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Vinnytsia National Pirogov Memorial Medical University

Department of Children Infectious Diseases

▪ “Approved”

at sub-faculty meeting

“__”_____20__, protocol №_____

Head of Department

prof. _______I.I. Nezgoda

Study Guide for Practical Work of Students

Topic: “Differential diagnostics and emergency aid of the respiratory diseases in children.”

Course VI

English-speaking Students’ Medical Faculty

Duration of the class-6,6 hours

Composed by assistant O.V. Bodnariuk

Vinnitsa

I. The theme actuality.

Diphtheria is an acute infectious disease caused by Corynebacterium diphtheria and characterized by the appearance of a fibrinous membrane on the site of pathogen invasion, which can spread on to the tonsils, larynx and pharynx, leading to symptoms of toxemia and toxic lesions of the cardiovascular system, nervous system, adrenal glands and kidneys.

Infectious mononucleosis (Filatov’s disease) is an acute feverish viral disease, being spread by air-droplet route. It is characterized by polyadenitis (especially cervical one), acute membranous tonsillitis, enlarged liver and spleen, leukocytosis, limphocytosis, presence of atypical lymphocytes. The pathogen of the disease is Epstein-Barr virus (EBV), which contains DNA. EBV is isolated in other diseases: such as Burkitt’s lymphoma and nasopharyngeal carcinoma.

Mumps remains endemic in many countries throughout the world, and mumps vaccine is used in only 57% of countries that belong to the World Health Organization, predominantly in countries with more developed economies. As in the prevaccine era, most cases of mumps are still in children ages 5 to 14, but the proportion of young adults who become infected has been rising slowly over the last two decades. Mumps infections are uncommon in children younger than 1 year old. Death due to mumps is rare; more than half of the fatalities occur in persons older than 19 years.

In the prevaccination era, pertussis (i.e., whooping cough) was a leading cause of infant death. The number of cases reported had decreased by more than 99% from the 1930s to the 1980s. However, because of many local outbreaks, the number cases reported worldwide increased dramatically. The disease is still a significant cause of morbidity and mortality in infants younger than 2 years. The World Health Organization (WHO) estimates that 294,000 children died from pertussis worldwide in 2002. About 90-95% of patients die from secondary pneumonia, dehydration, hypoxia, encephalopathy, or cerebral hemorrhage.

ІІ. Primary aims of the study

A student should know:

1. Etiology of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

2. Epidemiology (source of infection, ways of transmission, age-old receptivity and morbidity) Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

3. Pathogenesis of disease, pathomorphologic changes in the skin and staggered organs Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

4. Classification of clinical forms of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

5. Clinic of typical form of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

6. Clinical manifestations of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

7. Complications of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.).

8. Methods of laboratory research of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

9. Principles of therapy of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

10. Measures of prophylaxis of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

11. Differential diagnostics of these diseases.

A student should be able:

1. To follow the basic rules of work with patient a bed sick with Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

2. To take anamnesis with the estimation of epidemiology information (taking into account seasonality, origin of febricities, polymorphism of clinical signs of illness).

3. To examine a patient and reveal the basic clinical signs of illness.

4. To represent information of anamnesis and objective inspection in a hospital chart and formulate the preliminary diagnosis.

5. To write a plan of examination.

6. To write a clinical diagnosis (form of disease, type, severity, course of disease).

7. To prescribe the treatment taking into account age, severity of illness.

8. To write out a prescription.

9. To organize disease measures in the hearth of infection (to find out the source of infection, fill an urgent report in SES, to set a quarantine, to define the circle of contact persons).

10. To write epicrisis with the estimation of development of illness, results of inspection, efficiency of treatment, prognosis, by recommendations for a subsequent supervision or treatment depending on the form of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

III. Educational aims of the study

- forming the deontological presentations, skills of conduct with the patients

- to develop deontological presentations, be able to carry out deontology approach to the patient

- to develop the presentations of influence of ecological and socio-economic factors on the state of health

- to develop sense of responsibility for a time illness and loyalty of professional actions

- to be able to set psychological contact with a patient and his family.

IV. Control questions:

1. Indexes of morbidity from Diphtheria, Infectious mononucleosis, Mumps, Pertussis in Ukraine.

2. Sources of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

3. The ways of transmission of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

4. Prophylactic measures in the hearth of these infections.

5. Conditions necessary for development of Diphtheria, Infectious mononucleosis, Mumps, Pertussis in children.

6. Duration of incubation period of the illness in children.

7. Clinical forms of Diphtheria, Infectious mononucleosis, Mumps, Pertussis in children.

8. Clinical diagnostics of Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

9. What clinical forms of Diphtheria, Infectious mononucleosis, Mumps, Pertussis occur in children of early age?

10. Laboratory methods of inspection of the patients with Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

11. What complications occur in children more frequently?

12. Causes of complications of Diphtheria, Infectious mononucleosis, Mumps, Pertussis in children.

13. Indications for hospitalization of children with Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

14. Principles of treatment of children with Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

15. Discharge from hospital and attendance the children’s institutions by children with Diphtheria, Infectious mononucleosis, Mumps, Pertussis.

16. Differential diagnostics of these diseases.

V. Tests

Variant 1

1. What virus is Infectious mononucleosis caused by?

A. human herpesvirus type 1

B. Varicella-Zoster virus

C. human herpesvirus type 4

2. The most early symptoms of Infectious mononucleosis are:

A. increase in temperatures of body

B. Swelling of the neck lymph nodes

C. difficulty in nasal breathing

D. tonsillitis

E. all answers are right

3 What is not applied for treatment of Infectious mononucleosis?

A. Penicillin G

B. Azithromycin

C. Cefotaxim

D. Prednizolon

4 . What treatment is used for Mumps orchitis?

A. . acyclovir

B. Ribavirin

C.Ozeltamivir

D. prednisolone

5 What an active specific prophylaxis of Mumps do you know?

A. vaccination

B. isolation

C. immunoglobulin

6 The mechanism of diphtheria transmission:

А. Transmissible

B. Contact

C. Paranteral

D. Vertical

7 Where do fibrinogenous films of diphtheria localize form apper?

А. Bronchus

B. Larynx

C. Trachea

D. Fauces

8 Everything is typical for the localize form of diphtheria during the first hour, exept:

А. They look like net with grayish colour

B. They are taken easily off

C They are taken heavily off

D. They are quickly enlarged in side. If they are taken off they will appear again

9 Laboratory findings is characteristic in late catarrhal and paroxysmal stages of pertussis:

A. Absolute increase in neutrophils

B. Leukocytosis due to absolute lymphocytosis

C. Eosinophilia

10. Bordetella pertussis is susceptible to:

A. Macrolides

B. Quinolones

C. Third-generation cephalosporins

D. Meropenem

E. All answers are correct

Variant 2

1 The causative agent of Infectious mononucleosis belongs to:

A. Arbovirus

B. Togavirus

C. Enterovirus

D. Herpesvirus

2 What is not characteristic for Infectious mononucleosis?

A. tonsillitis

B. hepatomegaly

C. gastroenterocolitis

D. fever

3 The marker of Epstein-Barr infection is:

A. CMV IgM

B. HBsAg

C. HSV1/2 IgM

D. EBV Ig M

4 The duration of incubation period of Mumps is:

A. a few hours

B. 11 – 21 days

C. 5 – 7 days

D. 3 – 5 days

5 What glands are affected by Mumps more often?

A. Parotid

B. sublingual

C. Thyroid

D. Thymus

6 Croupous fibrinogenous inflammation doesn’t spread on the surface of mucous membranes:

A. Bronchus

B. Tonsils

C. Trachea

D. Larynx

7 Which form of diphtheria is absent in the classification?

А.Diphtheria of the fauces

B. Diphtheria of upper respiratory tract

C. Diphtheria of the skin

D. Diphtheria of the CNC

8 The dose of ADS depends on:

А. The age of a child

B. The severity of the disease

C. The weight of a child

9. Laboratory findings is characteristic in late catarrhal and paroxysmal stages of pertussis:

A. Absolute increase in neutrophils

B. Leukocytosis due to absolute lymphocytosis

C. Eosinophilia

10 The most common complication of pertussis in children is:

A. Pneumonia

B.Seizures

C. Encephalopathy

D. Apnea

E. Epistaxis

Variant 3

1. What causative agent can cause mononucleosis-like syndrome at children?

A. Cytomegalovirus

B. Toxoplasma gondii

C. AIDS

D. all answers are right

2 .What complication is characteristic for Infectious mononucleosis?

A. rupture spleen

B. glomerulonephritis

C. gastroenterocolitis

3. What diseases is Infectious mononucleosis necessary to differentiate with?

A. lymphogranulomatosis

B. mumps

C. AIDS

D. Adenoviral infection

E. all answers are right

4.The way of transmission of Mumps is:

A. fecal-oral

B. Contact

C. air-droplet

D. transmissible

5 What age group mostly suffers from Mumps?

A. younger 1year of age

B. 5 -10 years of age

C. 10 - 15 years of age

6. C.diphtheria belongs to:

А. Nesseria

B. Corinebacteria

C. Rickettsia

D. Listeria

7. The leading part (level) in the pathogenic mechanism of diphthiria is:

А. Bacteriemia

B. Toxaemia

C. Sensibilization

8. Point the date of vaccination against the diphtheria:

А. 6 mo,18 mo, 6 year

B. 3 mo, 4 mo,5 mo

C. 3 mo, 6 mo, 18 mo.

9. The laboratory diagnosis of pertussis can’t be accomplished by:

A. Culture of nasopharyngeal secretions

B. Gram stain of blood

C. Direct fluorescent antibody (DFA) testing of nasopharyngeal secretions

D. Serologic tests

E. Polymerase chain reaction (PCR) to test nasopharyngeal specimens

10. Bordetella pertussis isn’t susceptible to:

A. Aqueous penicillin G

B. First- generation cephalosporins

C. Second-generation cephalosporins

D. All answers are correct

Variant 4

1. The Epstein-Barra virus has tropism to:

A. T- lymphocytes

B. B- lymphocytes

C. neutrophils

D. all answers are right

2. The marker of Epstein-Barr infection is:

A. CMV IgM

B. HBsAg

C. HSV1/2 IgM

D. EBV Ig M

3. What is not applied for treatment of Infectious mononucleosis?

A. Penicillin G

B. Azithromycin

C. Cefotaxim

D. Prednizolon

4.. What laboratory method is used for confirmation of Mumps?

A. bacterioscopic

B. general blood test

C. Bacteriological

D. Serological

5. What organ is not affected by Mumps?

A. salivary glands

B. liver

C. pancreas

D. Testicles

E. nervous system

6. Peculiarities of the C.diphtheria are:

А. Grampositive stabs, which produce exotoxins

B. Gramnegative stabs, which produce endotoxins

C Grampositive stabs, which produce endotoxins

D. Gramnegative stabs, which produce exotoxins

7. Diphtheritic fibrinogenous inflammation spreads on the surface of the mucous membranes:

А. Tonsils

B. Larynx

C. Trachea

D. Bronchus

8. The dose of ADS depends on:

А. The age of a child

B. The severity of the disease

C. The weight of a child

9. The complications of pertussis are:

A. Secondary infections (such as pneumonia and otitis media)

B. Conjunctival and scleral hemorrhages

C. Central nervous system and retinal hemorrhages

D. Pneumothorax and subcutaneous emphysema

E. Umbilical and inguinal hernias

F. All answers are correct

10. What vaccine has been used in children against pertussis:

A. DTP vaccine

B. DTaP vaccine

C. All answers are correct

Task №1

A 2-month-old boy has being had a cough for 2 weeks. The disease began with dry cough, which increased gradually. The temperature has been normal. After the first week of illness paroxysmal cough appeared. When the child is coughing his face gets red. The episodes of coughing often end with expulsion of a thick plug of transparent mucus and sometimes vomiting. On the 15-th day of illness his mother sow a bout of apnea during the coughing. The child was hospitalized.

Questions:

1. Make a diagnosis.

2. What laboratory examinations should be administered?

3. Make the plan of treatment.

4. What methods of specific prophylaxis against this infection do you know?

Task №2

A fourteen-year child has temperature (38,3-38,9°С) during 3 days and painful swallowing.

Physical Examination: The child is sleepy and lethargic. The changes in the throat stipulate the obstructing of the breath (photo 2), the lymphatic nodes of the neck are enlarged (photo 2), hepar +4 cm, spleen +6 cm are protruding from the ribs.

The findings on the PCR are as follows: DNA EBV (+), on the IFA are: IgM EBV (+).

The blood test is: (Er – 4,1x1012\l, Hb – 130h\l, L – 4,8x109\l, b – 2%, s – 25%, l – 41%, m – 12%, at. l – 20%, ESR – 20mm\hr).

Questions:

1. What is your diagnosis?

2. What is the causative agent of this disease?

3. What diseases is it necessary to differ diagnostics with?

4. Prescribe the antibacterial drug for treatment tonsillitis.

Task №3

A fourteen-year child has an acute onset of the disease. His complains are: high temperature 38,0°С, headache, the pain during opening mouth and mastication. Physical Examination: edema is determined in the projection of the salivary gland on the right, auricle is lifted upward (look at the photo), on palpation – moderate painful, the skin over the inflamed gland is moderate tense and lustrous, customary colour. The mucous membrane of the oral cavity is dry, the papilla of the efferent duct is hyperemic.

Questions:

1. What is your diagnosis?

2. What organs and systems are effected at this disease?

3. What is the causative agent of this disease?

4. What do you know about active immunization?

Task №4

A nine-year child complains on the bad condition, the temperature increases up to 38-38,7°С, painful swallowing during 3 last days. Physical Examination: the submaxillary lymphatic nodes are enlarged on both sides. After taking the fibrinous membranes off the glands’ surface, it is bleeding. Bacterioscopy of mucous swabs: Gr (+) positive bacteriums in pairs with clavate thickening at the endings.

Questions:

1. What disease has the child?

2. The doctor’s tactics according to hospitalization

3. Prescribe the primary medicines for the disease.

4. What do you know about active immunization?

Apnoea

1. Remove everything that impede normal breathing (closes, pampers etc.)

2. Remove mucus from oral cavity with the help of electric or hand-operated balloon suction pump, or use your own finger wrapped in a thin gauze pad.

3. Press on the root of the tongue to provoke gag reflex and to diminish respiratory center hyperactivity.

4. Tongue fixation and preparation to give breath (head tilt position).

5. “Mouth-to-Mouth” or “Mouth-to-Nose” breathing.

6. If it is not successful – artificial lung ventilation.

VI. Literature

Basic literature:

|№ |Author(s) |Name of source |City, |Year of |Number of |

| | |(textbook, manual, monograph, etc.) |Publishing house |edition, vol.,|pages |

| | | | |issue | |

|1. |Mikhailova A.M., Minkov I., |Infection diseases in children. | Odessa |2003 |219 |

| |SavchukA. | | | | |

|2. |Robert M. Kliegman et al. |Nelson Textbook of Pediatrics |NY, SAUNDERS |2007 |3121 |

| | | | |18th Edition | |

|3. |Jonathan Cohan |Infectious disease. |Harcourt Publishers |2004 2nd|2136 |

| | | |limited |edition | |

|4. |David C Dale |Infectious diseases The clinician guide to |WebMD Corporation |2004 edition |310 |

| | |Diagnosis, Treatment and Prevention. | | | |

|5. |Duker - Krugman's |Infectious Diseases of Children. |Mosby |11th edition |1574 |

|6. |Gary R. Fleisher, Stephen Ludwig |Textbook of Pediatric Emergency Medicine. |Lippincott Williams |6th edition |2052 |

| | | |& Wilkins |2010 | |

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