Signs are externally observable and recorded symptoms.
The relationship between features and categories is ambiguous. One sign may have several categories behind it.
Signs are distinguished by the fact that they can be directly observed and recorded. Categories are hidden from direct observation. Therefore, in social sciences they are usually called “latent variables”. For quantitative categories, the name “diagnostic factors” is also often used. Diagnostic inference is a transition from observed features to the level of hidden categories. A particular difficulty in psychological diagnostics lies in the fact that there are no strict one-to-one relationships between features and categories. For example, the same external act of a child (tearing out a piece of paper from a diary) can be due to completely different psychological reasons (an increased level of the hidden factor “propensity to deceive” or an increased level of another hidden factor “fear of punishment”). For an unambiguous conclusion, one symptom (one action), as a rule, is not enough. It is necessary to analyze a complex of symptoms, that is, a series of actions in different situations.
Diagnostic conclusion - there is a transition from externally observable symptoms to the level of hidden categories.
Features of quantitative and qualitative approaches in psychodiagnostics: standardized and clinical methods.
Psychodiagnostic methods provide analysis of various symptoms and their systematic selection.
Psychodiagnostic methods are divided into qualitative and quantitative approaches.
Quantitative approach (standardized method):
Standardization (standard - standard) is the uniformity of the procedure for assessing the implementation of a methodology and conducting a test.
This includes all testing methods: questionnaires, intelligence tests, tests of special abilities and achievements.
Areas of application: easily measured psychological reality.
Peculiarities:
Economical (group, using computers).
Psychometrically or technically sound (correct diagnosis).
Qualitative approach (clinical method):
Individual case analysis. Not a pathology!
Understanding and expert assessment methods are used: conversation, observation, projective techniques, life path analysis, analysis of activity products.
Areas of application: difficult to measure psychological reality (meanings, experiences).
Peculiarities:
Strictly individual method.
Psychometrically not substantiated.
The effectiveness depends on the professionalism of the psychologist and his work experience.
5.Psychological diagnosis. Causes of diagnostic errors. Requirements for a psychological diagnosis.
Diagnosis- from Greek. Recognition.
Medical understanding of diagnosis:
Symptom - from Greek. A sign of some disease. They are divided into two types - subjective (interoceptive sensations) and objective (measurement results, blood test, ECG).
Syndrome - from Greek. Clutch. A natural combination of symptoms caused by a single pathogenesis (pathology), considered as an independent disease, or as a stage of a disease.
Diagnosis is the determination of the essence and characteristics of the disease based on a comprehensive examination of the patient.
The medical understanding of the diagnosis is firmly associated with the disease, a deviation from the norm. This understanding also prevailed in psychology, that is, a psychological diagnosis is always the identification of the hidden cause of the detected problem.
S. Rosenzweig proposed using diagnosis exclusively for “naming” any disorders or disorders.
Psychological diagnosis turns out to be broader than in medicine. Both in norm and in pathology. And normally, it is not necessary to search for any violations or disorders.
Psychological diagnosis(Burlachuk L.F.) is the result of the activities of a psychologist, aimed at clarifying the essence of individual mental characteristics of a person in order to assess their current state, predict further development and develop recommendations for psychotherapeutic and psychocorrective influences, determined by the task of a psychodiagnostic examination.
Subject of psychological diagnosis– there is an establishment of individual psychological differences in normality and pathology. The most important element is to clarify in each individual case why these manifestations are found in the behavior of the subject, what are their causes and consequences.
Requirements for a psychological diagnosis.
A psychological diagnosis has a detailed and complex (subjectivity, causality, presence of contradictions) nature.
Psychological diagnosis is the result of systemic technical diagnostics. Not only the individual units of analysis are described, but also their relationships. The reasons for such relationships are revealed and a behavioral forecast is made based on such analysis. The diagnosis cannot be made using one method.
A psychological diagnosis must be structured. The parameters of a person’s mental state must be brought into a certain system: they are grouped by level of significance, by relatedness of origin, and by possible lines of causal origin. Specialists process the relationships of various parameters in a structured diagnosis in the form of diagnosticograms. The simplest option is a psychodiagnostic profile.
Causes of diagnostic errors.
A. Levitsky sees the following as sources of inaccuracies and errors: insufficient time allotted for the examination, lack of reliable sources of information about the subject and the low level of our knowledge about the laws governing behavioral disorders.
A more complete analysis of the causes of diagnostic errors is presented by Z. Plevitskaya, who distinguished them into two main groups.
Errors related to data parsing:
observation errors(for example, “blindness” to traits important for diagnosis, personality manifestations; observation of traits in a qualitatively or quantitatively distorted form);
registration errors(for example, the emotional coloring of the entries in the protocol, indicating more about the attitude of the psychologist to the subject rather than about the characteristics of his behavior; cases when an abstract assessment is presented as a substantive assessment, differences in the understanding of the same terms by different people);
instrumental errors arise as a result of the inability to use equipment and other measuring equipment, both in the technical and interpretive aspects.
Errors related to data processing:
"first impression" effect- error based on overestimation of the diagnostic value of primary information;
attribution error- attributing to the subject traits that he does not have, or considering unstable traits as stable;
false cause error;
cognitive radicalism- a tendency to overestimate the value of working hypotheses and a reluctance to look for better solutions;
cognitive conservatism- extremely careful formulation of hypotheses.
The most important diagnostic features of minerals include morphological features that characterize the shape of mineral deposits; optical properties: transparency, mineral color, streak color, luster; mechanical properties: cleavage, fracture, hardness, brittleness, elasticity, ductility, flexibility; other physical properties: specific gravity (density), taste, smell, magnetism, etc.
1. Morphological features
Most often, minerals are found in nature in the form of irregularly shaped grains. Well-formed crystals are rarer; their shape is usually a characteristic diagnostic feature. Variety of existing crystal shapes can be divided into three types.
Isometric – having similar sizes in all directions: cubes (galena, pyrite), tetrahedra (sphalerite), octahedra (magnetite, pyrochlore), bipyramids (zircon, cassiterite), rhombic dodecahedrons (garnet), rhombohedrons (calcite), etc., as well as various combinations of these simple forms.
Extended in one direction – prismatic, columnar, columnar, needle-shaped, fibrous crystals (tourmaline, beryl, pyroxene, amphibole, rutile, etc.).
Elongated in two directions (flattened) – tabular, lamellar, leafy, scaly crystals (mica, chlorites, molybdenite, graphite, etc.).
As a result of the process of metasomatic replacement or dissolution with subsequent filling of voids, crystalline forms belonging to one mineral turn out to be represented by another mineral; such formations are called pseudomorphoses .
Hatching. In addition to the shape of the crystal, a characteristic property of the mineral that helps in its diagnosis is the shading on the faces: transverse parallel (quartz), longitudinal parallel (tourmaline, epidote) or intersecting (magnetite).
In nature, it is not single crystals of a mineral that are more widespread, but their various accretion, or units. Many minerals are characterized by oriented regular twin intergrowths of two or more crystals in a certain way. The most widespread specific forms of mineral aggregates, intergrowths and secretions, which have received special names, are given below.
Granular aggregates . Depending on the shape of the constituent grains, granular aggregates proper (consisting of isometric grains), as well as lamellar, leafy, scaly, fibrous, needle-shaped, columnar and other aggregates are distinguished. According to the size of the grains, there are coarse-grained aggregates - more than 5 mm in diameter; medium-grained - from 1 to 5 mm and fine-grained - with grains less than 1 mm. In particular, most igneous and metamorphic rocks, as well as many sedimentary rocks, some types of sulfide ores, etc., are composed of granular aggregates.
Druze – intergrowths of regular, well-formed crystals of minerals on the walls of voids of various shapes (cracks, caverns, “cellars”, “gnarly holes”, “caves”, etc.). In morphological terms, they are very diverse: “brushes” of crystals, “crystalline crusts” (small closely intergrown crystals, completely covering the walls of narrow cracks), “comb” intergrowths, etc. Crystal druses are typical of pegmatites, some types of hydrothermal veins and alpine-type veins .
Secretions – execution of voids of an isometric, often round shape, distinguished by a concentric-zonal structure. The outer zones of secretions are often made of amorphous or cryptocrystalline minerals, and in their inner part there is a cavity, on the walls of which druses of crystals or sinter aggregates of minerals grow. Small secretions found in erupted rocks and tuffs are called tonsils , large, especially characteristic of pegmatites and alpine veins, - geodes .
Concretions – spherical or irregularly shaped nodules and nodules formed in loose sedimentary rocks (silts, clays, sands, etc.). Unlike secretions, nodules grow from some center (clastic grain, organic residue, etc.), around which a clot of colloidal substance is formed, subsequently crystallized. Concretions are characteristic of phosphorites, siderites, marcasites and other types of ores of sedimentary origin.
Oolites like nodules, they have a spherical shape, but their size is much smaller: from tenths of a millimeter to several millimeters. They are formed by the layering of colloidal material on grains of sand and organic debris that are suspended in mobile aqueous media. Oolites are very characteristic of some limestones, sedimentary iron and manganese ores, and bauxites.
Sinter forms mineral deposits form on the walls of various voids and cavities during the slow drainage of solutions. These include calcareous and ice stalactites and stalagmites of caves, similar in shape to ordinary ice icicles, kidney-shaped, cluster-shaped mineral deposits in zones of oxidation and weathering of ore deposits, etc. The sizes and shapes of sinter formations can be very diverse: from fractions of a millimeter to huge pillars (in large caves). Sintered forms of sediments are characteristic of many supergene and low-temperature hydrothermal minerals: calcite, aragonite, malachite, hematite, hydroxides of iron, manganese, opal, gypsum, some sulfides, smithsonite, etc.
Earthy masses – loose, soft, mealy aggregates of an amorphous or cryptocrystalline structure, sooty (black) or ocher (yellow, brown and other bright colors). Most often they are formed during chemical weathering of rocks and in the oxidation zone of ores (for example, manganese ores).
Plaques and lubricants – thin films of various secondary minerals covering the surface of crystals or rocks. Such are films of limonite on rock crystals, smears of copper green on cracks in rocks containing sulfide deposits with copper minerals, etc.
Fading – periodically appearing (in dry weather) and disappearing (in rainy periods) loose crusts, films, deposits, often fluffy or mossy, on the surface of dry soils, ores and rocks and along cracks in them. These formations are most often composed of easily soluble aqueous chlorides, sulfates of various metals, or other water-soluble salts.
2. Physical properties
Optical properties. Transparency – the property of a substance to transmit light. Depending on the degree of transparency, all minerals are divided into the following groups: transparent – rock crystal, Iceland spar, topaz, etc.; translucent – sphalerite, cinnabar, etc.; opaque – pyrite, magnetite, graphite, etc. Many minerals that appear opaque in large crystals are translucent in thin fragments or grain edges.
Mineral color – the most important diagnostic sign. In many cases, it is due to the internal properties of the mineral (idiochromatic colors) and is associated with the inclusion of chromophoric elements (Fe, Cr, Mn, Ni, Co, etc.) in its composition. For example, the presence of chromium determines the green color of uvarovite and emerald, the presence of manganese determines the pink or lilac color of lepidolite, tourmaline or sparrowite. The nature of the coloring of other minerals (smoky quartz, amethyst, morion, etc.) lies in the violation of the homogeneity of the structure of their crystal lattices, in the occurrence of various defects in them. In some cases, the color of a mineral can be caused by the presence of the finest scattered mechanical impurities (allochromatic colors) - jasper, agate, aventurine, etc. To indicate color in mineralogy, a common method is comparison with the color of well-known objects or substances, which is reflected in the names of colors: bloody- red, azure blue, lemon yellow, apple green, chocolate brown, etc. The names of the colors of the following minerals can be considered standards: violet - amethyst, blue - azurite, green - malachite, yellow - orpiment, red - cinnabar, brown - limonite, lead-gray - molybdenite, iron-black - magnetite, tin-white - arsenopyrite, brass-yellow – chalcopyrite, metallic-golden – gold.
Stroke color – the color of a fine mineral powder. A mineral trait can be obtained by passing the test mineral across the matte unglazed surface of a porcelain plate (biscuit) or a fragment of the same surface of a porcelain chemical vessel. This sign is more permanent compared to coloring. In some cases, the color of the line coincides with the color of the mineral itself, but sometimes a sharp difference is observed: for example, steel-gray hematite leaves a cherry-red line, brass-yellow pyrite leaves a black line, etc.
Shine depends on the refractive index of the mineral, i.e. a quantity that characterizes the difference in the speed of light when it passes from air to a crystalline medium. It has been practically established that minerals with a refractive index of 1.3–1.9 have glass luster (quartz, fluorite, calcite, corundum, garnet, etc.), with an index of 1.9–2.6 – diamond shine (zircon, cassiterite, sphalerite, diamond, rutile, etc.). Semi-metallic luster corresponds to minerals with a refractive index of 2.6–3.0 (cuprite, cinnabar, hematite) and metal – above 3.0 (molybdenite, stibnite, pyrite, galena, arsenopyrite, etc.). The brilliance of a mineral also depends on the nature of the surface. Thus, in minerals with a parallel-fibrous structure, silky luster (asbestos), translucent "laminated" and lamellar minerals often have pearl luster (calcite, albite), opaque or translucent minerals, amorphous or characterized by a disturbed crystal lattice structure (metamictic minerals) differ resinous shine (pyrochlore).
Mechanical properties. Cleavage – the property of crystals to split in certain crystallographic directions, due to the structure of their crystal lattices. Thus, calcite crystals, regardless of their external shape, always split along their cleavage into rhombohedrons, and cubic fluorite crystals into octahedra.
The degree of perfection of cleavage varies according to the following accepted scale:
Cleavage very perfect – the crystal easily splits into thin sheets (mica, chlorite, molybdenite, etc.).
Cleavage perfect – when struck with a hammer, cleavage marks are obtained; It is difficult to obtain a fracture in other directions (calcite, galena, fluorite).
Cleavage average – a fracture can be obtained in all directions, but on mineral fragments, along with an uneven fracture, smooth shiny cleavage planes (pyroxenes, scapolite) are clearly observed.
Cleavage imperfect or absent . The grains of such minerals are confined to irregular surfaces, except at the edges of their crystals.
Often differently oriented cleavage planes in the same mineral differ in degree of perfection. Thus, gypsum has three directions of cleavage: in one direction the cleavage is very perfect, in the other – average and in the third – imperfect. Cracks separately , unlike cleavage, are rougher and not completely flat; most often oriented transversely to the mineral elongation.
Kink . In minerals with imperfect cleavage, fracture plays a significant role in diagnosis - conchoidal (quartz, pyrochlore), splintery (for native metals), small-shelled (pyrite, chalcopyrite, bornite), earthy (kaolinite), uneven and etc.
Hardness , or the degree of resistance of a mineral to external mechanical influence. The simplest way to determine it is by scratching one mineral with another. To assess the relative hardness, it is taken Mohs scale , represented by 10 minerals, of which each subsequent one scratches all the previous ones. The following minerals are accepted as hardness standards: talc – 1, gypsum – 2, calcite – 3, fluorite – 4, apatite – 5, orthoclase – 6, quartz – 7, topaz – 8, corundum – 9, diamond – 10. When diagnosing, very It is also convenient to use for scratching such objects as a copper (hardness 3.0–3.5) and steel (5.5–6.0) needle, knife (5.5–6.0), glass (5.0) . Soft minerals can be scratched with a fingernail (2.5).
Fragility, malleability, elasticity . Under fragility in mineralogical practice, the property of a mineral to crumble when drawing a line with a knife or needle is implied. The opposite property - a smooth shiny mark from a needle (knife) - indicates the ability of the mineral to deform plastically. Malleable minerals are flattened by a hammer into a thin plate, elastic are able to restore their shape after removing the load (mica, asbestos).
Other properties. Specific gravity (density) can be accurately measured in laboratory conditions by various methods; An approximate judgment of the specific gravity of a mineral can be obtained by comparing it with common minerals, the specific gravity of which is taken as a standard. All minerals can be divided by specific gravity into three groups: lungs – with a specific gravity less than or equal to 2.9 (gypsum, muscovite, sulfur, chalcedony, amber, etc.); average – with a specific gravity of about 2.9–5.0 (apatite, biotite, sphalerite, topaz, fluorite, etc.); heavy – with a specific gravity greater than 5.0 (arsenopyrite, galena, cassiterite, cinnabar, etc.).
Magneticity . Some minerals are characterized by pronounced ferromagnetic properties, i.e. attract small iron objects - sawdust, pins (magnetite, nickel iron). Less magnetic minerals ( paramagnetic ) are attracted by a magnet (pyrrhotite) or an electromagnet; Finally, there are minerals that are repelled by a magnet - diamagnetic (native bismuth). The magnetic test is carried out using a freely rotating magnetic needle, to the ends of which the test sample is brought. Since the number of minerals with distinct magnetic properties is small, this feature has important diagnostic value for some minerals (for example, magnetite).
Radioactivity . All minerals containing radioactive elements - uranium or thorium - are characterized by the ability to spontaneous α-, β-, γ-radiation. In the rock, radioactive minerals are often surrounded by red or brown rims, and radial cracks radiate from the grains of such minerals included in quartz, feldspar, etc. Radioactive radiation affects photographic paper.
Other properties . For diagnostics in field conditions are important solubility minerals in water (chlorides) or acids and alkalis, private chemical reactions into individual elements flame coloring (for example, minerals containing strontium color the flame red, sodium - yellow). Some minerals emit noise when struck or broken. smell (for example, arsenopyrite and native arsenic emit a characteristic garlic odor), etc. Individual minerals are determined to the touch (for example, talc feels greasy to the touch). Table salt and other salt minerals are easily recognized to taste .
Department of Faculty Therapy and Occupational Diseases
EMERGENCIES
IN THE CLINIC OF INTERNAL DISEASES
Study guide for students
and pharmaceutical education in Russian universities as a teaching aid
for students studying in specialties: 060101 65 General Medicine,
060103 65 Pediatrics"
Ivanovo 2013
UDC 616.1/. 4-083.98
Emergency conditions in the clinic of internal diseases. Textbook for students / Ed. M.G. Omelyanenko. 2nd ed., rev. and additional – Ivanovo: GBOU VPO IvSMA of the Ministry of Health of Russia, 2013. – 109 p.
The textbook was developed in accordance with the Materials for the final state certification of graduates of medical and pharmaceutical universities in the specialties “General Medicine” and “Pediatrics”, approved by the Ministry of Health of the Russian Federation. It includes 20 emergency conditions for diseases of the cardiovascular system, respiratory system, disseminated intravascular coagulation syndrome, acute poisoning and intoxication, burns of the esophagus, acute allergic reactions, anaphylactic shock, fainting, fever, heat stroke, snake and insect bites. To develop a specific algorithm of practical actions and skills for the future doctor, each emergency condition is presented in the following presentation: definition, causes and provoking factors, leading clinical syndromes and diagnostic criteria, differential diagnostic signs, organizational basis for diagnostic actions, organizational basis for emergency care actions and treatment, situational tasks and standards of answers to them. The publication uses the main provisions of ICD-10, Russian and international clinical recommendations based on the principles of evidence-based medicine.
The textbook is intended for extracurricular training for students studying in the following specialties: 060101 65 “General Medicine”, 060103 65 “Pediatrics”.
The manual was developed by members of the Department of Faculty Therapy and Occupational Diseases (Omelyanenko M.G., Lebedeva A.V., Shumakova V.A., Sukhovey N.A., Arsenicheva O.V., Shchapova N.N., Nazarova A.V. .) with the participation of the department of outpatient therapy, general medical practice and endocrinology (Budnikova N.V.) and the department of hospital therapy (Kalinina N.Yu.)
Scientific editor:
Head of the Department of Faculty Therapy and Occupational Diseases
State Budgetary Educational Institution of Higher Professional Education "Ivanovo State Medical Academy of the Ministry of Health of Russia", Doctor of Medical Sciences, Professor M.G. Omelyanenko
Reviewers:
Head of the Department of Faculty Therapy, Yaroslavl State Medical Academy of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor P.A. Chizhov;
Head of the Department of Faculty and Polyclinic Therapy of the Medical Faculty of the State Budgetary Educational Institution of Higher Professional Education "Nizhny Novgorod State Medical Academy"
Ministry of Health of Russia", Doctor of Medical Sciences, Professor A.N. Kuznetsov
© GBOU VPO IvSMA Ministry of Health and Social Development of Russia, 2011
© State Budgetary Educational Institution of Higher Professional Education IvSMA of the Ministry of Health of Russia, 2013
List of abbreviations………………………………………………………………......
1. Anginal status………………………………………………………………...
2. Angina attack………………………………………………………...
3. Acute heart failure. Cardiac asthma and pulmonary edema………...
4. Cardiogenic shock………………………………………………………………...
5. Hypertensive crises…………………………………………………………
6. Sudden cardiac death……………………………………………………………………...
7. Attack of bronchial asthma ………………………………………………….
8. Infectious-toxic shock……………………………………………………………….
9. Pulmonary embolism……………………………………………………….
10. Acute respiratory failure………………………………………...
11. DIC syndrome…………….……………………………………………………..
12. Acute poisoning with psychoactive substances ………………………….
13. Burns of the esophagus………………………………………………………………..
14. Acute allergic reactions………………………………………………………..…
15. Anaphylactic shock………………………………………………………...
16. Fever……………………………………………………………………….
17. Heat stroke……………………………………………………………….….
18. Fainting…………………………………………………………………………………………
19. Insect bites………………………………………………………………
20. Poisonous snake bites……………………………………………………….…
SITUATIONAL TASKS……………………………………………………..
STANDARDS OF ANSWERS TO SITUATIONAL PROBLEMS………………………
LIST OF ABBREVIATIONS
AV block - atrioventricular block
BP - blood pressure
BP diast – diastolic blood pressure
BP syst – systolic blood pressure
BP av – mean arterial pressure
AK – aortic valve
ALT – alanine aminotransferase
ACE – angiotensin-converting enzyme
ASA – acetylsalicylic acid
AST – aspartate aminotransferase
APTT – activated partial thromboplastin time
BA – bronchial asthma
URA - upper respiratory tract
VS - sudden cardiac death
VEM – bicycle ergometer test
GB – hypertension
GCS – glucocorticosteroids
GM - brain
GERD – gastroesophageal reflux disease
DBST – diffuse connective tissue diseases
PAWP – pulmonary artery wedge pressure
VT – ventricular tachycardia
IHD – coronary heart disease
IVL - artificial lung ventilation
MI – myocardial infarction
CAG - coronary angiography
CTG – computed tomography
CABG – cardiogenic shock
ABC – acid-base state
LSD – lysergic acid diethylamide
LV – left ventricle
Health care facility – medical and preventive institution
MV-CPK – myocardial fraction of creatine phosphokinase
MAO – monoamine oxidase
MK – mitral valve
ICD-10 – international classification of diseases 10th revision
INR – international normalized ratio
LMWH – low molecular weight heparin
NMS - indirect cardiac massage
NSAIDs – non-steroidal anti-inflammatory drugs
NFG – unfractionated heparins
NCD – neuro-circulatory dystonia
ACS – acute coronary syndrome
AKI – acute renal failure
AHF – acute heart failure
FEV 1 – forced expiratory volume in the first second
BCC – volume of circulating blood
RV - right ventricle
ICU - intensive care ward
RCA – right coronary artery
PEF – peak expiratory flow
PVR - peripheral vascular resistance
CO - cardiac output
SLE – systemic lupus erythematosus
SMP - emergency medical care
SM ECG – daily ECG monitoring
ESR – erythrocyte sedimentation rate
CVD – cardiovascular diseases
TAD - tricyclic antidepressants
DVT – deep vein thrombosis of the leg
PE – pulmonary embolism
USDG – Doppler ultrasound
EF – ejection fraction
VF – ventricular fibrillation
FC – functional class
FEGDS – fibroesophagogastroduodenoscopy
COPD – chronic obstructive pulmonary disease
HDL cholesterol – high density lipoprotein cholesterol
LDL cholesterol – low density lipoprotein cholesterol
CHF – chronic heart failure
CVP – central venous pressure
RR – respiratory rate
HR – number of heartbeats
EIT – electric pulse therapy
EOS – electrical axis of the heart
EchoCG – echocardiography
ANGINOUS STATUS
1. Definition. Status angina (AS) is an attack of prolonged pain in the chest (behind the breastbone), which does not stop after repeated administration of nitroglycerin. AS is the most common and typical clinical syndrome of the onset of MI.
MI is an acute form of coronary artery disease, which is based on necrosis of cardiomyocytes, caused by acute complete occlusion of one of the main coronary arteries (CA) by an intracoronary thrombus (MI with ST segment elevation on the ECG) or the formation of a parietal (non-occlusive) thrombus and subsequent embolization with its fragments and material from a damaged atherosclerotic plaque of the distal segments of the coronary artery (MI without ST segment elevation on the ECG). MI is accompanied by clinical symptoms of myocardial ischemia and an increase in blood biomarkers of cardiomyocyte necrosis.
Main diagnostic signs of AS.
A) Clinical:
An attack of intense pain in the chest (behind the sternum), lasting more than 15 minutes and not stopping after repeated administration of nitroglycerin;
Emotional coloring of the attack, autonomic reactions (nausea, vomiting), possible complications (CABG, pulmonary edema, tachy- or bradyarrhythmias, VS);
History of coronary artery disease and/or the presence of risk factors for it.
B) Instrumental:
Direct and reverse (reciprocal) ECG signs of myocardial ischemia, damage and necrosis.
B) Laboratory:
Diagnostically significant increase in the level of biomarkers of myocardial necrosis (MB-CK, cardiac troponins).
3. Diseases manifested by intense chest pain:
a) diseases of the cardiovascular system– TELA; aortic dissection; pericarditis; GB; AC defects; pulmonary hypertension; hypertrophic cardiomyopathy (see Table 1);
Psychodiagnostics as a science.
Psychodiagnostics is a field of psychological science that develops theory, principles and tools, assessments, measurements, and individual psychological characteristics of a person.
The subject of psychodiagnostics is often limited to the use of various types of
diagnostic methods to a person in order to identify his mental uniqueness and
its subsequent measurement using various kinds of statistical methods. At
This overlooks the fact that both the nature of the information received and its
interpretation largely depends on the underlying psychodiagnostics
personality theories.
The main functions of psychodiagnostics are:
1. monitoring the formation of the necessary knowledge and professionally important qualities
2. assessment of the characteristics of mental and personal development of students during training
3. assessment of the quality of education itself.
4. the use of psychodiagnostic techniques for the selection of applicants to certain educational institutions.
Psychodiagnostics at a university allows you to:
1. more effectively select applicants
2. further development of students’ abilities and skills,
3. carry out the necessary correction of the educational process, taking into account the individual psychological characteristics of students.
The history of the formation of psychodiagnostics abroad and in Russia.
The history of modern psychodiagnostics begins with the first quarter of the 19th century, that is, with the beginning of the so-called clinical period in the development of psychological knowledge. This period is characterized by the fact that doctors begin to play a key role in obtaining and analyzing empirical psychological knowledge about a person (before them, philosophers and writers did this). Doctors are interested in the causes of the origin of mental illnesses and neuroses that were difficult to treat and spread in those years in the developed countries of the world. Psychiatrists begin to conduct systematic observations of patients in European clinics, recording and analyzing the results of their observations. At this time, psychodiagnostic methods such as observation, survey, document analysis. However, in general, psychodiagnostics in these years is not yet strict, arbitrary in nature, which is manifested in the various conclusions and conclusions that doctors come to when observing the same patients and studying them using the same methods. This is in particular because the methods of psychodiagnostics at that time were still of a qualitative nature.
The beginning of the creation of quantitative methods of psychodiagnostics should be considered the second half of the 19th century. - at a time when, under the leadership of the German psychologist W. Wundt, the world's first experimental psychological laboratory was created, where various technical devices and instruments began to be used for the purpose of psychodiagnostics. The discovery of a psychophysical law dates back to the same time, which, having shown a quantitative connection between physical and psychological phenomena, accelerated the creation of quantitative psychodiagnostic tools. The basic psychophysical law opened up the possibility of measuring psychological phenomena, and this discovery led to the creation of so-called subjective scales for measuring sensations. In accordance with this law, human sensations became the main object of measurement, and for a long time, until the end of the 19th century, practical psychodiagnostics was limited to measuring sensations.
Diagnostic signs and diagnostic categories.
Signs are variables that can be directly observed and
register.
Categories- these are variables hidden from direct observation, they
are usually called “latent variables”.
Diagnostic conclusion is a transition from observed signs to the level
hidden categories. For quantitative categories, the name is often also used
“diagnostic factors”.
The difficulty of psychological diagnosis lies in the fact that between
There are no strict one-to-one relationships between features and categories. One and
the same external act of a child - for example, he tore out a piece of paper from a diary, maybe
due to completely different psychological reasons, such as
increased level of the latent factor “propensity to deceive” or increased level
Another hidden factor is “fear of punishment.” For an unambiguous conclusion of one symptom
or action is not enough. It is necessary to analyze the complex of symptoms, that is,
a series of actions in different situations.
1. Introduction
2. Systematic position
3. Distribution
4. Diagnostic signs
5. Life cycle
6. Medical and epidemiological significance
7. Diagnostics
8. Prevention: public and personal
9. Applications
10. Literature
Introduction
Systematic position
Phylum: Arthropoda - arthropods
Subphylum: Chelicerata - chelicerates
Class: Arachnoidea - arachnids
Sat.gr: Acarina - mites
Family: Ixodidae – Ixodidae
Genus1: Ixodes - actual ixodid ticks
Species: Ix.ricinus – dog tick
Type: Ix. Persulcatus – taiga tick
Genus2: Dermacentor
Species: D. pictus - carrier and reservoir of tularemia
Species: D. marginatus is a carrier and reservoir of tularemia, rickettsiosis and brucellosis.
Spreading
Ixodid ticks are found in various climatic conditions, even in the Arctic and Antarctic, but individual species are concentrated in different areas. For example, the dog tick (Ix.ricinus) is an inhabitant of the European part of Russia, Western Europe and North America. The taiga tick (Ix.Persulcatus) is common in Siberia and the Far East. D.pictus is an inhabitant of the southern part of the Urals, Western Siberia, Primorsky, Krasnodar and Stavropol Territories, Chechnya, Ingushetia, Dagestan, Ukraine, Belarus, and the Republic of Transcaucasia. And D.marginatus - in the steppe zone of the European part of the Russian Federation, Western Siberia, Krasnodar and Stavropol Territories, Astrakhan Region, Kalmykia, the Republic of the North Caucasus, Transcaucasia and Central Asia, Kazakhstan, Ukraine.
Diagnostic signs
This family (Fig. 3) is characterized by large sizes, up to 4 - 5 mm. After feeding, the size of the female almost doubles. The chitinous cover of males contains a scute on the dorsal surface of the body; in females, the scute is localized in the anterior part. The oral apparatus is composed of the bases of the pedipalps, lateral quadruple palps and a proboscis with a protrusion (hypostome) equipped with sharp teeth. The ends of the chelicerae have sharp teeth. With the help of chelicerae, mites pierce the skin of the victim.
Ixodidae proper (Fig. 1) are characterized by an anal groove, which goes around the anus from above. Representatives of the genus Dermacentor (Fig. 2, 3) have a light enamel pattern on the shield, and scallops on its lower edge.
The larvae of ixodid ticks (Fig. 5) have 3 walking legs, the front part of the dorsal surface is covered with compacted chitin, forming a scute. The border is clearly visible. On the ventral side is the anal opening. The nymph (Fig. 5) is larger in size. The main distinguishing mark is 4 pairs of walking legs. Behind the fourth are stigmata, through which air enters the tracheal system. The anus is clearly visible along the midline on the ventral side. The nymph does not have a genital opening. On the dorsal side, the front part of the body is covered with a shield.
Life cycle (Fig. 6)
Metamorphosis, including the stages: eggs, larvae, nymphs and adult forms, lasts at least three years. The low possibility of meeting a host entails massive death of ticks at all stages of development, but this is counteracted by greater fertility. Females of some species of ixodid ticks lay up to 17 thousand eggs, but only a small number of them reach sexual maturity. Eggs are laid in crevices in the ground or in the bark of dead trees. Hatched larvae feed once, usually on small mammals (rodents, insectivores).
A well-fed larva leaves its host and after a while molts, turning into a nymph. The latter, after feeding and molting, turns into an imago. Sexually mature female ixodid ticks feed only once in their lives and mainly on large mammals. The place has a change of three hosts-feeders, but there are ticks that change two hosts, and sometimes develop on the body of one host. The larvae and nymphs of ticks have a very subtle adaptation to find a host-feeder: well-developed receptors that perceive soil vibration, increased temperature and concentration of carbon dioxide in the air.