Добавил:
kiopkiopkiop18@yandex.ru Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:

4 курс / Дерматовенерология / Dermatologia_i_venerologia_KGMU_g_Simferopol_2012_g

.pdf
Скачиваний:
1
Добавлен:
23.03.2024
Размер:
9.49 Mб
Скачать

'9~~(1up~

6.Be3MK}'JIMT - aocnarrettwe ceMeHJmro IIf3bipbKa.

7. BanaHMT -- Bocnanei-rne ron oBKH nonoaoro ·'Uletta.

8.BanattonocTHT - socnarrem'1eBttyrpei-mero Jl.HCTKa KpaftHeCi: nnoTM w r OJIOBKM IlOJIOBOro "llieHa.

9.,D;e¢epeHTHT - socnane1u1e ceMHBbnrnc5rrn;ero n poToKa.

10.Cl>yHl1K}'JIHTBOCnarreHne ceMeHHOro K8H8Tl1K8.

11 . JllflTpettT - socnane1-me *ene3 MoqeHcnycKaTeJibHoro Kattarra (*ene-

3bl JlMTTpe).

12.M opraHttT - socnane1n1e naKyH ;111oqe11criycKaTeJibHoro KaHaJJa (naKYHbI MopraHbtt).

13.IlapaypeTpJ.1T - Bocrraner-rn:e napaypeTpaJibHblX Kattan oB.

14.Ttt30HHT - nocrrarreHMe )!(eJie3 Kpamie Ci: ru10TH.

.l{uazHocmuK:a zonopeu ocHoBaHa Ha ;:i;aHHhIX aHaMHe3a, Kl\liHWieCKOH KapTHHe 3a6ot.eBaHllil H pe3yAbTaTax Aa6opaTOpHoro

o6cAe,Il;OBaHI-rn (MHKpOCKOilHSI rrpenapaTa, OKp arneHI-IOrO ITO I'paMMY HAM MeTH.r.eHOBbIM CHHHM, K}'Ab1y paAbHOe HCCAe;:i;osaHHe).

i le'l.eH.ue npe,zzycMaTpHBaeT Ae'I-eHHe He TOAbKO 60AbHOI'OroHOpeeH:, HO H scex ero HOAOBbIX rrapTHepoB . H cnOAb3YIOT 3THOTporrHb!e n aToreHeTH'IeCKHeH CHMilTOMaTW-IeCKHe npenapaTbI. AHTH6aK-

TepHaAbHhie npenapaTbl - neHHI.J:Hi\AHHLI, MaKpOAH,ll,hI, TeTpaU:HKl\H- HLI, u.ecpa.r.ocrropHHLI, cpTOpXHHOAOHbI. TaKJKe HCIIOAb3yIDT HMYffHO~

MOJlYA51TOpbI, 6HoreHHbie CTHMYASITOpbI, cpepMeHThI, BHTaMHHhI, QJH3Honpou:e,n;ypbl, MeCTHoe Ae'IeHHe.

XAaMHJJ;H03 - HHcpeKU:HOHHOe 3a6oAeBaHHe MO'IeITOAOBbIX

opraHOB, BhI3bIBaeMoe Chlamydia trachomatis. B HaCTo>rrn;ee apeMSI 3TO 0,ll,HI-I H3 HaH60Aee pacnpocTpaHeHHbIX B036y.n;HTeAeH BOCITaAHTeAbHbLX 3a6oAeBaHHH nepe,n;aro rn;HXCSI llOAOBbIM rryTeM.

3muo.nozust.

Chlamydia

trach oma tis npe,n;cTaBAHeT

co6oii:

r paMMOTpHU:aTeAbHYID

6aKTepHID

c )'HHKaAbHbIM JKH3HeHHLIM

I.J:HK-

AOM, He BCTpeqaIDIIJ;HMC>I 60Abllle B rrpupo,n;e. 3ToT MHKpoopraHH3M 3aHHMaeT npoMe:myro•-rnoe noAmKeHue Me:>KJJY 6aKTepllilMH u snpycaMH H CO'IeTaeT B ce6e HX OCHOBHhie xapaKTepHCTHKH. XAa..'1lH.l{H51 o6Aa,n;aeT YHHKaAbHbI~ U:HKJ\OM pa3BHTlliI, B npou:ecce KOTOporo rrpoHCXO)l;HT CMeHa o,n;Ho:H ¢opMbI ee cyrn;ecTBOBaHH>I 3AeMeHTapHoro

TCAhll.a (3T) , ,n;pyroii: - peTHK}'Af!pHblM TeAbU:eM (PT). 3apa>KeHHe

n poHCXO,ll;HT MCTa6oAH'-JeCKHHeaKTH:BHblM 3T, KOTopoe B l.]JiTOITAa3Me KAeTKH n peo6pa3yeTC.H B MeTa6oAH'-eCKHI a.KTHBHOe, HO HeHHcpeKU:H- OHHOe PT. 0Ho MHOroKp aTHO ;:i;eAHTC.H 6HHapHhIM .n;eAeHHeM, a 3aTeM TpaHc¢opMHpyeTC>I B 3 T HOBOro HOKOt.eHllil, crroco6Hoe 3apruKaTb

221

oqepe.[(Hble KAeTKH . )KH3HeHHhlH D;HKA pa3BHTllil 3aHHMaeT 48-72

·qaca.

llamozeH.e3. XAaMHAHH 061ui.a;a10T TponH3MOM K D;HAHHApHqecKOMY 3HHTeAflIO. 3T ap,cop6Hpy:IOTCH Ha nosepxHOCTH KAeTOK U:H- AllH.[(pH'IeCKOrO 3IIUTeAHH, c:ParoU:HTHPYJOTCH HMH H OKa3bIBaIOTCH BttyrpH KAeTOK. 06pa3yIOTCH TaK Ha3hJBaeMbie BKAIO'leHHH, KOTOpbie

OTTeCHSIIOT HAPO KAeTKH K nepHcpepm-1, a 3aTeM MOJKeT rrpOH30HTH H pa3pbIB KAeTKH c BhIXO,[{OM TeAeu: XAaMH,[(HH B MeJKKAeTO'lHOe npoCTpaHCTBO H nocAe)l,YlOrn:HM 3apaJKeHHeM ApyrHx 3IIHTeAHaAhHblX KAeTOK.

Knunwca. H Hey6au::aoHHhIH rrepHo,n ,nAHTCH s cpe,n:HeM 10-14 p;Heli . OcHOGHbte npoJie.JLeHUR 60.11.e3HU y MYJICll.W-t: cey,nHh1e CAH3H-

CTO-rHOHHhie BhI,[{eAeHHH H3 MO'lencrrycKaTeAhHOro KaHaAa, Ou.tym;e- HHe A HCKOMcPOPTa B ypeTpe (3yA, HHOr,Aa 6oAe3HeHHOCTh npH MO'!e- HCIIYCKaHHH), IIOK pacHe HHe ry6oK ypeTpbI. IlpH OCAOJKHeHHHX (3IIHAH.ZJ.HMHT, npocTaTHT H Apyrtte) B03HHKaeT COOTBeTCTBYJOW:aH KAHHUqecKaH KapTHI-Ia.

0CH061ible npORe.Jl.eH.UR XJU1.MUOU03a y JK:eH.UJUH.: CAH3HCTOrHOHHhie B hI)].eAeHHH H3 u:epBHKaAhHOro KaHaAa; 3KTOIIH51/3p03HH meHKH MaTKH (cPOAAHKYA5IPHhlH u:e pBHU:HT).

Hy MYJK'IHH,Hy JKeHW:HH B 6oAee 'leM50 % CAyqaes XAaMH-

.ZJ.HHHaH HHcPeKU:H51 n poTeKaeT 6eCCHMIITOMHO, rrpH HaAH'iHHOCAOJKHeHHH Ha6AI-O.[(aI-OTC51 COOTBeTCTBYI-OIJJ,He KAHHH'leCKHerrpOHBAeIUHI .

,l{uaznocmu1ea. 1\a6opaTOpHb1e MeTO.AbI HCCAeAOBaHHSI: .lV\H

HCCAe,n:osaHH5I 6epyT COCK06 (KAeTKH 1..I;HAHHApH'ieCKOro 3IIHTeAlf.H) HAH 6HOAOrH'!eCKHeJKH,[{KOCTH.

1.li1MMJiiOcPJUOOpecIIetITHbie MeTO,!l;bl - MeTO)l; rrp.st:MOH ttM}'HHOtj,JJIOO·· pecu;eHQHH (Ill1<l>), 1'1CITOJib3YIOT MOHOKJJOIHUJbHbie aJITIITeJJa, crroco6Hbie ofo.iapy)f<HTb BHeKJieTO'iHOpacrroJIO)!(eHHbie XJiaMH)J,1111.

2.li1MMJHOcpepMeFfTI-Ibil1 aHaJil13 (li1<l>A) BbffiBJI.si:IOT HaJIH'IHeamwreJI K Chlamydia trachomatis B KpoBM m m am"l!IreH B cocKo6ax .

3.KyJibTfpaITbHhie Hccrrep;osattIDJ.

4.M eTOAbI AHK-p;11arHOCTID<H - ITOJI1'1Mepa3ua}l1leITHa}l p eaKIJl!I}l (1111,P),

JIHra3HM QeITHa}l peaKIJIDI (JII..W), AHK30H,lJ;bI.

ile'l.eH.ue. 3THOTpOIIHaH TeparrHH - HCIIOAh30BaHHe aHTH-

6 H OTHKOB (TeTpar..i;HKAHHbI, MaKpOAHAhI, QTOpXHHOAOHhI). B CBH3H c npo,n:OAJKHTeAhHhIM JKH3HeHHhIM UHK/\OM XAaMHAHH, speM.H B03JJ;eikTBllil aHTH6HOTHKa ,n:oAJKHo 6 hITb He MeHee 7 cyToK. TalOKe HCIIOAb3YIOT rrpenapaTbI ll.AfI CHMIITOMaTJiqecKOM H naTOreHeTH''leCKOHTepa-

222

223

11HH, MeCTHoe Ae'IeHHe. IIau:HeHTOB HHcpopMHpyIOT 06 o65I3aTeAbHOM

Heo6xo.n;HMOCT H o6cAe)l;OBaHH.H H Ae'IeHH.HIIOAOBbIX IIapTHepos .

TpHXOMOHHa3 - HH<j:>eKU:HOHHoe (nap a 3 HTapHoe) BOCilaAH-

TeAbHoe 3a6oAeBaHHe IIepe,Ll,aBaeMoe npeHMYIIJ,CCTBeHHO IlOAOBblM

nyTeM , B036y,Ll,HTeAb - Trich o monas v aginali s. TpaxoMOHHa3 - nm-

poKo pacnpoCTpaJieHHOe 3a6oAeBai-me, O,Ll,HHaKOBO <J:aCTO IIOpIDKalOlll,ee ?..f)'JK'IHHH ::a<eHIUHH, IIO )J.aJ!HhlM B03, e:l:Kef'O)J.HO B MHpe 3apa-

:>Kal-OTCH OKOJ\O 180-2 00 MAH '-IeAOBeK.

3muoJtozusr... Bo36Y.D.HTeA b HMeeT OBaAbHo-rpyllleBHAHYIO cpopMy-, pa3 Mepbl OT 8 11.0 4 0 M KM . CHap}')KHITOKpbIT o 60AO'IKOI1,TeAO COCTOHT 113 TOHK0-3epHHCTOM IlpOT0!11\a3Mbl c MHOrO'IHCAeH blMH BaKyOAHMH, Ha TeAe HMeIOTCH :lr.."TYTHKH, 6 A aro.n:apSI KOTOpbIM T pHXOMOHa,n:a cnoco6Ha nepe,n:sHraThCH . BHe opraHH3Ma qeAoBeKa TpHXOMOHa.n.a.·6b1cTpo TepHeT ·::a<H3Hecnoco6HocTL , 6b1CTpo nortt6aeT npH .n.eliCTBHH BblCOKH X TeMnepaTyp, np.HMblX COJ\He'lHbIXA)"IeM, BhICY11IHBaHHH, ycTOll'IHBaK HH3KHM T e MneparypaM. 11H<j:>HU:HpOBa HHe n p OHC-

XO.IJ.HT n pH IIOAOBOM KOHTaKT e c 60AhHbIM MO'lCilOAOBbIM TpHXOM01Hfa30M.

KnuH.urca. IIpo.n.oJUKHTeALHOCTh 1u1ey6~HOHHoro nepno.n.a B

c pe.n.HeM COCTaBAHeT 6-10 .D.He M, HO MmKeT yse AH '-IHBaTbCH.no 30 cyTOK . 06bl'IHO60AhHbie :>KaAYIOTCH Ha H OHBAeHHe B hJ.IJ.eJ\eHHH, Hepe.n.Ko

TICHHCTbIX, HaAH'IHe 3y,Ll,a,

:liOKCHHH B o 6AaCTH Hapy:>KHbIX

IlOAOBbIX

opraHOB, )l;H3ypHH.

 

 

 

y AHU: o6onx ITOJ\OB

B03Mo:lKHO pa3BHTHC U:CAOro pa.n.a OCJ\O:lK-

HCHHH c BOBAe'-eHHeMI B npou:ecc o pra ltoB M O'-ICilOAOBOH CHCTeMbI.

 

)lHarHOCTHKa OCHOBaHa Ha ,n:aHHbJX aHaMHC3a, KJ\HHH'-IeCKOH

KapTHHhl H Aa6opaTOpHOM o6cAe .D.OBaHHH:

 

ttccnep;oaaHHe HaruBHbIX (tte 0Kpa me1nmrx) nperrapaTOB -

caMbm

..

npocT011:, .n:oc1yrrnh111: tt .n:o c ToaepHbIM cnoco6 ,n:ttarnocTin<M,

 

K)'JlbT)'pa7IbHaJIp;11:anIOCTH K a ,

 

11:MMyHocpepMeHTHa}l A ttanrocn1.Ka,

JJ:.HK-,n:warnoCTH:Ka•

Ae'tettue. 3THoTponnaa Tepa nH.H - Ha3aH'-ICHHenperraparos HMH.IJ.a3 0AbHOH rpynllbI (MeTpaHH.IJ.a30A, opHH,ZI;a30A) . TaIOKe HCilO.J\.b-

3yioTCSI CHM T OMaTH'lCCKaHTepanH.H, n a TOreHeTH'-IeCKaH, MeCTHoe Ae- 'leHHe.06.H3aTeAbHOe o6cAe,ll.OBaHHe H Ae'-IeHH IlOAOBbIX rrapTHepos.

MHKODAa3M03, ypeaniUl3M03 -

H H <j:>eK11.HH

MO'-IeilOA OBOH

c HcTeMI>1, BbI3bIBaeML1e Mycoplazma

genitalium,

Ureaplazma

u realiticum.

 

 

0 ,3-0,8

3muon.ozusi. MHKOnAa3MhI - npoKapHOTH'!ecKHe opraHH3-

MhI, 3aHHMaIOru:He npoMe:>l<yTO'IHOe IlOAO)KeHHe Me:JK.DY BHpycaMH H 6aKTepH.SlMH. MHKOIJAa3Mhl He HMeIOT KAeTO'lHOHCTeHKH H orpaHH- 'leHhI AHillh I.J;HTOilAa3MaTH'leCKOH MeM6paHOH. Pa3Mep MHKOIJAa3M

MKM, pa3MHO)KaIOTCSI nyTeM 6HHapHoro .zi;eAeHHSI, OCHOBHblM MeCTOM 06~1TaHHJI B opraHH3Me 'leAOBeKa.SIBARIOTC.H 3IlHTeAHaAhHhie KAeTKH CAH3HCTbIX o6oAO'Ie K. MHKOIJAa3MhI cnoco6HbI K BHYT PHKAeTO'lHOMY rrpOHHKHOBeHHIO , 'ITO Il03BOAReT HM 3aW:HW:aTbCSI OT rro- B pe:lKJJ:aIOm;ero ,n;eHCTBlffi: ryMopaAbHOl'OHMMYffHTeTa H aHTH6HOTHKOB H cnoco6cTBYeT yC'raHOB Ae H HIO A aTeHTHbl X H xpOHH'leCKHXcpopM MH-

KOilAa3MeHI-IOH HHcj;JeKI.J;H H.

Kn.UHUKa. MHKOUAa3MeHHa.SI HHcj;JeKI.J;H.SI MO'IeIJOAOBOH CHC-

TeMhI B 60AbillHHCTBe c 11.yqaeB xapaKTepH3yeTC.H XpOHH'Ie CKHM pell,H- AHBHpyIOW:HM Te'ieHHeM6e3 BblproKeHHblX .KAHHH'IeCKHXnpo.SIBAeHHH

H qaru:e acero o 6HapjT)KHBaeTCSI npH Aa6opaTOpHOM o6cAe)l.OBaHHH .

IlpHCYTCTBHe MHKOIJAa3MeHHOH HHcj;JeKI.J;HH MO)KeT Bhl3bIBaTb pa3BHTH'e BOCilaAHTeAbHOI'O rrpou;ecca opra1rns MO'lenoAOBOH CHCTeMbI, a TaK>Ke HapymaTb penpO/IYKTHBHYIO <PYHKIIHIO 'leAOBeKa .

 

,l{uazHocmuKa. A a 6opaTopHbie

MeTOAhI HCCAe .n.oBaHH.SI: .ll.Afl

HCCAe)l.OBaHHSI 6epyT COCK 06

(KAeTKH

I.J;HAHH.D;pH'IeCKOI'O3IlHTeLrnSI)

HAH 6HOAOI'H'leCKHe)KHJJ:KoCTH .

 

1.

V1MM)'Hocj;Jmoopecu;eHTHbie

MeT0,!1,b! -

MeTO,!I, npmmtl HM)'IiHocpmoo-

 

p ecu;eHl(WM (ITM<l>), 11CIJOJib3Y IOT M OHOKJIOHaJlbHbie aHTIITeJia, cnoco6-

 

Hbie o6Jmpy)IUITb BHeKJieTO'IHOp acnOJIO)l(eHHbie MJ1KOWia3MbI w ypea-

 

nna3MbI.

 

 

2.

MMM)'Hocpe p MeHTI-fbifl aHaJIM3 (M<DA) -

BbIBBJISlIOT HaJIH'lMeaiiTI1TeJI I<

 

Mycoplaz ma genitalium, Ureaplazma urealiticum B 1<poau WJtt a1n1<1reH

B coc1<06ax .

3.K y rrhrypanhHbie MCCJie,!1,osamur.

4.MeT O)J;hI }JJ-IK-,IJ,vtan-10cn1KM - norrHMepa3HaSI u;ermaSI peaK[(HSI (IIUP),

Jrn:ra3HaSI l~enHaSI peaKl(H.li (JJUP), )JJiK -

30Hp;hI.

Ae<ieHue. H a

OCHOBe )KaA06,

KAHHH'IeCKHX CHMI1TOMOB,

aHaMHe 3 a H .zi;aHHbIX Aa6opaTOp Horo o6cAe)l.OBaHH.SI Ha3Ha'!aIOT3 THO-

Tp0I1H)'10TeparrHIO (aHTH 6HOTH KOTepamrn - TeTpau;HKAHHbl, MaKpO-

AH)l;hl, cj;JTOpXHHOAOHbI) .

06.sl3a TeAbHHM

.SIBA.HeTCSI o6cAe.D.OBaHH e H.

Ae'leHHeIlOAOBbIX rrapTHepoa .

 

KOHTpon&HblH Teer K conep»<aTenbHOMY MOttynfO N!! 12

1. K K~HM IKOKKaM OTH OCWTOI B036y,rvrreJib roHopew - roHOKOKK? (_a ) apHbIM KOKKaM rpa M-OTJml(aTeJibHhIM,

224

5) rrapHbIM KOKI<aM rpaM-IIOJI0)1(11TeJ!bHblM,

a)napHblM KOKKaM rpaM-Bapliffi5eJibHbIM,

r)KOKK05an;wm:aM rpaM-OTpID.J;aTeJibHbIM,

A)KOKKo5au,wmaM rpaM-Baptta6eJibHbIM.

2.B 1.JeM COCTOJIT npaBMJlbHaB. TaKTMKa Jie'!eHl1HTOpIIH)l,HbIX J1 xpoHJ11.Je-

CKJ1X cpopM rotropel1HOM l1HcpeKD;J1l1.?

a) ViMM)'HOTepaneBTir'lecKne,aHTI1rncraMMHHbie nperrapaThr, MecT-

~

Hoe ne'!etrne,

.

~ HMMyHoTepaneBTwiecKMe, aHTH6aKTepI1aJibHbie, aHTT1Til:CTaMHH-

Hbre npenapaTur, Mecrttoe Jie'len11e,

s) a1-rrtt6atcrepJ.fanbHbie npenapaThr, MecTHoe Jie'leHMe,

r ) KMMYHOTepaneBTH'lecKMenpenapaTbI, MecTHoe ne'leH11e,

A)TOJlbKO Mecnwe Jie'lettvce.

3.4T.O He .JIBJUieTCH IIOKa3aHHJIMJ1 ,O:JIH o6cne.u.ouaHHH Ha roHopeHHO-

XJiaMJ)J',[~Hl1Ho-ypeanJia3MeHH)'lO HHcpeKU;Hl-0?

a)Becrmo,n:HMl1: 5paK,

(!!l apyIIIeHTrn ¢YHKQKlii In;MTOBM)J;HO~[)KeJie3bl,

s)rraTononrn 6epeMeHHOCTH,

r)xpott11qecK11e socnanKreJI1>Hble 3a6orresa1-l~ opraHos Manoro Ta3a,

A)ttapymettmr Mencrpyan:bttoro I~J.fKJia.

4.KaKne npH3HaKn He 06yc11aBJIJ1BaIDT 6aKTep nocKon11'lec1cywn.a;eH- THcp11Kan;n1-0 rOHOKOKKOB?

a) IlapHOCTb KOKKOB,

~rpaM·O'rpHl:J;aTeJibHOCTb,

~rpaM-IIOJIO)KJ1TeJibHOCTb,

r)BHYTPMKITeToqHoe pacnoJIO)KeHMe,

A)6060B11AHOCTh cpopMbI.

5.KaKoua TaKTnr<a Jie1.1emm rrpw p;nartro3e (y »<eHID;HHbI): cne:n<MM TopllJ1Jl.HbIH ypeTp11T, 3H)l,On;epBHll,11T ro11opeJ1:HOK 3TJ10JIOrnM?

'a})AHTM6MOTMKOTeparrMH,

6)cnen;HcpMqecKasr BaKQMHOTeparmsr,

s)Hecnen;Hcpf,f'lecKasrsaKQHHoreparmsr,

r)MeCTHOe Jie'leHMe,

A) see rrepeq11crreHHoe.

6.4To He HBJUleTCH KJIHHH'leCKHMHCHMilTOMaMit ronopen rJia3? a) OreKBeK,

6) 3K30cpTaJihMa,

s) cseTo6osr3Hb, rnoereqeHMe, r rMIIepeMMH KOH"bIOHKTMBbl,

,A) pacna,o;aroru;rui:or Sl3Ba B porosol1: o6onoqKe.

225

7.qTO He rrpwMeHJle'I"CJI np11: Jie'leIHUi roHopeilHO-XJiaMH,ll,J1HHO-

KaH,ll,MA03HOH MHcpe~J1J1?

a) AuTM6aKrepttai1Mn.1e npenapaTbc,

6) rrponmorpM6KoB1>1e rrpenapaT1>1,

B)npenapaTbI rpynnbl <flTOpXHHOJIOHOB, r ponmonpoT030'1lHbienperrapaTbI,

A)HMM'/HOKOppeKTOpbI.

8.KaKtte n pm:m11eH11JI He HBJIJIJOTCJI OCHOBHbl Ml1 KJIMH1111eCK11Ml1 CffM-

DTOMaMM opocpapMHreaJibHOM rmrnpeH?

a 5baeHHbie rropax;::eHttSI CJIH3l1CTOM o6oJIO'lKl1MmI,[l,aJIHH I"JlOTKtt, ) nmepeMIDI CJil13MCTOM o6oJIO'IKH,

B) OTeK CJlll!3MCTOJi[ o6oJIO'lKH,

r) rHOMHbIM HaJieT l-Ja MHHLl.aJlJ1:Hax,

A)pern0Hapub1l4 ageHttT.

9.KaK11e M11KpoopraHH3MbI 11:3 nepe1111:c11e~a1>1x BbI3bIBaIOT roHopero?

a flarro'lKM,

6 KOKKtt,

a) npocremrrne,

r) cnophl,

A)T)JenoueM1>I.

10.KaKott npenap aT rrpm11:e1rneTCJ1 )J.JIJI ne11emrn TpnxoMOHMa3a? a) fleHHL(HJIJIHH,

6) 3pttT]JOMJ:1l(HH,

B MeTpOI-IffAa30JI, r ttwrpaT cepe6pa,

p,) cy11b<flattHJiaMJ;1/.l,bl.

11.KaKMe CJll13HCTbie 060110'-II'-HHBJJJIIOTOI uaw6onee .zi;ocrynnhIM. p;nn

nopIDKeHHJlrOHOKOKKaMM?

a) BhICTna1-JH1>1e MHOroc11oi11-11>1M nnocKttM Heoporosesarom;HM 3n!1'feJIMeM,

6) BbICTJiaHHbie rrepexop;HbI M 31Il1.TeJIM.eM, ~BbICTJiaHHbie l(WIWHP,pl1.'lecK11M3m.rrem1eM,

r) BbICTJiaJiHbie MHOrOCJIOJii:HblM IIJIOCKHM oporoaemuom;MM 31IH"reJIH-

eM,

A)BbICTJiaHHbre J.."}'6J11'1ecKMM31IHTeJitteM.

12.KaKM H03onorHH ue BKJIIO'laeTCJIB KJiaccwcpwKaa;HIO 6one3Heil, rre-

pep;arom;wxrn nonoBLIM nyreM?

A TpID<OMOH03,

6)payp03,

226

r) ypearma3M03,

A) 6aKTepMaJTbHblli sarn1-I03.

13. KaKoJ1 npenapaT npoTMBonoKa3aH npu neqe1unr rottopett y 6epeMeHH1>1x?

a) oeH3MJIUeHIDJ;HJIJUIH,

6) 3pl1:TpOMHJJ;HH,

B) nesmrn:u,eTIIH,

~al.J,HKJIID-r,

,a:) cynhcj:>a1rnJiaM:v1Ji;:br.

14. KaKwMw nyu1MH rottoKOKKM MOIYT pacrrpocrpaWIThCH B opraHH3Me OOJil>HhIX?

a) I1HMcporeHHbrM, 6) reMaToreHHbIM,

a) no nosepxHOCTH CJIH3MCTbIX reHHTaJlMM, r) TpaHCKaHMHKf.ID!pHbIM,

§l)sceMM rrepe'l:HCJieHHblMHrryTSIMM.

15. qTO BKJllO'IaeTUOJIHl>Hi H npaBHJil>Hh!H AHaTH03 rottopeHHOtf HH- ¢eKu,m1?

a) <l>opMy aocnamrrenhHoro npou,ecca M noKam13au,mo oqaros no-

-·~ pCOKeHIDJ;

~cpopMy BOCfla.JIB.Telibl-IOI'Orrpo:u;ecca, TOillf<leCKHM ,[(HarH03, xapaKTep OCJIO)!(HeHHH M HaJlM'lHe,r:i:pyrux naTOreHHbrx B036y,r:i:H- Te.Jiel1;

B) n 0Kam13au;mo oqaroB nopa)f(eHHSI, xapru..'TepocnoX<HeHwi'I,HMM- 4'Me,r:i:pyrnx naTOreHHhrx B036y,r:i:wre.ne"C!:;

r) cpopMY socnarremrn, xapaKTep ocno>K1-1ettl111;

A) JJOKMH3au,mo oqaroB BOcnaneHM51, ttani-r·q11e ,r:i:pyrnx naToreHHhIX B036y,a,nTeneft.

16.KaKHe ¢opMbI He OTHOCHTCH K npocrann:y?

a)KaTapa!ThHblli,

6)cpOJIJ1Hey.ID!pHb1H,

B)rpatty.ID!l.J,HOHHhH1',

r)napeHXHMaT03Hhlli,

,a: 6cu,ecc npe,a,cTaTe.JibHO"C!: )f(eJie3bI.

17.KaKCUI cpopMa He HBllileTCR cpopMOH roHopew?

a)CBe)f(rui: ocrpa51,

6)CBe)f(rul llOJJ.OCTPaSI,

B)CBe)f(a.sJ Top nHP,I-Ia51'.,

r)Be)f(rur rraTeHTttM,

A xpOHM"tJeCKa.51'..

227

r) KYJTh'rypanoHoeli1CCJie,a:oaaID1:e,

A)MMKpOCKOfIIDI HaTliIBHOro nperrapaTa.

24.KaKttMff n p1nuaKaM1i1 He xapaicrepli13YeTCH cae)KttH ocrpb111 nepep;- Hl1H ypeTpl1T rouopeimoi1: 3Tli1onorm1?

a)0611J1bHble rI-IOHHDie Bbl,!l;eJJeHIDI,

6)6orreJHeHHOCTb rrpli1 MO'Ieli1cnycKaH1111,

a) r11rtepeMIDI ry6oK ttapyX<Horo oTBepCTIDI y peTpbI,

r raJJl1lJHe rHOHHbIX HMTel1B1-11 Iii 2-Jil rropu;IDix MO'Iff,

A)uanwme rHOHHbIX HJ1"rel1 B1-Jir: rropu;HW MO'IW.

25.KaKaH Tepanl1H noKa3aHa rrp11 ocrpoJir: 11 nop;ocrpoi1: ¢opMax HeocJIO)KHeHHOH rottope11?

a)fo1-msaKu;HHoft,

6)MeCTHbIM JJe'IeH11eM,

,B) HTJ16T10Tl1KaMff,

r)Tp11xonon oM,

A)rrwporenanoM.

26.KaKoft np113HaK He xapaKTepeH JJ,JIH xp oHl'.l'IecKoro TOTani.uoro ypeTpHTa roriOpeJir:Hoft 3TT1onorww y MYJK<fHH?

a)3acroJl!Ho-rmrepeM11poaaHHbrl1 u;aeT crr11311croi1: ry6oK Hapy)f(fforo OTBepCTIDl ypeTPbI,

6)CKYAHbie rttoftHore BbJAeJJeHIDI,

B)6one3HeHHOCTb B KOtru;e aJ<Ta MO'IeHcnycKaHWH,

r)HaJJT11IWe He3Hff'lwreJJbHOroKOJIT1'IeCTBar HOHHblX HJ1"Tet1 B 1-11 Iii 2-

H nopu;IDix MO'llil,

\

~HaJIW-lli1e rHOl1Hbll< Hkrew B 1-w nopu;T111 MO'llf.

27. KaKMe npenapaTbI He BKJ1JO'l3IOTC11'B KOMilJieKCHoe ne<1eHJ1e npH ocrpoH: 11 rrop;ocrpon ocJIO)KHeHHOJ1: roHopee y MY)K'IT1H11 )KeHru;11u?

a) Airrn6HoTI1K11, ,6})rouosaKu;wHa, .

'BJaHTT1rli1CTaM11HHbie rrpenapaTbI,

r)rrpenapaThI KaJibIIIDl, A) crra3MOJIT1Tli1KT1.

28.qTO He OTHOCHTCR K 3KcrpareHHTaJibHOff roHopee?

. a)' JilWTTPeMT,

6) apTpl1T,

a)npoKTT1T,

r ) ¢apmrrl1T,

A) KOH"bIOH1'.'TJ1Bl1T;

229

29. Ha pe3yrr1>TaTax KaKHX nepeq11CJJeHHblX 11CCJie,D;OBaHMJf He OCHOBhiBa-

eTCH p;11arHOCTttKa ocrporo rrpocrarHTa?

a)MaJKOB,

6)perpocKomrn,

B) amtJTHJa 3 rropIJ,m1 MO'IH,

r) naJTbnau,11H rrpep;craTeJibt-rolii: )KeneJJ>I,

A)Y3l1 rrpep;craTeJihHOM )f(eJieJbI.

30.KaKOH npenapaT 3aKaOhJBaJOT Ha CJIJ13ttcryJO rrra3a HOBOpo:>K)J.eHHLIM B u,err.R:x npocj:mrraKTttKH rouo6rreHopew?

a)30 % pacTBop cyrrbq>auWia ttaTpIDI rrocrre po)f(,)];eHIDI,

6)30 % paCTBop cyrr1>cpau,111Ja uarpIDI cnycni: 2 q nocrre po)f(,)];eHIDf,

a)2 % pacTBop peJopu;Htta tteMep;rreHHO nocrre po)f()J;eHIDf,

r)2 % pacraop pe3opu,HHa neMe.a.rreHHo H cnyCTI1 3 q nocrre po)f()J;eHIDI,

A 30 % pacTBop cyrr1>¢auHJia ttarpIDI norne po)f()J;eHHH cpaJy l1 qepeJ 2 <I.

CHrya1.1HOHH&1e 3a11a ·'IH K COJlep:>KaTenbHOMY Mo11yn10 N!! 12

1.Ha nptteM K spaqy o6panmra nau,11euT 26 ner c )KaJI06aMH Ha 06HJI1>- H1>1e rHOHHble BbI,D;eJieHJtll Jf3 yperphI, conpoBO)K,[l,aJOILI,J1eCH pe3HMJ1 BO speMn MO'lettcrryc1<aHHH, Il01lBl1BWHMHCH qepe3 6 ,a;Heft rrocne CJIY'IaHHOrOIlOJIOBOr O KOHTaKTa. IlpM M11KpOCKOTIH<IeCKOM 11CCJJe,D;O- BaHHH Ma3Ka H3 yperphl c OKpacKOH no fpaMMY 11 MeTttJieHOBblM Cl1HHM Ha ¢oHe 3Ha'lJHTeJJhHOroKOJIH'lJeCTBarre'H:KOQHTOBo6Hapf)l(eHbl BHfTPHKJieTO'lJHhie rpaMOTpwu,aTeJihHbl e ,ll,HnJJOKOKKH J1 .)KJ}'Tl1KOBble npocrewmw:e.

1. 0 KaKOM )J;l1aI'H03eMQ)[(HQ AYMilTh? fQ KO re.A.

'

2. c KaKl1Ml1 Ja6oneBaHllil'Ml1. MO:>KHO n p oBO)J;MTb p;mp<j:>epe~l1aJibHYJO p;u:ani:ocnIKy'?

3. OrrpegerrwTe TaKTl1K)'H rre'IeHHe.

2.K .n;epMaToBeHeponory Ha nptteM o6paTHJJCJI 6onhHOH Ill. 19 neT c )Kano6aMH Ha 3YJJ. 11 )K)KeHtte B o6nacrw MO'lJettcnycKaren1>Horo KaHana, ruo'H:Hhie B1>1.n;erre1nrn, pe)Kym;we, )K1y•n1e 6ontt nptt MO'IettcnycKaHHH no BCeH ypeTpe, )J.l13)'plUO. B KOHQe MO'leHcnycKaHHH60JJb ycwJIJrnaeTCH, w B MO<Ie noHBJJReTCJI npttMech KpoBtt. He.n;enro Ha3a.n; 60JibHOH scrynl1JI. B TIOJIOBOJf KOHTaKT c MaJI03HaKOMOK )KeHI1J,J1HOl1.

Ilptt OCMOTpe: ry6KM ypeTpbl OTeliHbl, rwnepeMttpOBaHbl, nptt Ha,a,aaJIHBillHHH J13 yperplbI BbIJJ;em1eTC:H rHOH. IlpH npoBep;~Rl1J1 .a.uyxcra-

KaHHOM IIp06bI TOMilCOHa MO'laB o6ettX noel.l;J11lX MfTHCUI[.

1. KaI<oB Barn rrpe,IJ,nonmK11Te1Thm..ri1 ,IJ,l1arnm? \ 01<-<'.' >:-~ .,,

2.COCTaBbre nnau 06cn:e,a.osa1u'1l!, ne"leHlliI u: sropH"IHofi rrpoqmnaKTIUC11.

3.Ha npHeM K Bpaqy o 6paTJ1JIC1l 60JibHOl1 n. 25 JleT c )f(aJJ06aMJ1 Ha CJ<YAHbie cnH3HCThle lJbIJJ;eneHttH H3 ypeTphl no YTPaM, 6one3HeH-

230