clinic of the people for a total of 36,540
people service is displayed .
in 2020 sugar diabetes number of patients - 126 people and in 2021 - 177 people . In
clinic "D" account : 1020 people , according to 2020 - 500 people , in 2021 - 510 people , in
2020 in clinic #1 , 126 people in " D" account , in 2021 177 people received .
in 2020 sugar from diabetes 5 people died formed _
in 2021 7 people died formed _

Questions :
1. The clinic fixed residents sugar with diabetes first to morbidity analysis driving _
2. To death analysis conduct of the clinic registered residents sugar from diabetes general death
coefficients calculation .
3. Normative and legal regulations of the Republic of Kazakhstan to acts according to sugar patients with
diabetes ( dynamic control and efficiency indicators ) driving according to make recommendations .
With yourself have a calculator together need _

Patient V., 38 years old , 10 doses of salbutamol with reception unstoppable suffocation seizure , dry
cough , weakness , heart knocking , fear feeling with complaints to the clinic applied .
Medical history : Recent years daytime of seizures frequency once a month lot no , nocturnal seizures
was not noticed . Of the patient say according to , one day ago at home repair works conducted by the
walls old wallpapers received _ At night suffocation profit was _ By itself with salbutamol to stop tried ,
right the result not observed . The situation to deterioration it depends husband by car to the clinic giant
came _
Behavior features : anxiety , nervousness , any thought to confirm tendency typical , but all case to the
end until to deliver strength no _
Tasks :
1. Doctor and patient between communication to the process what skills included ?
2. Doctor and patient mutually interaction skills What belongs to the group ?
3. Doctor and patient connection effective finish for what skills need ?

Patient S., student, 24 years old . With acquaintances general practical to the doctor delivered .
The left side ankle of the region external on the page suddenly profit was to pain , of pain movement
during to increase ( bend and write , export and import ), same jaw ankle lateral in the area to the heel
spread tumors and a few to mold complained .
Medical history : about 1 hour ago from the bus came out when he is from the stairs down and whole
body by weight bent that to the feet relied on . He is immediately external ankle in the area sharp of
pain profit presence in this region swelling profit to be and growth especially passed . With friends to
the clinic delivered .
Behavior features : clinic to doctors careless looks at them as " non- specialists " . thinks , good doctors
paid in medicine , for " other " money work to do reliable .
Questions :
1. Doctor the most first what relationship skills use Need help _ give me
2. Calgary- Cambridges to the model according to of the patient and the doctor between communicative
of the process stages
3. According to R. Vich (R. VICH, 1972) . of the patient and the doctor between communicative of the
process stages , briefly description give it

Patient V., 44 years old , to the GP chest behind squeeze to the pain , that jaw to the hand , shoulder ,
clavicle spreads . Pain duration 3-5 min. Pain walking when and secondly to the floor when rising profit it
will be in peace is pressed . in the amount of 3 months bothers . Ago to the doctor not reviewed .
Objective : temperature 36.6 C. General situation satisfaction . The skin is clean. Subcutaneous fat layer
more developed .. Height-173 cm, weight -89, abdomen circumference - 95 cm. Breath vesicular , CT
scan 16 times per minute . Heart tones rhythmic , clear , YYYY 84 times per minute , BP 120/80 mm Hg.
Art. Abdominal pathology is not revealed.
Harmful habits - 20 years 10 cigarettes a day smokes on weekends with friends big He drinks a lot of
beer , he works with business trips related , nutrition often eats fast food
irregularly . Questions :
1. Estimated diagnosis put and justify
2. Need add on delays name it , what kind with the document fixed when _ accepted ?
3. To the patient it depends planned measures name , who , what in term spends .

Patient K., 35 years old , complaints that jaw milk gland pain , menstruation before pain adds _ Lower-
internal in the quadrant right jaw milk in the gland vertical in shape tumor 2x2 cm in size formation
defined , painless , mobile . Local lymph nodes did not increase . Internal members there is no pathology
. History of 3 pregnancies , 2 births , 1 early in time by itself miscarriage . In registration does not stand .
Relatives healthy _
Questions :
1. In the patient what clinical symptoms check do you need Preliminary diagnosis _ put and differential
diagnosis conduct
2. Diagnosis justification for what special from studies to pass do you need
3. Oncology of the Republic of Kazakhstan help what with the document approved ? The patient
dynamic of control what clinical in the group controlled ? To order according to studies volume .
2 days to the child born profit was diagnosed with pneumonia , health to the situation it depends eating
milked mother to milk replaced , born when weight 2800.0, height 48 cm.
1. Daily and one time eating amount calculate :
a) Filkenstein formula ;
c) Zaitsev's formula ;
c) Unique volume formula .
2. Per day how many child feeding times need _
3. Eating what formula physiological daily quantity to determine opportunity gives ? Why?

Alima is 5 years old , in kindergarten goes _ Mother's say according to urgent sick left , body of heat rise
up to 38 °C , cough , inherited from blockage started . In the next 3 days body fever febrile , catarrhal
views strengthened . Cough hard , frequent , eyelids swollen , conjunctivitis, from light fear _ On the 3rd
day in his mouth slimy on the floor white spots 1-2 mm in diameter It happened on the 4th day of the
illness temperature rises to 39.5C and face and ears behind spotted-papular rash profit was _ Later two
every day he is spots to the body and leg departments spread .
QUESTIONS: 1. RK DM clinical to the protocol according to clinical diagnosis put
2. Driver clinical syndromes determine
3. RK DM clinical to the protocol according to Given to the situation special not preliminary healing _
measures

In the polyclinic of the city, according to the RPN "Polyclinika" in 2020 and 2021 serves a total
population of 35,035 people
. Incidence of MI (2020) Men aged 50-60-20. 60-70 years old -7, Total - 27 Women 50-60 years old - 4,
60-70 years old - 12, Total - 16 37 Women 50-60 years old - 10, 60-70 years old - 3, Total - 13

Mortality from MI in 2020 was 7 people. Mortality in 2021 was 10 people. for 2020 -300 people, 2021 -
310 people

Question: 1. Conduct an analysis of primary morbidity from myocardial infarction of the attached
population of the Polyclinic2. Conduct a mortality analysis, calculate the overall mortality rates from
myocardial infarction of the attached population of the Polyclinic3. Give recommendations on long-term
treatment after NSTE -ACS , in accordance with the regulatory legal acts of the Republic of Kazakhstan.
Bring a calculator with you

In the polyclinic of the city, according to the RPN "Polyclinika" in 2020 and 2021 serves a total
population of 36,540 people
. The number of patients with diabetes in 2020 - 126 people and 2021 - 177 patients In the clinic on the "
D " account is: 1020 people, according to diabetes for 2020 -500 people, 2021 -510 people
126 people, 177 patients in 2021. Mortality from diabetes in 2020 was 5 people. Mortality in 2021 was 7
people.

Question:1. To analyze the primary incidence of diabetes in the attached population of the Polyclinic2.
Conduct a mortality analysis, calculate the overall mortality rates from diabetes of the attached
population of the Polyclinic3. Give recommendations on the management of patients with diabetes
(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, came to the clinic with complaints of an asthma attack that was not stopped by
taking 10 doses of salbutamol , an unproductive cough, weakness, palpitations, and a feeling of fear.
History of present illness : In recent years, the frequency of daytime attacks is not more than 1 time per
month, no night attacks were noted. The day before, I did home repairs, removed old wallpaper from
the walls. At night there was suffocation. I independently tried to stop it by taking salbutamol , there
was no positive effect. Her condition continued to worsen, and her husband took her to the clinic by car.

Behavioral features: characterized by anxiety, suspiciousness, a tendency to fixate on any thought, but
there is no strength to bring all things to an end. Tasks: 1. What skills are included in the process of
establishing contact between a doctor and a patient?2. What belongs to the group of doctor-patient
interaction skills?3. What skills are needed to effectively complete the contact between doctor and
patient?

Patient S., student, 24 years old. Delivered by friends to general medical practice.
Complaints of sharp pain in the left ankle joint, on the outside, aggravated by attempts to move in it
(flexion and extension, abduction and adduction of the foot), swelling and moderate cyanosis in the
lateral (outer) ankle of the left lower limb with spread to the foot. Anamnesis of the present illness:
about 1 hour ago, when leaving the bus, she stumbled down the stairs and leaned on her bent left foot
with her whole body weight. Immediately noted the appearance of a sharp pain in the area of the outer
ankle, the appearance and growth of edema in this area. She was taken to the polyclinic by friends.
Behavioral features: she demonstrates a disdainful attitude towards the doctors of the polyclinic,
considering them " non -specialists ", she is convinced that good doctors work in paid medicine, for
"other" money.
Tasks:1. What communication skill should the doctor apply first of all, give a definition?
2. What stages does the structure of the communication process between a doctor and a patient include
according to the Calgary-Cambridge model?
3. Indicate the models of interaction between the doctor and the patient identified by R. VICH (R.VICH,
1972) and give a brief description of them

Patient V., aged 44, turned to the GP with complaints of attacks of compressive pain that occur behind
the sternum, radiating to the left arm, under the left shoulder blade, to the left collarbone. The duration
of pain is 3-5 minutes. Pain occurs when walking and climbing two floors, at rest they pass. Worried
about 3 months. Previously, the doctor did not apply.
Objectively: the temperature is 36.6 C. The general condition is satisfactory. The skin is clean.
Subcutaneous fat is overdeveloped. Height-173 cm, weight -89, waist circumference - 95. Vesicular
respiration, NPV 16 per minute. Heart sounds are rhythmic, clear, heart rate is 84 per minute, blood
pressure is 120/80 mm Hg. Art. Abdominal pathology was not revealed. Bad habits - smokes about 10
cigarettes a day for 20 years, drinks large quantities of beer with friends on weekends, work involves
business trips, does not eat regularly, often eats fast food. Tasks1. Formulate and justify the
presumptive diagnosis.2. Name the necessary additional studies, what document regulates the scope of
studies, when was it 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., aged 35, complains of pain in the right mammary gland, aggravated in the premenstrual
period. In the lower-inner quadrant of the right mammary gland in a vertical position, a tumor-like
formation 2x2 cm in size, painless, mobile, is found. Regional lymph nodes are not enlarged. There are
no pathologies 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 conduct 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 oncological care in the Republic of Kazakhstan? In which clinical follow-up group will
this patient be observed? The scope of the survey in accordance with this order.

feeding with expressed milk, birth weight 2800.0, height 48

cm
. c) Zaitseva's formula; c) one-time volume formula.2. How many times a day the child should be fed.3.
What formula allows you to calculate a more physiological daily amount of breast milk? Why?

Alima, 5 years old, attends kindergarten. According to her mother, she fell ill acutely, with a rise in
temperature to 38 ° C, cough, runny nose. In the next three days, the temperature remained at febrile
levels, catarrhal phenomena intensified. The cough is rough, frequent, swelling of the eyelids,
conjunctivitis, photophobia. On the 3rd day, white spots 1-2 mm in diameter appeared on the buccal
mucosa opposite the small molars. On the 4th day of illness, the body temperature rose to 39.5 °C, a
maculopapular rash appeared on the face, behind the ears, which spread to the trunk and limbs in the
next two days.
QUESTIONS:1. Clinical diagnosis in accordance with the Code of Practice of the Ministry of Health of the
Republic of Kazakhstan?3. Assess the leading clinical syndromes.2. Non-specific preventive measures in
this case in accordance with the Code of Practice of the Ministry of Health of the Republic of
Kazakhstan?