СумДУ
MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
INFECTIOUS DISEASES AND EPIDEMIOLOGY DEPARTMENT
2729 METHODICAL RECOMMENDATIONS
FOR BEFORE-CLASS OF PREPARATION TO PRACTICAL CLASSES OF
INFECTIOUS DISEASES
(module 1)
for the students of senior courses of higher medical institutions
of ІІІ - ІV levels of accreditation
SUMY
Sumy State University
2010
Methodical recommendations for before class preparation to practical classes of infectious diseases (module 1) / Compilers: M.D. Chemych, N.I. Il’ina, V.V. Zakhlebaeva. Sumy: Sumy State University, 2010. - 210 p.
Infectious diseases and epidemiology department
CONTENT
|I |Introduction to the course of Infectious diseases. General description of the group of | |
| |infectious diseases with the fecal-oral mechanism of transmission. "Infectious | |
| |diseases" in the system of medical knowledge. The development of Infectious diseases as| |
| |science................................................................................| |
| |..................... |5 |
|II |General description of the group of infectious diseases with the fecal-oral mechanism | |
| |of transmission. Typhoid. Paratyphoids A and | |
| |B......................................................................................|19 |
| |................. | |
|III |A diarrhoea syndrome in clinic of infectious diseases. Salmonellosis. Food | |
| |toxicoinfection. Infectious diseases of viral etiology with the mainly fecal-oral | |
| |mechanism of transmission (enterovirus diseases, rotavirus infection). | |
| |Poliomyelitis................... | |
| | |36 |
|IV |Types of violations of water-electrolytic balance. Dehydration shock. Cholera. | |
| |Diagnostics and principles of treatment of dehydration | |
| |shock..................................................................................|57 |
|V |Intestinal infectious diseases with the primary defeat of colon : shigellosis, | |
| |amebiasis. Protosoal intestinal invasion: giardiasis, | |
| |balantidiasis..........................................................................|82 |
| |.................. | |
|VI |Iersiniosis: pseudotuberculosis, intestinal Iersiniosis......................... |112 |
|VII |Helminthisms. | |
| |Ascaridosis. Enterobiasis. Trichocephallosis. Ancilostomidiasis. Strongyloidosis. | |
| |Strongyloidosis as AIDS-associated invasion. Trichinosis. | |
| |Dirophyllariosis................................................................. |129 |
|VIII |Helminthisms. | |
| |Toxocarosis. Diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, | |
| |hymenolepiasis, echinococcosis. Alveococcosis. Opisthorchiasis. | |
| |Schistosomiasiss......................................................... |149 |
|IX |Botulism...............................................................................|168 |
| |................... | |
|X |Emergency states of the patients with infectious diseases with the fecal-oral mechanism| |
| |of transmission. Dehydration shock. Enterorrhagia and other surgical complications. | |
| |Principles of diagnostics and aid. | |
| |............................................................................... |185 |
|XI |Concluding class of module |204 |
| |1................................................................ | |
І INTRODUCTION TO THE COURSE OF INFECTIOUS DISEASES. GENERAL DESCRIPTION OF THE GROUP OF INFECTIOUS DISEASES WITH FECAL-ORAL MECHANISM OF TRANSMISSION. "INFECTIOUS DISEASES" IN SYSTEM OF MEDICAL KNOWLEDGE. DEVELOPMENT OF INFECTIOUS DISEASES AS SCIENCE
Duration - 2 hours.
1. Actuality: infectious diseases and in our time remain one of the main reasons of death rate in countries that are developing. Information about the causative agents of new infectious diseases appear. Therefore infection does not lose the actuality. Large prevalence of infectious diseases, invention of new causative agents, development of diagnostic possibilities require the knowledge of classification of diseasees. The early diagnostic of infectious patients is important for the early beginning of therapy. Treatment and prophylaxis of diseases cause make the ultimate goal of practical and theoretical medicine.
2 Educational aims of class (and the knowledge which is planned to gain)
2.1 A student must know:
а- 2
• basic stages of the development of Infectology as science;
• "Infectious diseases" in the system of medical knowledge;
• general description of the group of infectious diseases with the fecal-oral mechanism of transmission;
• determination of classification;
• principles of classification;
• alternative, clinical classifications, ICD OF WHO 10;
• basic clinical symptoms of infectious diseases;
• laboratory and instrumental diagnostics of infectious diseases;
• essence of the fundamental approach at treatment of infectious patients;
• concept of etiotropic, specific, nosotropic therapy;
• detoxication, rehydration, desensitizing, immune-correct therapy;
• complications of medical therapy;
• structure and steady-state conditions of infectious department;
• order of hospitalization, examination and discharge of infectious patient;
• features of filling and writing of case history of infectious patient.
2.2 A student must be able:
а- 3
• to observe the basic rules of work at the bed of infectious patient;
• to take the case history with the estimation of epidemiology data;
• to provide examination of infectious patient;
• to distinguish main symptoms;
• to interprete the analyses obtained with the specific laboratory and instrumental diagnostics of infectious diseases;
• to make and write diagnosis in obedience to clinical classification;
• to prescribe adequate treatment to the infectious patient depending on the period of infectious process;
• to specify valid for one occasion and course doses for manipulation treatments and applied medications;
• to give recommendations in relation to the observance of the regimen, diet, sanitary-hygenic rules during treatment;
• to estimate efficiency of the prescribeed treatment;
• in good time to recognize complications of medicinal therapy;
• to provide the prophylaxis of infectious diseases in reconvalescence;
• to fill case history and urgent notification about the exposure of infectious patient;
• correctly, faultlessly and neatly to fill medical documentation.
3 Materials of before class free work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of microorganisms, methods of |To interpret results of specific methods |
| |specific diagnostics of infectious |of diagnostics of infectious diseases |
| |diseases | |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory inspection|
| |organs and systems of man; indexes of | |
| |laboratory inspection in a norm (general | |
| |analysis of blood, urines, biochemistry | |
| |of blood, parameters of AAC, electrolytes| |
| |etc.) | |
|Physiopathology |Mechanism of violation of functions of |To interpret pathological changes on |
| |organs and systems at the pathological |results clinical and laboratory research |
| |condition of different genesis | |
|Immunology and allergology|Basic concepts of object, role of the |To estimate data of immunological |
| |system of immunity and unspecific factors|researches |
| |of defence in an infectious process, | |
| |influence on the term of elimination of | |
| |causative agent from the organism of man | |
|Epidemiology |Epidemic process (source, mechanism of |To take the epidemiology history, provide|
| |infection, ways of transmission) at |antiepidemic and prophylactic measures in|
| |infectious diseases |the hearth of infection |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical inspection of |
| |disease |patient with the defeat of the nervous |
| | |system |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the clinical|
|diseasees |inspection of patient |inspection of patient, determine |
| | |pathological symptoms and syndromes. To |
| | |analyse finding |
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics, |To prescribe treatment depending on the |
| |side effects of facilities of specific |degree of severity of course, individual |
| |nosotropic therapy |features of patient. |
| | |To write recipes |
|Dermatology |Pathogenesis, clinic and stages of |To recognize a rash for an infectious |
| |development of rash for an infectious |patient |
| |patient | |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics of |To provide differential diagnostics of |
| |clinical displays, possible complications|diseasees of different genesis. To |
| |of infectious diseases. Principles of |recognize an infectious disease, his |
| |prophylaxis and treatment |complication; to interpret data of |
| | |laboratory inspection. In good time to |
| | |hospitalize a patient in an infectious |
| | |in-patient department. To render the |
| | |first aid in the case of necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential diagnostics of |
| |Principles of diagnostics, treatment, |diseasees of different genesis. To |
| |prophylaxis of infectious diseases. |recognize an infectious disease, its |
| |Pathogenesis, epidemiology, dynamics of |complication; to interpret data of |
| |clinical displays, laboratory |laboratory inspection. To prescribe |
| |diagnostics, possible complications of |treatment. To render the first aid on |
| |infectious diseases |the before-hospital stage |
3.3 List of the recommended literature
Basic
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - С. 1-904.
2. Guidance on infectious diseases / under cor. of Yu. V. Lobzin. - SPb.: Folio, 2003. - 1040 p.
3. Ifectious diseases at General practice / by cor. of M. A. Andreichin. - Ternopil’: TSMU, 2007. - С. 430-434.
Additional
4. Infectious diseases: classification, schemes of diagnostics: guidance for students higher medical study institutions 3-4th levels of grade / M.D. Chemich, Z.I. Krasovitskiy and oth. - Sumy: Publishing house Sumy State University, 2000. - 225 p.
5. Guidance for examination of infectious patient, write of academic case history/.-Chemich M.D., Il’ina N.I., V.V. Zakhlebaeva - Sumy: Publishing house of Sumy State University, 2008. - 31 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Basic stages of development of INFECTIOUS DISEASES as science.
2 Place of discipline "Infectious diseases" in the system of medical knowledge.
3 General description of group of infectious diseases with the faecal-oral mechanism of transmission.
4 Determination of classification.
5 Principles of classification.
6 Alternative, clinical classifications, ICD OF WHO 10.
7 Basic clinical symptoms of infectious diseases.
8 Laboratory and instrumental diagnostics of infectious diseases.
9 Essence of the fundamental going near treatment of infectious patients.
10 Concept of etiotropic, specific, nosotropic therapy.
11 Detoxication, rehydration, desensitizing, immune-correcting therapy.
12 Complications of medicinal therapy.
13 Structure and regimen of operations of infectious in-patient department.
14 Governed order of hospitalization, inspection and discharge of infectious patient.
15 Features of filling and writing of case history of infectious patient.
3.4.2 Tests for self-control
To choose right answers
1 What order does regulate the sanitary-antiepidemic regimen and guard of work of personnel of infectious hospitals (departments)?
A - № 236;
B - № 916;
C - № 1231.
2. The least of layers of gauze in a mask for the prophylaxis of drop infections :
A - 2;
B - 3;
C - 4;
D - 5.
3. Urgent notification is filled by doctor:
A - finding out an infectious disease;
B - confirming diagnosis of infectious disease;
C - defining the borders of epidemic hearth.
4 When is it necessary to fill urgent notification about an infectious patient?
A - after laboratory confirmation of diagnosis;
B - not later than 3th day after making of diagnosis;
C - immediately after suspicion on an infectious disease.
5 Is stay of just arriving on treatment in one chamber with convalescent patients Assumed?
A - yes, if it is patients with identical nosologies;
B - yes, if it is patients with different nosologies;
C - no.
6 Is expectation of reception Assumed two and more patients in the apartment of induction centre?
A - yes;
B - yes, if it is patients of drop infection;
C - no.
7 Urgent report about an infectious patient is sent:
A - in the management of health care;
B - in a district laboratory;
C - in SES.
8 If an infectious patient needs reanimation measures:
A - he is delivered in a reanimation department, passing an induction centre;
B - he is delivered in a reanimation department after urgent sanitary washing in induction centre;
C - all reanimation measures are conducted only in an induction centre.
9 Mechanisms of transmission of infectious diseases :
A - respiratory;
B - fecal-oral;
C - transmissible;
D - wound;
E - all answers are true.
10 What chemical drugs are used for treatment of infectious diseases?
A - antibacterial;
B - antiviral;
C - антиprotosoal;
D - antihelmint;
E - all answers are true.
Standards of right answers
1. B; 2. C; 3. A; 4. C; 5. C; 6. C; 7. C; 8. A; 9. E; 10. E.
3.4.3 Tasks for self-control
Task 1
At the inspection of patient B. diagnosed "leptospirosis, icteric form".
1 If it necessary to hospitalize a patient in an infectious department?
2 What measures are conducted to the contact persons?
3 At what infectious diseases immediate hospitalization is necessary?
Task 2
The group of contact workers returned from a business trip in one of countries of Asia. In the moment of business trip cases of malaria and cholera were determined in that country.
1 Is it necessary to provide the inspection of this group of people after a home-coming?
2 What laboratory inspections is it necessary to provide for them?
Task 3
Patient М., 15 years, is on treatment in an infectious department with a diagnosis "flu, intermedius degree of severity". According to the calendar of inoculations he needs to be provided revaccination of ADT.
1 Can revaccination be provided for the patient?
2 In what cases revaccination is contra-indicated?
Task 4
The patient С., 9 years, entered infectious department with a diagnosis "scarlatina, intermedius degree of severity". From anamnesis: 2nd day of disease. She was placed in box, where is another patient with the same diagnosis, but she prepares to the discharge.
1 Did patient С place Correctly?
Standards of answers for tasks
Task 1
At leptospirosis hospitalization is obligatory in an infectious department, on testimonies - in reanimation department. An isolation is not practiced. In a hearth they provide disinfection, as at enteroideas, deratization.
Immediate hospitalization of infectious patients is necessary at a plague, cholera, anthrax, glanders, hydrophobia, spotted fever, typhoid, paratyphoids A and B, fevers of Lass, Ebola, Marburg.
Task 2
At the direction of SES a doctor conducts the clinical and laboratory inspection of persons, which arrived from countries, problematic on cholera, yellow fever, malaria, tropical helminthisms. Arriving from countries, where a cholera is registered, subject to the daily medical supervision during 5 days since arrival. In the case of plague supervision lasts 6 days. Persons which returned from tropical countries pass medical examination in CID; research of thick drop and stroke of blood in the presence of plasmode of malaria, microfilaria, spirochetas, trypanosomas; sediment of urine on the eggs of shystosomas; excrement on the eggs of helmints and the intestinal simplest.
Task 3
Realization of revaccination is contra-indicated for this patient, because of patient’s acute infectious disease.
Temporal contra-indications to immunization are acute infectious and uninfectious diseases which include reconvalescence. By foundation for abstention from inoculations there can be also the second half of pregnancy and pectoral feeding. After the carried disease immunization can be provided out not earler than in 2 months from the moment of clinical recovery.
Task 4
A patient which acted just was placed wrong. According to an order (about placing of patients in infectious department) patients which acted just must not be in one chamber with a convalescent or sick with complications. On possibility provide the one-moment filling of chambers and simultaneous discharge.
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class
To capture the methods of inspection of infectious patient .
To provide curation of infectious patient.
To provide differential diagnostics of infectious diseases of different genesis.
To work out plan of laboratory inspection.
To interpret the results of specific inspection of infectious patient.
To recognize complications of infectious diseases.
To work out a plan of treatment of infectious patient.
To define a medical tactic in the case of origin of the urgent conditions.
To draw medical documentation in fact of establishment of infectious disease.
4.2 Materials of the methodical providing of the basic stage of class
4.2.1 Professional algorithm in relation to forming of skills and abilities of diagnostics of infectious diseases
|№ |Task |Sequence of |Remarks, warnings in relation to self-control |
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the methods |І Find out the |To separate complaints which characterize |
| |of clinical inspection |complaints of patient |syndromes : |
| |of infectious patient | |- - to general intoxication; |
| | | |- - organ defeats |
| |To provide curation of | | |
| |patient |ІІ Find out anamnesis:| |
| | |1 Anamnesis of disease| |
| | | | |
|2 | | |To pay attention on beginning, term, sequence of |
| | |2 Anamnesis of life |origin of symptoms, dynamics |
| | | | |
| | |3 Epidanamnesis |To find out the carried diseases |
| | | | |
| | | | |
| | | |To find out data in relation to realization of |
| | | |certain mechanism of transmission, to pay |
| | | |attention on stay of patient in touch with |
| | | |infectious patients or presence |
| | | |this disease for a patient in the past |
| | |ІІІ Provide an |To remember: presence, expressed, dynamics of |
| | |objective inspection |symptoms conditioned by a term and severity of |
| | | |course of disease, depend on age sick, concomitant|
| | | |pathology |
| | | | |
| | | |To pay attention on: |
| | |1 General examination:|- the common condition of patient; |
| | | | |
| | |2 Skin: |- presence, localization, character of rash; |
| | | | |
| | |3 Mucous membranes | |
| | | | |
| | |4 Muscles, bones, |- degree of development, sickliness |
| | |joints | |
| | | |- Examination of thorax, palpation, comparative |
| | |5 the Respiratory |and topographical percussion of lungs, |
| | |system |auscultation of lungs |
| | | | |
| | | |- Pulse; ARTERIAL TENSION; examination and |
| | | |palpation of cardiac area; percussion and |
| | |6 Cardiovascular |cardiophony |
| | |system | |
| | | |- Examination of oral cavity; examination of |
| | | |abdomen, superficial and deep palpation, |
| | | |percussion of abdomen; liver, gall-bladder, |
| | |7 System of digestion |pancreas, spleen |
| | | | |
| | | | |
| | | | |
| | | |- Examination of area of Kidneys, |
| | | |palpation, sickliness, Pasternatsky symptom, |
| | | |diuresis |
| | |8 Urinary system | |
| | | |Development, intellect, memory, orientation in |
| | | |space and time, contact with a patient, provide, |
| | |9 Nervous system |motive and sensible spheres, dermographism; |
| | | |changes of rumor and sight |
|3 |To prescribe laboratory|1 General analysis of |To pay attention on typical changes |
| |and additional |blood | |
| |researches, interpret |2 the General analysis|To pay attention on typical changes |
| |results |of urine | |
| | |3 Specific methods of | |
| | |research : | |
| | |а) bacteriological, | |
| | |virologic, |- exposure of causative agent |
| | |parasitologic; | |
| | |b) serologic; | |
| | | | |
| | | |- exposure of AB to the causative agent |
| | |c) immunological; | |
| | | |- exposure of Ig M and Ig D |
| | |d) PLR | |
| | | | |
| | | |- exposure RNA or DNA of causative agent |
Materials of after-class free work
Subjects of Research work :
Features of course of infectious diseases in modern terms.
• Modern methods of specific diagnostics of infectious diseases.
• Problems of etiotropic treatment of infectious diseases today.
ІІ GENERAL DESCRIPTION OF GROUP OF INFECTIOUS DISEASES WITH FECAL-ORAL MECHANISM OF TRANSMISSION. TYPHOID. PARATYPHOIDS A AND B
Duration - 2 hours.
1 Actuality of theme: typhoid meets in all regions, but most widespread in the countries of Africa, South America, Asia. Annually in the world about 33 million people are ill on typhoid, lethality in regions is 0,3-2,3 %. Spreading disease is promoted by absence of effective methods of sanitation of transmitters of S. typhi - basic source of infection (chronic transmitter of causative agent is formed at 2-4 % reconvalescents); firmness of causative agent is in an environment; fecal-oral mechanism of transmission; propensity of disease to epidemic distribution in regions with a low social and sanitary-hygenic level, in the conditions of ecological calamities; high enough receptivity of man to disease.
Distribution of typhoid in Ukraine is assisted by the low social and sanitary-hygenic level of population, natural calamities (floods in western areas and others like that), defects of utilits, development of international contacts, immigration processes ( from the countries of the Asian region), absence of the proper watchfulness, and often and corresponding knowledge for doctors.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of typhoid, factors of pathogenicity of causative agent;
• epidemiology of typhoid;
• pathogenesis;
• clinical displays of typhoid at a typical course;
• clinical-epidemiological features of paratyphoid A and paratyphoid B;
• pathogenesis, terms of origin and clinical displays of complications of typhoid;
• laboratory diagnostics of typhoid;
• principles of treatment;
• principles of prophylaxis;
• tactic in case of origin of the urgent conditions;
• prognosis of typhoid, paratyphoids A and B;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation of reconvalescents.
2.2 A student must be able:
а- 3
• to observe the basic rules of work at sick-bed with typhoid, paratyphoids A and B;
• to take the case history with the estimation of epidemiology data;
• to inspect patient, distinguish basic symptoms and syndromes of typhoid, ground a clinical diagnosis for timely direction of patient in an in-patient department;
• to provide differential diagnostics of typhoid;
• on the basis of clinical inspection in good time to recognize possible complications of typhoid, urgent conditions;
• to draw medical documentation in fact of establishment of diagnosis "typhoid" (urgent notification);
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to analyse the results of specific methods of diagnostics depending on material and period of disease;
• to work out an individual plan of treatment taking into account epidemiology data, stage of disease, presence of complications, severity of the condition, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
• to work out a plan of antiepidemic and prophylactic measures in the hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, supervision in a reconvalescence.
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of S. typhi, S. paratyphi A, S. |To interpret the results of |
| |paratyphi B; methods of specific diagnostics |specific methods of diagnostics of |
| |of typhoid |typhoid, paratyphoids A and B |
|Physiology |Parameters of physiological norm of organs |To estimate data of laboratory |
| |and systems of man; indexes of laboratory |inspection |
| |inspection in a norm (general analysis of | |
| |blood, urines, biochemistry of blood, | |
| |parameters of AAC, electrolytes of and other)| |
|Physiopathology |Mechanism of violation of functions of organs|To interpret pathological changes |
| |and systems at the disorders of different |on results of laboratory inspection|
| |genesis |at the parafunctions of organs and |
| | |systems of different genesis |
|Immunology and |Basic concepts of object, role of the system |To estimate data of immunological |
|allergology |of immunity, in an infectious process, |researches |
| |influence on the term of elimination of | |
| |causative agent from the organism of man. | |
| |Immunological aspects of chronic bacterial | |
| |transmitter | |
|Epidemiology |Epidemic process (source, mechanism of |To take the epidemiology history, |
| |infection, ways of transmission) at typhoid |provide antiepidemic and |
| |and paratyphoids; prevalence of pathology in |prophylactic measures in the hearth|
| |Ukraine and in the world |of infection |
|Neurology |Pathogenesis, clinical signs intoxication |To provide a clinical inspection |
| |encephalopathy |patient with the defeat of the |
| | |nervous system |
|Dermatology |Pathogenesis, clinical description of |To recognize a rash for a patient |
| |exanthemas |with typhoid |
|Surgery |Clinical-laboratory signs of perforation of |In good time to diagnose these |
| |ulcer of small intestine, enterorrhagia, |complications, prescribe a |
| |tactic of the first aid |corresponding inspection, render |
| | |the first aid |
|Propaedeutics of |Basic stages and methods of clinical |To take the history, provide the |
|internal diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms and|
| | |syndromes. To analyse finding |
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics, side |To prescribe treatment depending on|
| |effects of chloramphenicol, cyprofloxacin, |age, individual features of |
| |facilities of nosotropic therapy |patient, to choose the optimal |
| | |regimen of reception and dose of |
| | |preparation, write recipes |
|Reanimation and |Urgent conditions: |In good time to diagnose and give |
|intensive therapy |ITS; |help at the urgent conditions |
| |enterorrhagia; | |
| |perforation of intestines, | |
| |infectious-toxic encephalopathy | |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics of |To provide differential diagnostics|
| |clinical displays, possible complications of |of diseasees of different genesis. |
| |infectious diseases. Principles of |To recognize an infectious disease,|
| |prophylaxis and treatment |his complication; to interpret data|
| | |of laboratory inspection. In good |
| | |time to hospitalize patient in an |
| | |infectious in-patient department. |
| | |To render the first aid in the case|
| | |of necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. Principles |To provide differential diagnostics|
| |of diagnostics, treatment, prophylaxis of |of diseasees of different genesis. |
| |infectious diseases. Pathogenesis, |To recognize an infectious disease,|
| |epidemiology, dynamics of clinical displays, |its complication; to interpret data|
| |laboratory diagnostics, possible |of laboratory inspection. To |
| |complications of infectious diseases |prescribe treatment. To render the |
| | |first aid on the before-hospital |
| | |stage |
The scheme of diagnostic and treatment of typhoid fever (Typhus abdominalis)
The epidemiological anamnesis:
yes. The clinical characteristic: no
yes yes, the typhoid fever. The verification of diagnosis: no
no
yes. The diagnosis is true no
Treatment:
Recovery: discharge
Dispansarisation:
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - С. 433-457.
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov . : Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, T.V. Antonova Infectious process. Clinical и pathophysiological aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Way of transmission of typhoid, paratyphoids A and В.
2 Factors of pathogenicity of S. typhi.
3 Stages of pathogenesis of typhoid.
4 Morphological changes in the wall of small intestines depending on the period of disease.
5 Stages of cyclic clinical course of typhoid.
6 Basic symptoms of typhoid in the initial period of disease.
7. Supporting symptoms of typhoid in height of disease.
8. Description of rash for a patient with typhoid.
9. Types of fever at typhoid.
10. Features of paratyphoid A and paratyphoid В.
11. Specific complications of typhoid.
12. Pathogenesis, clinical displays of perforation of small intestine at typhoid, time of origin.
13. Pathogenesis, clinical displays of enterorrhagia at typhoid, time of origin.
14. Hemography of patient with typhoid in height of disease.
15. Plan of inspection of patient with typhoid.
16. Methods of specific diagnostics of typhoid. Interpretation of results depending on the period of disease and material for research.
17. Etiotropic therapy of typhoid : doses, ways of introduction, duration of treatment.
18 Principles of nosotropic therapy of typhoid.
19 Treatment of complications of typhoid.
20 Rules of discharge of reconvalescents from an in-patient department.
3.4.2 Tests for self-control
To choose right answers
1. The causative agent of typhoid is:
A - Salmonella enteritidis;
B - Salmonella typhi;
C - Salmonella paratyphi A;
D - Salmonella paratyphi B;
E - Salmonella typhimurium.
2 Source of infection at paratyphoid A:
A is a patient with paratyphoid A;
B is a healthy transmitter of causative agent;
C is a cattle;
D is poultry;
E are rodents.
3 Latent period at typhoid mostly makes:
A - 1-3 days;
B - 3-7 days;
C - 9-14 days;
D - 14-25 days;
E - no less 21 day.
4. Typical clinical displays of typhoid in height of disease:
A is diarrhoea with substantial aquatic-electrolyte violations;
B is an enteroplegia;
C is a fever;
D is insomnia;
E is a hepatolienal syndrome with an icterus.
5. Status typhosus appropriately nosotropic predefined:
A - by the action of exotoxin;
B - by the action of endotoxin;
C - bleeding;
D – thrombovasculitis of vessels of cerebrum;
E - by inflammation of brain-tunics.
6. Bile culture is prescribed to research:
A - on the first week of disease;
B - on the second week of disease;
C - on the third week of disease;
D - on the fourth week of disease;
E - on the fifth week of disease.
7. For an exanthema at typhoid characteristically:
A - appears simultaneously with the increase of temperature;
B are single elements on a stomach;
C - appears at once, without rash in addition;
D - has roseola character;
E - appears not early than the 8th day of disease.
8. Types of fever at typhoid:
A - Wunderlich;
B - Kildushvsky;
C - Botkin;
D - Padalka;
E - subfebrile.
9. Typical changes in hemography in height of typhoid:
A is leukocytosis;
B is leukopenia;
C is a change of formula to the left;
D is a change of formula to the right;
E is an eosinophilia.
10. Antibacterial therapy of typhoid is completed:
A - right after normalization of temperature;
B - on the third day after normalization of temperature;
C - on the 21st day of disease;
D - on a 10 days after normalization of temperature;
E - antibacterial therapy is not obligatory.
Standards of right answers
1. 2. A, 6. C; 7. B, C, D; 8. B; 9. B; 10. B
Dynamics of clinical symptoms of typhoid
|Symptom |Week of disease |
| |1 |2 |3 |4 |5 |
|Headache |+ |+ |+ |- |- |
|Insomnia |- |+ |+ |- |- |
|Typhus status |- |+ |+ |- |- |
|General weakness |+ |+ |+ |+ |+ |
|Flatulence |+ |+ |+ |- |- |
|stomach-ache |- |- |- |- |- |
|Rash |- |+ |+ |+ |- |
|Symptom of Padalka |+ |+ |+ |- |- |
|Symptom of Filippovich |- |- |+ |+ |+ |
|Hepatolienal syndrome |- |+ |+ |+ |+ |
|Relative bradycardia |- |+ |+ |- |- |
3.4.3 Tasks for self-control
Task 1
For a patient during a week temperature rose gradually, appeared headache, general weakness, appetite decreased. Appealed to the doctor on the 8th day of disease. Objectively: temperature 39,5 0С, on questions answers languidly, answers clearly, skin pale, tongue is fuliginous, arterial TENSION is 100/60 mm Hg, pulse 74 in min. Flatulence, there are few roseolas on the skin of abdomen. Hepatolienal syndrome is determined. Constipations.
1 Formulate a diagnosis.
2 Plan of inspection.
3 Treatment.
Task 2
The patient of 32 years appealed to the district internist on the 5th day of disease with complaints about great headache, general weakness, absence of appetite, insomnia, increase of temperature from 37,5 0С in the first day of disease with her gradual increase to 39,0 0С in the day of appeal for medical help. Objectively: pallor of skin. A tongue is incrrustated by a greyish-white raid, imprints of teeth on sides, free of raid. Pulse 78 in min, arterial TENSION is 110/60 mm of Hg. A abdomen is mildly swollen, painless. A liver on a 1,5-2 cm comes under the edge of costal arc. Symptom of Padalka is positive. There is no stool during 2 days.
1 Formulate a diagnosis.
2 Plan of inspection.
3 Treatment.
Task 3
A patient 36 years ill about 3 weeks: gradual increase of temperature, which from the 2th week of disease purchased undulating character, decline of capacity, headache, insomnia. Treated oneself ambulatory with the diagnosis of "ARI". Because of absence of effect directed in an in-patient department. At examination: pale, adynamic, on questions answers languidly. Temperature 40 0С, fuliginous tongue, flatulence, positive symptom of Padalka. Liver comes on 2-3 cm from under the edge of costal arc. The bottom pole of spleen is palpated. In 2 days dizziness, sonitus, , death-damp on face, melena appeared after hospitalization. Arterial TENSION is 70/40 mm Hg, pulse 120 in min, temperature decreased to norm.
1 Diagnosis.
2 Plan of inspection.
3 Treatment.
4 Materials for audience independent work
4.1 List of educational practical tasks which must be executed on practical class
• To capture the methods of inspection of patient with typhoid, paratyphoids A and В.
• To provide curation of patient with typhoid.
• To provide differential diagnostics of typhoid.
• To work out a plan of laboratory inspection.
• To interpret results of specific inspection of patient with typhoid.
• To recognize complication of typhoid.
• To work out plan of treatment of patient with typhoid.
• To define a medical tactic in the case of origin of the urgent conditions.
• To draw medical documentation at making of diagnosis "typhoid".
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of typhoid, paratyphoids A and B
|№ |Task |Sequence of implementation |Remarks, warnings in relation to |
| | | |self-control |
|1 |2 |3 |4 |
|1 |To capture the methods |I to Find out the complaints |To distinguish complaints which |
| |of clinical inspection |of patient |characterize syndromes : |
| |of patient with | |- - general intoxication; |
| |typhoid, paratyphoids A| |- - organ defeats; |
| |and B | |- - additional defeats |
| | | | |
| | | | |
| | | | |
| | |1 Anamnesis of disease |To pay attention on gradual beginning; |
| | |II to Find out anamnesis: |term, sequence of origin, dynamics |
| | | |- fever; |
| | | |- - headache; |
| | | |- - parahypnosiss; |
| | | |- delays of stool; |
| | | |- rash; |
| | | |- - other symptoms |
| | | | |
| | |2 Anamnesis of life | |
| | | |To find out the carried diseases |
| | |3 Epidemiological anamnesis | |
| | | |To find out data in relation to |
| | | |realization of fecal-oral mechanism of |
| | | |transmission, to pay attention on stay of |
| | | |patient in regions with |
| |To provide curation of | |increased risk of infection of typhoid and|
| |patient | |paratyphoids A and B |
|2 | | | |
| | | |To remember: presence, expressed, dynamics|
| | |II to Provide an objective |of symptoms predefined by a term and |
| | |inspection |severity of course of disease, depend on |
| | | |age sick, to concomitant pathology |
| | | | |
| | | |To pay attention on: |
| | | | |
| | | |- languor, adynamy, dormancy of patient; |
| | |1 General examination: |- - temperature of body; |
| | |- it is the common condition |- pallor of skin; |
| | |of patient; |- presence, localization, character of |
| | | |rash; |
| | |- it is a skin, mucous |- presence of quinsy of Duge (2 -5 % |
| | |gutturs |patients) |
| | | | |
| | | | |
| | | |To pay attention on: |
| | | |- "fuliginous tongue"; |
| | |2 Digestive system: |- hepatolienal syndrome; |
| | |- glossoscopy; |- flatulence; |
| | |- percussion of abdomen; |- positive symptom of Padalka; |
| | |- palpation of abdomen; |- symptoms of peritonitis (presence |
| | | |testifies to the perforation of small |
| | | |intestine); |
| | | |- propensity to constipations (appearance |
| | | |of melena testifies to the enterorrhagia) |
| | |- description of defecating | |
| | | | |
| | | | |
| | |3 Cardiovascular system: |To pay attention on: |
| | | |- relative bradycardia (tachycardia |
| | | |testifies on complication!); |
| | |- pulse; |- - dicrotism of pulse; |
| | |- arteriotony; |- - mildly decreased arterial TENSION |
| | | |(considerable decline testifies on |
| | | |complication!); |
| | | |- moderate deafness of tones of heart |
| | |- cardiophony | |
| | | |To pay attention on: |
| | | |- presence of signs of bronchitis at part |
| | |4 Respiratory system: |of patients. |
| | |- it is an auscultation of |At severe course the typhus condition, |
| | |lungs |delirium, hallucinations are possible |
| | |5 Nervous system | |
|3 |To prescribe laboratory|1 General analysis of blood |To pay attention on typical changes: |
| |and additional | |leukopenia, lymphomonocytosis, |
| |researches, to | |aneosinephyllia, thrombopenia |
| |interpret their results| |(leukocytosis, anaemia, acceleration of |
| | | |ESR arise up in the case of development of|
| | | |complications) |
| | | | |
| | |2 General analysis of urine |Absence of considerable changes at typical|
| | |3 US of OAC |course |
| | |4 Hemoculture |Hepatolienal syndrome |
| | | |Prescribeed regardless of period of |
| | | |disease during all period of fever, |
| | | |desirably as possible before |
| | |5 Coprourine culture |From the end of the first week of disease |
| | |6 Serum methods: |Prescribeed in the pair serums of blood |
| | |- RA, (Widal reaction) RIHA; |with interval 10 days; diagnostic titrus -|
| | |- - IEA |1:200; |
| | | |diagnostic titrus 1: 100 |
5 Materials of after-class of independent work
Subjects of Research work
Features of course of typhoid in modern terms.
Modern methods of specific diagnostics of typhoid.
Problems of etiotropic treatment of typhoid.
Modern looks to pathogenesis of chronic transmitter of S. typhi.
Ways of sanitation of chronic transmitters of S. typhi.
ІІІ DIARRHOEA SYNDROME IN CLINIC OF INFECTIOUS DISEASES. SALMONELLOSIS. FOOD TOXICOINFECTION. INFECTIOUS DISEASES OF VIRAL ETIOLOGY WITH MAINLY FECAL-ORAL MECHANISM OF TRANSMISSION (ENTEROVIRUS DISEASEES, ROTAVIRUS INFECTION). POLIOMYELITIS
Duration - 2 hours.
1 Actuality of theme: the problem of acute enteroideas with a diarrhoea syndrome has the actuality and today, because of her wide prevalence, considerable frequency of development of severe, complicated forms of disease and postinfectious violations of digestion, is characteristic. The viral infections of GIT are less known to the general practitioners, than bacterial: part of viruses is 30-40% of acute episodes of diarrhoea for the children of early age, among which the "first violin" is played by a rotavirus infection (60-80%). Such diseases, as salmonellosis, food toxicoinfection, enterovirus diseases, poliomyelitis, are accompanied by diarrhoea syndrome.
2 Educational aims of class (with pointing of mastering level, that planned)
2.1 A student must know:
а- 2
• etiology of salmonellosis, food toxicoinfection, enterovirus infection, rotavirus infection, poliomyelitis, factors of pathogenicity of causative agents;
• epidemiology;
• pathogenesis;
• clinical displays of diseases with a typical course;
• clinical-epidemiological features;
• pathogenesis, terms of development and clinical displays of complications;
• laboratory diagnostics;
• principles of treatment;
• principles of prophylaxis;
• tactic in the case of origin of the urgent conditions;
• prognosis.
2.2 A student must be able:
а- 3
• to observe basic rules at a sick-bed;
• to take the history of disease and estimate epidemiology data;
• to inspect a patient and determine basic symptoms and syndromes, ground a clinical diagnosis for timely direction of patient in an in-patient department;
• to provide differential diagnostics;
• on the basis of clinical inspection in good time to recognize possible complications, urgent conditions;
• to draw medical documentation after establishment of preliminary diagnosis;
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, degree of severity, complications, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
• to work out a plan of antiepidemic and prophylactic measures, give recommendations about the regimen, diet, inspection, supervision in a reconvalescence.
3 Materials of before class of free work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Preceding disciplines |
|Microbiology |Properties of causative agents of |To interpret the results of |
| |salmonellosis, enterovirus infection, |specific methods of diagnostics |
| |rotavirus infection, food | |
| |toxicoinfections, poliomyelitis. | |
| |Methods of specific diagnostics | |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of |inspection |
| |laboratory inspection are in a norm | |
| |(CBC, urines, biochemistry of blood, | |
| |parameters of AAC, electrolytes and | |
| |др) | |
|Physiopathology |Mechanism of violation of functions of|To interpret pathological changes|
| |organs and systems at the pathological|on results of clinical and |
| |conditions of different genesis |laboratory inspection |
|Immunology and allergology |Basic concepts of object, role of the |To estimate data of immunological|
| |system of immunity, in infectious |research |
| |process, influence on the term of | |
| |elimination of causative agent from | |
| |organism of man | |
|Epidemiology | Epidemic process (source, mechanism |To take the epidemiology history,|
| |of infection, ways of transmission); |provide antiepidemic and |
| |prevalence of disease in Ukraine and |prophylactic measures in the |
| |in the world |hearth of infection |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical |
| |disease |inspection of patient with the |
| | |defeat of the nervous system |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms |
| | |and syndromes. To analyse finding|
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics,| To prescribe treatment |
| |side effects of facilities of specific|depending on the degree of |
| |and nosotropic therapy |severity of disease, individual |
| | |features of patient. To write |
| | |recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, |To provide differential |
| |dynamics of clinical displays, |diagnostics of diseasees |
| |possible complications of |different genesis. To recognize |
| |infectious diseases. Principles |an infectious disease, his |
| |of prophylaxis and treatment |complication; to interpret data |
| | |of laboratory inspection. In good|
| | |time to hospitalize a patient in |
| | |an infectious in-patient |
| | |department. To render the first |
| | |aid in the case of necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential |
| |Principles of diagnostics, |diagnostics of diseasees of |
| |treatment, prophylaxis of |different genesis. To recognize |
| |infectious diseases. Pathogenesis, |an infectious disease, his |
| |epidemiology, dynamics of clinical |complication; to interpret data |
| |displays, laboratory diagnostics, |of laboratory inspection. To |
| |possible complications of |prescribe treatment. To render |
| |infectious diseases |the first aid on the |
| | |before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
Chart of diagnostics and treatment of salmonellosis (Salmonellosis)
Epidemiology anamnesis:
yes. Clinical signs: it is not
no
no
yes
yes, salmonellosis. Verification of diagnosis : it is not
diagnosis is confirmed: it is not
Treatment:
Recovery: discharge
Observation:
Chart of diagnostics and treatment of food toxicoinfection (FTI)
((Toxicoinfectiones alimentares)
Epidemiology anamnesis:
no
yes. Clinical signs:
yes, FTI. Verification of diagnosis not
yes. A diagnosis is confirmed: it is not
Treatment:
Recovery: discharge
Observation:
Chart of diagnostics and treatment of enterovirus diseasees (Morbus Enteroviralis)
Epidemiology anamnesis:
yes. Clinical signs: it is not
Yes, enterovirus disease. Verification of diagnosis :
Yes. diagnosis is confirmed: not
Treatment:
Recovery: discharge observation:
Chart of diagnostics and treatment of rotavirus infection (Rotavirosis)
Epidemiology anamnesis:
ні
yes. Clinical signs: it is not
н ні
ні
no yes, rotavirus infection. Verification of diagnosis :
і
so
Yes. A diagnosis is confirmed: it is not
Treatment:
Recovery: discharge
Observation:
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - С. 433-457
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of causative agent of salmonellosis, enterovirus diseases, rotavirus infection and poliomyelitis. Reasons of origin of food toxicoinfection.
2 Factors of pathogenicity of these causative agents.
3 Source of infection and factors of transmission.
4 Pathogenesis.
5 Classification.
6 Basic clinical syndromes.
7 Clinical displays depending on severity of course.
8 Specific complications.
9 Differential diagnosis.
10 Plan of inspection of patient.
11 Methods of specific diagnostics.
12 Interpretation of results of laboratory research.
13 Specific therapy: doses, ways of introduction, duration of treatment.
14 First aid to the patient.
15 Rules of discharge from an in-patient department.
16 Prophylaxis and measures in hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 In pathogenesis of gastrointestinal forms of salmonellosis basic value has:
A infectious factor;
B allergic factor;
C toxic factor;
D septic factor;
E immune factor.
2 Antigen structure of salmonellas :
A - О-, Н-, К-, Vi -antigens;
B - only О-antigen;
C - only Н-antigen;
D - only К-antigen;
E - only Vi -antigen.
3 Source of infection at FTI:
A - all answers are true;
B sick people;
C animals;
D bacillicarriers;
E people and animals.
4 Mechanism of transmission at FTI:
A - respiratory;
B - fecal-oral;
C - transmissible;
D contact;
E - contact, fecal-oral.
5 Ways of transmission of infection at the gastrointestinal form of salmonellosis :
A - alimentary;
B - vertical;
C - transmissible;
D - all answers are true.
6 Source of infection at salmonellosis:
A poultry;
B pigs, cattle;
C cats and dogs;
D - all answers are true.
7 Bacteria carrying at a salmonellosis can be:
A - acute, chronic, transitory;
B - acute, subclinical, transitory;
C - chronic, subclinical, low-grade;
D - there is not a right answer.
8 To the generalized forms of salmonellosis behave:
A - subalgid;
B -algid;
C - typhoid, septicopyemic;
D - there is not a right answer.
9 In pathogenesis of gastrointestinal form of salmonellosis basic value has:
A allergic factor;
B toxic factor;
C septic factor;
D immune factor.
10 In pathogenesis of generalized forms basic value has:
A infectious-toxic factor;
B - infectious;
C - toxic;
D allergic.
Variant 2
1. Clinical forms of poliomyelitis :
A - meningeal;
B - abdominal;
C - spinal;
D - all answers are true;
E - there is not a right answer.
2 Morbidity of poliomyelitis prevails in:
A summer-autumn months;
B- spring-autumn;
C- winter;
D- does not depend on season
3 Etiotropic therapy of enterovirus infection :
A absents;
B antibacterial preparations;
C antihistaminic preparations;
E vitaminotherapy.
4 Mechanism of transmission of enterovirus infection :
A - vertical;
B - transmissible;
C - fecal-oral;
D respiratory.
5 What seasonality is characteristic for enterovirus infection?
A - winter;
B - summer;
C - seasonality is not characteristic;
D - spring.
6 Source of infection at enterovirus infection:
A sick man, virus carrier;
B animals;
C rodents;
D - all answers are true.
7 To the paralytic form of poliomyelitis behaves to:
A - spinal;
B - pontial;
C - bulbar;
D - mixed;
E - all answers are true.
8 To the unparalytic form of poliomyelitis behaves all, except:
A - inapparent;
B - abortive;
C - meningeal;
D - mixed.
9 Laboratory diagnostics of poliomyelitis includes:
A - IEA;
B - RIHA;
C determination of antibodies in an excrement;
D - all answers are true.
10 Contra-indications for vaccination of poliomyelitis:
A immunodeficient condition (innate or acquired);
B oncologic diseases;
C anaphylactic reactions on Neomycinum and streptomycin;
D - all answers are true.
Variant 3
1 Basic mechanism of transmission of rotavirus infection :
A - there is not a right answer;
B - fecal-oral;
C - transmissible;
D vertical.
2 Latent period of rotavirus infection :
A - 10 days;
B - 1-2 months;
C - 6 months;
D - 1-5 days;
E - 2 days.
3 Where is rotavirus replicates :
A - in the enterocytes of villus of small intestine;
B - red corpuscles;
C - in hepatocytes;
C - in kidney pelvis;
E - in lymphoid tissue?
4 Determination of virus of the rotavirus infection is maximal on:
A - on a 3-5th day;
B - on the 15th day of disease;
C - in the 1th day of disease;
D - in a week;
E - on the 7-10th day of disease.
5 Who is more frequent ill on rotavirus infection:
A adults;
B elderly people;
C children;
D - all answers are correct
6 Reconvalescence lasts:
A - 10 days;
B 1 month;
C - 4-5 days;
D - 7-10 days.
7 Is there specific vaccine of rotavirus infection:
A - exists in Europe and USA;
B - does not exist;
C - does exist in Ukraine and Russia?
8 Seasonality:
A - summer;
B - spring;
C - winter;
D - not characteristic.
9 What types of rotaviruses exist:
A - A, B, C;
B - A, B, C, D, E;
C - A;
D - A, C
10 Genome of rotavirus contains:
A 1 fragment;
B 10 fragments;
C 3 fragments;
D 11 fragments;
E 22 fragments.
Standards of right answers
Variant 1: 1 - C; 2 - E; 3 - A; 4 - B; 5 - A; 6 D; 7 - A; 8 - C; 9 - B; 10 - A.
Variant 2: 1 - B; 2 - A; 3 - A; 4 - C; 5 - B; 6 - A; 7 - E; 8 D; 9 - A; 10 -
Variant 3: 1 - B; 2 D; 3 - A; 4 - A; 5 - C; 6 - C; 7 - A; 8 - C; 9 - B; 10 -
3.4.3 Tasks for self-control
Task 1
The patient Т., 17 years, entered infectious department with complaints about paroxysmal pain in the muscles of back and thorax. Pain increases at changing of position of body, during breathing, cough. Disease began acutely with fever to 38,7 0С, chill, headache. Then pain appeared in muscles. At examination skin in area of back and breast without changes.
1 What clinical form of enterovirus disease is observed for this patient?
2 With what diseases is it necessary to provide differential diagnostics of this clinical form?
Task 2
A woman ate the piece of cake, which stood on a table during days. The common condition became worse in 4 hours. Nausea, paroxysmal stomach-ache, single vomiting appeared. Skin is pale, tongue is covered by a white raid. Temperature of body did not rise, diarrhoea have not been observed.
1 Diagnosis.
2 With what diseases is it necessary to provide differential diagnostics?
Task 3
Patient А., 30 years appealed to the hospital. Became ill acutely. Complaints about chill, increase of temperature to 38,5 0С, nausea, vomiting, fetid stool 7 times, without admixtures, pain in epigastrium and on motion in large intestine. 10 hours prior to a disease ate meat of duck, which was kept 12 hours at room temperature.
1 Formulate a diagnosis.
2 With what diseases is it necessary to provide a differential diagnosis?
Task 4
Man 30 years entered infectious department. Disease began acutely with the increase of temperature to 37 0С, watery stool without pathological admixtures with frequency to 10-15 times a day, nausea, vomiting, expressed intoxication. According to a patient, the day before ate unwashed fruit, what became reason of disease. From data of coprogram in an excrement much undigested cellulose, grains of starch and undigested muscular fibres.
1 Formulate diagnosis.
2. What diseases is it necessary to provide differential diagnostics with?
Standards of answers to the tasks
Task 1
1 Epidemic pleurodynia.
2 Appendicitis, pleuropneumonia, banal miositis, radiculitis.
Task 2
1 Food toxicoinfection (clinically), gastritic form, easy degree of severity.
2 Dysentery, salmonellosis, cholera, escherichiosis, enterovirus diarrhoea.
Task 3
1 Salmonellosis (clinically, epidemiologically), noncommunicative form, gastroenteritic variant, intermedius severity.
2 Cholera, FTI, escherichiosis, dysentery.
Task 4
1. Rotavirus infection.
2 Cholera, dysentery, escherichiosis, intestinal Iersiniosis.
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class :
• to capture the methods of inspection of patient with salmonellosis, FTI, enterovirus infection, rotavirus infection, poliomyelitis;
• to provide curation of patient;
• to provide differential diagnostics;
• to work out a plan of laboratory inspection;
• to interpret the results of specific inspection of patient;
• to recognize complications;
• to work out a plan of treatment of patient;
• to define a medical tactic in the case of origin of the urgent conditions;
• to draw medical documentation.
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of diarrhoea syndrome of different etiology
|№ п/п |Task |Sequence of |Remarks, warnings in relation to self-control|
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the methods |Complaints |To distinguish complaints and characteristic |
| |of clinical inspection | |syndromes. |
| |of patient |Anamnesis of disease |To pay attention on beginning, duration, |
| | | |sequence of origin of symptoms, their |
| | | |dynamics |
|1 |2 |3 |4 |
| | |Anamnesis of life |To determine the carried diseasees |
| | | | |
| | |Epidemiological anamnesis|To determine given, touching realization of |
| | | |fecal-oral mechanism of transmission : the |
| | | |use of off-grade foods of animal origin, |
| | | |patient: to specify, with whom used foods, |
| | | |causing a disease, where foods were bought |
| | | |and kept |
|2 |To provide curation of |To provide an objective |Express, dynamics of symptoms conditioned by |
| |patient |inspection |duration and severity of course of disease |
| | | |To pay attention on: |
| | |General examination |- color of skin covers; |
| | | |- turgor; |
| | | |- condition of mucous membranes |
| | | | |
| | | |To pay attention on: |
| | |Digestive system |--mucous shell of cavity of mouth; |
| | | |- flatulence; |
| | | |- - diarrhoea; |
| | | |- absence of peristaltic murmurs |
| | | |To pay attention on: |
| | | |- muffled tones; |
| | | |- - tachycardia; |
| | |Cardiovascular system |- expansion of borders of relative dullness |
| | | |of heart; |
| | | |- systole murmur on an apex |
| | | | |
| | | |To pay attention on: |
| | | |- violation of breathing (apnoea) rhythm; |
| | | |- increasing of frequency breathing |
| | |Respiratory | |
| | |system | |
| | | | |
| | | | |
| | |General analysis of blood| |
| | | | |
| | | | |
| | | | |
| | |Coprogram | |
| | | | |
| | | | |
| | |Serum research | |
| | | | |
| | | | |
| | |Bacteriological | |
| | |hemanalysis, vomitive | |
| | |masses, scourages of | |
| | |stomach, excrement | |
|3 |To prescribe laboratory| |To pay attention on: |
| |and additional | |-neutrophilic leukocytosis with change of |
| |researches | |leukocytar formula to the left; increase of |
| | | |ESR; |
| | | | |
| | | |--to pay attention on presence in the |
| | | |excrement of blood, mucus, pus. |
| | | |IEA, RA, RIHA, RA with autostamm, growth of |
| | | |titrus of antibodies. |
| | | | |
| | | |Determination of causative agent |
5 Materials of after-class of independent work
Subjects of Research work
Features of course of diseases with a diarrhoea syndrome in modern terms.
Modern methods of specific diagnostics of diseases, which have course with diarrhoea syndrome.
IV TYPES OF VIOLATIONS OF AQUATIC-ELECTROLYTE BALANCE. DEHYDRATION SHOCK. CHOLERA. DIAGNOSTICS AND PRINCIPLES OF TREATMENT OF DEHYDRATION SHOCK
Duration - 2 hours.
Actuality of theme: dehydration shock is the urgent condition for infectious patients, often developing at the severe course of disease. Wrong diagnostic decisions result not only in ineffective and uneffective medical measures, but have a damage for life of patient. If it is earlier diagnosed at sick dehydration shock and realization of reanimation measures is before begun, the greater probability of success is in treatment.
Knowledge of the urgent conditions for infectious patients necessary for the doctors of all specialities, especially those, who works in multi-field and rural medical establishments. They often remain in private with problems which arise up for a patient suddenly. From speed of decision-making, life of man depends on the rightness of actions of doctor.
A cholera is acute intestinal infection, which is accompanied by the defeat of the enzyme system of intestinal epithelium and shows up as diarrhoea, vomiting, haemodynamic disorders which result in dehydration and acidosis.
Kherson, Mykolaiv, Odesa to the area are Endemic on a cholera in Ukraine. Choleraic vibrios are distinguished on territory of all Ukraine. The low-grade and atypic forms of disease predominate; there is possibility of forming of secondary endemic hearths. Annually in the world from 12 to 65 thousands people suffer from cholera.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of cholera, factors of pathogenicity of causative agent;
• epidemiology of cholera;
• pathogenesis;
• clinical displays of cholera with typical course;
• clinical-epidemiological features of cholera;
• pathogenesis, time of origin and clinical displays of complications of cholera;
• laboratory diagnostics of cholera;
• principles of treatment;
• principles of prophylaxis;
• tactic in the case of origin of the urgent conditions;
• prognosis of cholera;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation of reconvalescents.
• clinical and laboratory diagnostics of aquatic-electrolyte violations at the different degrees of dehydration;
• pathogenesis of dehydration shock;
• differential diagnostics of dehydration shock with the shock conditions of other genesis;
• principles of treatment, first aid to patient on the before-hospital stage.
2.2 A student must be able:
а- 3
• to observe the basic rules of work at sick-bed;
• to take the case history with the estimation of epidemiology data;
• to inspect patient and determine basic symptoms and syndromes of cholera, ground clinical diagnosis for timely direction of patient in an in-patient department;
• to provide differential diagnostics of cholera;
• on the basis of clinical inspection in good time to recognize possible complications, urgent conditions;
• to draw medical documentation in fact of establishment of preliminary diagnosis "cholera" (urgent notification is in SES);
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment the account of epidemiology data, severity of condition, presence of complications, allergist anamnesis, concomitant pathology;
• to render the first aid on the before-hospital stage;
• to work out a plan of antiepidemic and prophylactic measures in hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, supervision in reconvalescence;
• to provide differential diagnostics of dehydration shock.
3 Materials of before class free work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of Vibrio cholerae. Methods of|To interpret the results of |
| |specific diagnostics |specific methods of diagnostics |
| | |of cholera |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of |inspection |
| |inspection in a norm (CBC, urines, | |
| |biochemistry of blood, parameters of AAC,| |
| |electrolytes and other) | |
|Physiopathology |Mechanism of violation of functions of |To interpret pathological changes|
| |organs and systems at the pathological |on results a clinical and |
| |conditions of different genesis |laboratory inspection |
|Immunology and |Basic concepts of object, role of the |To estimate data of immunological|
|allergology |system of immunity in infectious process,|research |
| |influence on the term of elimination of | |
| |causative agent from the organism of man | |
|Epidemiology |Epidemic process (source, mechanism of |To take the epidemiology history,|
| |infection, ways of transmission) at |provide antiepidemic and |
| |cholera; prevalence of disease in Ukraine|prophylactic measures in the |
| |and in the world |hearth of infection |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological |
| | | |
|1 |2 |3 |
| | |symptoms and syndromes. To |
| | |analyse finding |
|Clinical pharmacology |Pharmakokinetics and |To prescribe treatment depending |
| |pharmacodynamics, side effects of |on the degree of severity of |
| |facilities |disease, individual features of |
| |to specific and nosotropic therapy |patient. To write recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics of |To provide differential |
| |clinical displays, possible complications|diagnostics of diseasees of |
| |of infectious diseases. Principles of |different genesis. To recognize |
| |prophylaxis and treatment |an infectious disease, its |
| | |complication; to interpret data |
| | |of laboratory inspection. In good|
| | |time to hospitalize a patient in |
| | |an infectious in-patient |
| | |department. To render the first |
| | |aid in the case of necessity |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential |
| |Principles of diagnostics, treatment, |diagnostics of diseases of |
| |prophylaxis of infectious diseases. |different genesis. To recognize |
| |Pathogenesis, epidemiology, dynamics of |an infectious disease, its |
| |clinical displays, laboratory |complication; to interpret data |
| |diagnostics, possible complications of |of laboratory inspection. To |
| |infectious diseases |prescribe treatment. To render |
| | |the first aid on the |
| | |before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
Chart of diagnostics and treatment of cholera (Cholera)
Epidemiology anamnesis:
no
yes. Clinical displays:
yes, cholera Verification of diagnosis not
yes. A diagnosis is confirmed:
no
Treatment
Recovery: discharge
Observation:
Chart of diagnostics and treatment of dehydration shock
[pic]
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - p. 433-457
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov. : Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 What diseases are accompanied by the syndrome of dehydration?
2 Stages of pathogenesis of syndrome of dehydration.
3 Basic clinical symptoms at the syndrome of dehydration.
4 Degrees of dehydration depending on the loss of fluid.
5 Basic reason of lethality at syndrome of dehydration.
6 Plan of inspection of patient with syndrome of dehydration.
7 Hemography of patient with syndrome of dehydration.
8 Differential diagnosis of dehydration shock.
9 Determination of dehydration shock.
10 Clinic of dehydration shock.
11 Estimation of degree of dehydration on the before-hospital stage for a patient with diarrhoea.
12 Stages of treatment of patient with dehydration.
13 Complex of medical measures at the syndrome of dehydration.
14 What solutions do need to be used for rehydration?
15 Features of causative agent of cholera.
16 Description of toxins.
17 Source of infection and factors of transmission.
18 Pathogenesis of cholera.
19 Classification of cholera.
20 Basic clinical syndromes of cholera.
21 Clinical displays depending on severity of course.
22 Complications of cholera.
23 Differential diagnosis.
24 Plan of inspection of patient with cholera.
25 Methods of specific diagnostics of cholera. Interpretation of results of laboratory research.
26 First aid to the patient with cholera.
27 Rules of discharge of reconvalescents from in-patient department.
28 Prophylaxis and measures in hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 Pathological condition which develops because of the catastrophic diminishing of volume of circulatory fluid and loss of electrolytes is:
A. dehydration shock;
B. anaphylactic shock;
C. infectious-toxic shock;
D. hemorragic shock.
2 Hypovolemic shock - is:
A. dehydration of ІV level;
B. dehydration of І level;
C. dehydration of ІІ level;
D. dehydration of ІІІ level
3 Hypovolemic shock develops because of loss of fluid at:
A. all answers are true;
B. bleeding;
C. vomiting and diarrhoea;
D. long fever.
4 Mostly dehydration shock develops at:
A. acute intestinal diseases;
B. respiratory diseases;
C. blood infections;
D. diseases of external covers.
5 Diarrhoea syndrome and vomiting are reason of:
A. dehydration shock;
B. anaphylactic shock;
C. infectiously-toxic shock.
6 Compensated dehydration shock develops:
A. because of lack of changes of hemodynamics at ward;
B. there is arterial TENSION at the decline of systole;
C. at hypothermia;
D. at hypohemoglobinemia.
7 Subcompensated dehydration shock develops at:
A. decline of systole arterial TENSION;
B. increase of systole arterial TENSION;
C. decline of diastole arterial TENSION;
D. increase of diastole arterial TENSION.
8 Normal index of imperceptible losses of fluid for adult with weight 70 kg is:
A. 1000 ml in day;
B. 500 ml in day;
C. 700 ml in day;
D. 1500 ml in day.
9 Normal concentration of sodium in plasma of blood :
A. 135-150 mmole/l;
B. 125 mmole/l;
C. 170 mmole/l;
D. 110 mmole/l.
10 Mostly dehydration shock develops at:
A. acute intestinal diseases;
B. respiratory diseases;
C. blood infections;
D. diseases of skin covers.
11 Normal concentration of potassium in plasma of blood :
A. 3,5-5,5 mmole/l;
B. 2,5 mmole/l;
C. 2,0 mmole/l;
D - 4,5 mmole/l.
Variant 2
1 Cholera belongs to:
A. food toxicoinfection;
B. blood infections;
C. enteroideas;
D. viral diarrhoea;
E. food intoxications.
2 causative Agent of cholera :
1 pale treponema;
2 fusiform stick;
3 Vibrio comma;
4 Vibrio cholera;
5 Clostridium botulinum.
3 What toxins are distinguished by the causative agent of cholera :
A. endotoxin;
B. choleragen;
C. all mentioned;
D. exotoxin?
4 Source of infection at cholera:
A. food;
B. sick man and transmitter;
C. water;
D. grazing animal;
E. canned foods.
5 Factors of transmission at cholera:
A. food;
B. unwashed vegetables;
C. water;
D. all mentioned;
E. milk products.
6 Starting mechanism in pathogenesis of cholera :
A. toxin, able to oppress the tissue breathing;
B. defeat by the toxin of enterocytes of small intestines;
C. defeat by the toxin of the digestive system;
D. penetration of vegetative forms of causative agent from bowels in organs and tissues;
E. defeat by the toxin of adrenic departments of the nervous system.
7 Duration of latent period at cholera:
A. 2 weeks;
B. 1 month;
C. All are right;
D. 2-3 hours - 5 days;
E. 6-24 hours, continuation is possible to 10 days.
8 What research is basic for diagnostics of cholera :
A. hemanalysis for the exposure of toxin;
B. research of urine for the exposure of toxin;
C. hemanalysis, the vomitive masses, scourages of stomach, defecating, bits and pieces of food with the purpose of exposure of toxin;
D. research of foods for the exposure of vibrio;
E. bacteriologic examination of the vomitive masses, scourages of stomach, defecating.
9 What preparation is used for etiotropic therapy at cholera:
A. Bicillini - 5 intramuscular for 1500000 ME 1 time/day;
B. Sol. gentamуcini sulfatis 4 % intramuscular 1 ml 3 times/day;
C. Tab. Tetracyclini 0.3-0.5 D 4 times/day;
D. Laevomycetini succinatis solubil.1,0 intramuscular 4 times/day;
E. Tab. Rovamicini for 3000 МЕ 3 times/day?
10 For peroral rehydration they use:
A. glucosolan;
B. quartasol;
C. threesol;
D. acesol.
Variant 3
1 Way of transmission at cholera:
A. respiratory;
B. aquatic;
C. transmissible;
D. parenterally.
2 What research is basic for confirmation of diagnosis of cholera :
A. general analysis of blood;
B. bacteriological;
C. serum;
D. virologic?
3 Quarantine measures are conducted during:
A. 5 weeks;
B. 14 days;
C. 5 days;
D. not conducted.
4 Cholera belongs to:
A. food toxicoinfection;
B. blood infections;
C. viral diarrhoea;
D. enteroideas;
E. food intoxications.
5 On what does severity of course of cholera depend?
A. degree of dehydration;
B. dose of toxin;
C. product, that contains a toxin;
D. condition of the nervous system;
E. all mentioned?
6 Whether immunity is Produced after the carried cholera:
A. not produced;
B. compound-specific antitoxic is produced;
C. compound-specific antibacterial is produced;
D. is species-specific produced antibacterial?
7 What type of causative agent causes disease:
A. viruses;
B. helmints;
C. vibrios;
D. fungi?
8 Basic method of therapy :
A. serum-therapy;
B. antibiotics therapy;
C. antiviral therapy;
D. rehydration.
9 What complication is typical:
A. enterobrosia;
B. enterorrhagia;
C. hemiparesis;
D. typhoid?
10 Research of what material is most informing:
A. blood;
B. urines;
C. faeces;
D. saliva?
Standards of right answers
Variant 1: 1 A; 2 A; 3 A; 4 A; 5 A; 6 A; 7 A; 8 A; 9 A; 10 A; 11 A.
Variant of 2: 1 A; 2 D; 3 C;4 B; 5 C; 6 B; 7 D; 8 E; 9 C; 10 A.
Variant of 3: 1 B; 2 B; 3 C; 4 D; 5 A; 6 A; 7 C; 8 D; 9 D; 10 C
3.4.3 Tasks for self-control
Task 1
The patient С., 18 years, complains about frequent stool. Diarrhoea began acutely, unexpectedly. Stool to 20-25 times per day, watery, "rice-water" reminds. Then the frequent vomiting joined without preliminary nausea. Vomitive masses remind "rice-water" also. Weakness, dryness, is marked in the mouth, thirst. Temperature of body 36,5 0С. It is known from epidemiological anamnesis, that patient 2 days back had a rest in a village for a grandmother, where used water from an open reservoir. At examination: skin of cyanotic tint, cold to the feel, turgor is decreased. A abdomen is pulled in, painless. Tachypnea, tachycardia, decline of arteriotony, oliguria, cramps of muscle of shin.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 2
Patient К., 20 years, complains about diarrhoea without a stomach-ache, which began acutely a day ago. Stool more than 20 times per day, watery, a "rice-water" reminds. Frequent vomiting without previous nausea. A weakness, dryness, in to the mouth, thirst are marked. Temperature of body 36,0 0С. It is known from epidemiological anamnesis, that 2 days prior to disease socialized with a patient which had alike clinical presentation. At examination: skin pale, with a cyanotic tint, a turgor is decreased, "hands of laundress", lines of face are sharp, voice hoarse, myotonias of shin. Arterial TENSION is 70/50 mm Hg, pulse of the weak filling 130 per min, tachypnea.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 3
There is a patient in the induction centre of infectious hospital. He has sharp lines of face, round eyes black circles, on face expression of suffering, a body is covered by cold then. Skin easily going to the fold which is not smoothed out. Abdomen falling back. Myotonias of extremities. An arteriotony is decreased. Heart sounds are deaf. Pulse threadlike. Temperature of body 35 0С. According to the relatives of house he had the frequent vomiting and diarrhoea. A patient 2 days back returned from India.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 4
Patient А., 66 years, became ill at 5 o'clock of morning, disease began with diarrhoea. Stool 5-6 times, in great numbers, at first excrement, then watery, turbid, with white flakes, odourless; vomiting 5 times; thirst, myotonias of shins. It is known from anamnesis, that 3 days back a patient was in locality, where the cases of acute intestinal infection are registered. Hospitalized in an infectious hospital in 6 hours after the beginning of disease. In an induction centre there was vomiting by a "fountain". Objectively: consciousness is stored, skin is dry, cold to the feel, turgor is decreased, tongue dry, cyanosys of lips, tag of nose, acrocyanosis, hoarse voice, falling back eyes, oliguria. The lines of face are sharp, mucous membranes of cavity of mouth and conjunctiva dry, hyperemic. Sounds of heart are muffled. In lungs is vesicular breathing, RR 26 in min, pulse 120 in min, rhythmic, weak filling, arterial TENSION is 80/50 mm Hg; abdomen is pulled in, painless. In blood: Нb - 160 D/l, er. 5,0х1012/l, leuc 10х109/l ( change of formula to the left), ESR-15 mm/hour, Нt 0,55/l, K+ 3,5 mmole/l, Na 130 mmole/l, Cl 90 mmole/l. Uranalysis: specific gravity - 1030, albumen is tracks, er. - 1-2 in eyeshot, cylinders grainy.
1 Formulate a diagnosis.
2 Define the degree of dehydration.
3 Provide specific diagnostics of disease.
4 Hearth of infection at this disease.
5 Name mechanisms and factors of transmission of infection.
6 To what factors is pathogenicity of causative agent related?
7 Work out plan of treatment.
8 Define time of quarantine measures.
9 Plan an urgent prophylaxis at contact persons.
Task 5
The common condition of patient is very severe. On questions answers hardly. Voice getting hoarse. Skin covers pale, dry, the lines of face are sharp, eyes falling back. Nail phalanxes are cyanotic. Tongue dry. The folds of skin do not fall out. Pulse threadlike. Arterial TENSION is not determined. Heart Sounds are acutely weak. Abdomen is pulled in. Frequent cramps of lower limbs, vomiting, diarrhoea, temperature of body 350С. From epidemiological anamnesis: 2 days back returned from a journey on Crimea.
1 Formulate diagnosis.
2 Name a disease causative agent.
3 Hearth of infection?
4 Name the mechanism of infection at this disease.
5 What immunity is formed at this disease?
6 Work out a plan of inspection of this patient.
7 With what diseases is it necessary to provide differential diagnostics?
8 Work out a plan of treatment.
Standards of answers to the tasks
Task 1
1 Cholera, typical form, gastroenteritis, severe course. Dehydration of III degree.
2 Bacteriologic examination of excrement, the vomitive masses. RA, RIHA, IEA.
3 In/salt solutions (threesol, acesol, quartasol and other) to stopping of vomiting, diarrhoea, renewal of hemodynamics, diuresis. In flow of time Tetracyclinum 1,2 D in day or doxycyclin 0,2 D in day during 5 days.
Task 2
1 Cholera, typical form, gastroenteritis, severe course. Dehydration of ІІІ degree.
2 Bacteriologic examination of excrement, vomitive masses. RA, RIHA, IEA. Speed-up methods: immobilization and microagglutination of 01-vibrios by anticholreric serum, REEF.
3 Rehydration infusional therapy by salt solutions (threesol, bisol, quartasol etc.) to stopping of diarrhoea and vomiting, antibacterial therapy (Tetracyclinum 0,3 g of х 4 in day or doxycyclin 0,1 g x 2) is whereupon possible during 5 days.
Task 3
1 Cholera, typical form, algide. Dehydration shock of ІІІ level
2 Clinical hemanalysiss, urine, coprogramm, hematocritis, relative closeness of plasma. Bacteriologic examination of excrement, vomitive masses (classic and speed-up).
3 Rehydration therapy by crystalloid solutions (threesol, bisol, chlosol et cetera), rehydron, heparin 150 ME/kg, prednisolon 5 mg/kg, aminocaproic acid.
Task 4
1 Cholera, algide. Dehydration shock of ІV level
2 Biotypes of Vibrio cholerae: Vibrio cholerae asiaticae, Vibrio cholerae El - Tor.
3 Patient and bacillicarrier.
4 Fecal-oral.
5 Proof, species-specific.
6 Bacteriologic examination of excrement, vomitive masses, sowing on 1% peptone water. Serum reactions of RIHA, RN, IEA. General analysis of blood and urine. Determination of hematocritis, specific gravity of plasma, electrolytes (K, Na, Cl), AAC of blood.
7 With salmonellosis gastroenteritis, shigellosis, escherichiosis, rotavirus gastroenteritis, poisoning fly-agaric, arsenic, methyl alcohol, antifreeze.
8 Rehydration therapy (bi/threesol, quartasol, solution of Ringer, glucose, with the subsequent passing to peroral rehydration). Etiotropic therapy (Tetracyclinum, doxycyclin). Symptomatic therapy.
Task 5
1 Cholera, typical form, severe course. Dehydration of 3th degree.
2 2 th degree by WHO, 3th degree by Pokrovskiy.
3 Material for research are defecating and the vomitive masses of patient. 1 Reaction of immobilization and microaglutination of vibrios by anticholeric О-serum and immunofluorescent method. 2 Sowing on 1% peptone water for the selection of clean culture and her authentication. The results of bacteriologic examination can be got in 24-36 hours. 3 With the purpose of retrospective diagnostics determine the titrus of vibriocide and agglutinating АB in RA (pair serums), diagnostic titrus of aglutinating antibodies 1:80 - 1:320, and vibriocide - 1: 1000.
4 Patients and bacillicarriers, reconvalescents.
5 Mechanism of infection is fecal-oral, ways of transmission aquatic, alimentary, contact-domestic. Factors of transmission: infected water, foods (milk, rice, fish, crabs, shrimps), dirty hands, flies.
6 Termal stabile endotoxin, termal labile exotoxin (choleragen) with strong entertoxic action, and also fibrinolysin, hyaluronidase, collagenase, neuraminidase and other
7 I/v rehydration are crystalloid solutions (threesol, bisol, acesol, lactosol), solutions are infused at speed 100-120 ml/min to 4 l, then 60 ml/min. After normalization of pulse, arterial TENSION is a transition on drop infusion of solutions. For a fight against acidosis - 4% solution of sodium (drop infusion 5 ml/kg) bicarbonate; droperidol 0,25% 0,5 mg/kg, Tetracyclinum 0,3 g 4 times a day no less than 5 days.
8 5 days.
9 Hospitalization in an observation hospital; Tetracyclinum 0,3 g 4 times per day on the extent of 4 days.
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class :
• to capture the methods of inspection of patients with cholera and dehydration shock;
• to provide curation of cholera patient;
• to provide differential diagnostics of dehydration shock, cholera;
• to work out plan of laboratory inspection;
• to interpret the results of specific inspection of patient with dehydration shock;
• to recognize complications;
• to define a medical tactic in the case of origin of the urgent conditions;
• to draw medical documentation.
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics
|№ |Task |Sequence of implementation|Notes, warnings in relation to |
|pores. | | |self-control |
|1 |2 |3 |4 |
|1 |To capture the methods |I Find out the complaints |To separate complaints, which |
| |of clinical inspection |of patient |characterize syndrome of dehydration |
| |of patient with | | |
| |dehydration shock, | | |
| |cholera |II to Find out anamnesis: |To pay attention on: sequence of |
| | |1 Anamnesis of disease |origin, dynamics of symptoms, peculiar |
| | | |to dehydration shock |
| | | | |
| | |2 Anamnesis of life |To define suffered diseases |
| | | | |
| | |3 Epidemiological |To define data in relation to |
| | |anamnesis |realization of fecal-oral mechanism of |
| | | |transmission, to pay attention on stay|
| | | |of patient in regions with acute |
| | | |enteroideas |
|2 |To provide curation of |II Provide objective |To remember: presence, expressed, |
| |patient |inspection |dynamics of symptoms conditioned by |
| | | |term and severity of course of disease,|
| | | |depend on age of patient, concomitant |
| | | |pathology |
| | | | |
| | | |To pay attention on: |
| | |1 General examination: |- - languor, adynamy, dormancy of |
| | |--general condition of |patient; |
| | |patient; |- - temperature of body; |
| | |--skin, mucous membrane of|- cyanosys of skin, acutely decreased |
| | |oropharynx |turgor |
| | | | |
| | |2 Digestive system: | |
| | |- a glossoscopy; |To pay attention on: |
| | | | |
| | | |- - tongue is incrustated by a white |
| | | |raid; |
| | |--percussion of abdomen; |- dryness of tongue; |
| | |--palpation of abdomen; |- symptoms of peritonitis (a presence |
| | | |testifies to the perforation of small |
| | |description of defecating |intestine); |
| | | | |
| | | |- amount, character, propensity to |
| | |3 the Cardiovascular |constipations |
| | |system: | |
| | |- pulse; | |
| | |- arteriotony; | |
| | | |To pay attention on: |
| | | |- - tachycardia; |
| | |- cardiophony |- - mildly decreased arterial TENSION |
| | | |(a considerable decline testifies to |
| | | |complications); |
| | | |- - moderate deafness of tones of heart|
|1 |2 |3 |4 |
|3 |To prescribe laboratory |General analysis of blood |To pay attention on: |
| |and addtional researches| |- neutrophilic leukocytosis with change|
| | | |of leukocytar formula to the left; |
| | | |erythrocytosis; |
| | | |- increase of ESR |
| | |General analysis of urine |- albumen; |
| | | |- specific gravity; |
| | |Bacteriologic research of |- amount |
| | |defecating, vomitive |Presence of choleric vibrios |
| | |masses, scourages of | |
| | |stomach. | |
| | |Acid-alcalie condition | |
| | | | |
| | | |K+, Cl-, Na+, pH |
| | | | |
Materials of after-class free work
Subjects of Research work :
Features of course of cholera in modern terms.
Modern methods of specific diagnostics of cholera.
Problems of etiotropic treatment of cholera today.
Modern looks to pathogenesis of cholera.
• Pathogenesis of hypovolemic shock.
• DIC-syndrome. Etiopathogenesis, clinic, intensive therapy.
V INTESTINAL INFECTIOUS DISEASES WITH PRIMARY DEFEAT OF COLON : SHIGELLOSIS, AMEBIASIS. PROTOSOAL INTESTINAL INVASION: GIARDIASIS, BALANTIDIASIS
Duration - 2 hours.
1 Actuality of theme: shigellosis occupies one of leading places in the structure of acute intestinal infectious diseases. Since 1998. there is a height of morbidity. From data of State committee of statistics of Ukraine, morbidity on shigellosis increased from 21,4 to 100 thousands population in 1997 to 34,7 in 2009 and for today remains high.
In the last decade shigellosis is characterized by easier course, rare forming of chronic forms and decline of lethality. But now a situation became worse substantial character: level of morbidity rose, cases became more frequent severe and protracted shigellosis.
In Ukraine the sporadic cases of amoeba dysentery meet mainly on south. In countries CIS most unhappy are the states of Middle Asia and Transcaucasia, where a transmitter is educed in 15-35% habitants.
Special value the problem of amebiasis acquires now in connection with expansion of contacts with different countries, by the increase of number of tourist and business journeys to the regions with hot climate. Activating of own invasion, which courseed in form subclinic transmitter, is possible, what is assisted by overburning, change of terms of feed and other
Actuality of balantidiasis is conditioned by absence of watchfulness from the side of doctors to this pathology, by the risk of development of severe complications which can threaten to life of patient, and also enough high percent of lethality - 10-30 %, that contingently complications and general exhaustion, joining of sepsis. Reasons of distribution of balantidiasis in Ukraine are a low social and sanitary-hygenic level of population, absence of the proper attention of doctors to this disease.
The committee of experts of WHO considers a giardiasis a precinctive disease for many countries of the world, in which periodically there are "sporadic epidemics of disease". It is calculated, that in Africa, Asia and Latin America the number of infested arrives at 200 millions man. Although at most persons an invasion flows without symptoms, nevertheless the clinical displays of giardiasis annually come to light at 500 000 infested. In developing countries a giardiasis is one of principal reasons of acute or persistent diarrhoea. There is giardiasis in the USA and Great Britain - one of most often registered intestinal invasions of man. In Ukraine amount infested approximately 10 %makes by the lamblias of adults, among children, especially junior age, it aquires 30-40 %, and in some closed child's collectives - 70 %.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of shigellosis, amebiasis, giardiasis, balantidiasis;
• factors of pathogenicity of causative agent;
• epidemiology of shigellosis, amebiasis, giardiasis, balantidiasis;
• pathogenesis;
• clinical displays of shigellosis, amebiasis, giardiasis, balantidiasis;
• clinical-epidemiological features of shigellosis, amebiasis, giardiasis, balantidiasis;
• pathogenesis, duration of origin and clinical displays of complications of shigellosis, amebiasis, giardiasis, balantidiasis;
• laboratory diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis;
• principles of treatment of shigellosis, amebiasis, giardiasis, balantidiasis;
• principles of prophylaxis of shigellosis, amebiasis, giardiasis, balantidiasis;
• tactic in the case of origin of the urgent conditions;
• prognosis of shigellosis, amebiasis, giardiasis, balantidiasis;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation.
2. A student must be able:
а- 3
• to observe the basic rules of work at the sick-bed of shigellosisом, amebiasisом, giardiasis, balantidiasisом;
• to take the case history with the estimation of epidemiology data at shigellosis, amebiasis, giardiasis, balantidiasis;
• to inspect a patient and determine the basic symptoms of shigellosis, amebiasis, giardiasis, balantidiasis;
• to provide differential diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis;
• to draw medical documentation in fact of establishment of diagnoses of shigellosis, amebiasis, giardiasis, balantidiasis;
• to work out a plan of inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, stage of disease, severity of the condition, concomitant pathology;
• to work out a plan of antiepidemic and prophylactic measures in the hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, examinations in the period of reconvalescence.
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Property of shigellas, amoebae, |To interpret the results of |
| |lamblias, balantidium |specific methods of diagnostics of |
| | |shigellosis, amebiasis, giardiasis,|
| | |balantidiasis |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of |inspection |
| |laboratory inspection in norm (general | |
| |analysis of blood, urines, biochemistry| |
| |of blood, parameters of AAC, | |
| |electrolytes) | |
|Physiopathology |Mechanism of violation of functions of |To interpret pathological changes |
| |organs and systems at the pathological |on results of laboratory inspection|
| |conditions of different genesis |at the parafunctions of organs and |
| | |systems of different genesis |
|Immunology and allergology|Basic concepts of object, role of the |To estimate data of immunological |
| |system of immunity, in infectious |researches |
| |process, influence on the term of | |
| |elimination of causative agent from an | |
| |organism of | |
| | | |
| | | |
| | | |
|1 |2 |3 |
| |man. Immunological aspects of chronic | |
| |transmitter | |
|Epidemiology |Epidemic process (source, mechanism of |To make the epidemiology history, |
| |infection, ways of transmission) at |provide antiepidemic and |
| |shigellosis, amebiasis, giardiasis, |prophylactic measures in the hearth|
| |balantidiasis; prevalence of pathology |of infection |
| |in Ukraine and in the world | |
|Surgery |Clinical-laboratory signs of |In good time to diagnose these |
| |perforation of ulcer of small |complications, prescribe a |
| |intestine, enterorrhagia, tactician of |corresponding inspection, render |
| |the first aid, signs of defeat of |the first aid |
| |colon. | |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms and|
| | |syndromes. To analyse finding |
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics, |To prescribe treatment depending on|
| |side effects of antibacterial and |age, individual features of |
| |antiprotosoal preparations and |patient, to choose the optimal |
| |facilities of pathogenetic therapy |regimen of reception and dose |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
| | |preparation, to write recipes |
|Reanimation and intensive |Urgent conditions: |In good time to diagnose and render|
|therapy |- enterorrhagia; |the first aid at the urgent |
| |- enterobrosia with development of |conditions: enterorrhagia, |
| |peritonitis |enterobrosia with development of |
| | |peritonitis |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics of|To provide differential diagnostics|
| |clinical displays, possible |of diseasees of different genesis. |
| |complications of infectious diseases. |To recognize an infectious disease,|
| |Principles of prophylaxis and treatment|its complication; to interpret data|
| | |of laboratory inspection. In good |
| | |time to hospitalize a patient in an|
| | |infectious in-patient department. |
| | |To render the first aid in the case|
| | |of necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential diagnostics|
| |Principles of diagnostics, treatment, |of diseasees of different genesis. |
| |prophylaxis of infectious |To recognize infectious |
| | | |
| | | |
|1 |2 |3 |
| |diseasees. Pathogenesis, epidemiology, |disease, his complication; to |
| |dynamics of clinical displays, |interpret data of laboratory |
| |laboratory diagnostics, possible |inspection. To prescribe treatment.|
| |complications of infectious diseases |To render the first aid on the |
| | |before-hospital stage |
3.2 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - p. 433-457
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.3
Chart of diagnostics and treatment of shigellosis(Dysenteria)
Epidemiology anamnesis:
Yes. Clinical signs. no
and Yes, shigellosis. Verification of diagnosis : it is not
Yes. A diagnosis is confirmed: it is not
Treatment:
Recovery. Discharge:
Observation:
Chart of diagnostics and treatment of amebiasis (Аmoebiasis)
Epidemiology anamnesis:
yes Clinical signs: not
Yes, amebiasis. Verification of diagnosis : it is not
no
yes. A diagnosis is confirmed
yes
Treatment:
Recovery. Discharge:
Observation:
Chart of diagnostics and treatment of balantidiasis
Epidemiology anamnesis:
yes. Clinical signs: it is not
yes, balantidiasis. Verification of diagnosis it is not
yes. A diagnosis is confirmed. no
Treatment
Recovery: observation
Chart of diagnostics and treatment of giardiasis(Lambliosis)
Epidemiology anamnesis:
yes. Clinical signs:
yes, giardiasis. Verification of diagnosis :
no
yes. A diagnosis is confirmed: it is not
Treatment:
Recovery. Discharge: observation:
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of causative agents of shigellosis, amebiasis, balantidiasis, giardiasis.
2 Factors of pathogenicity of Sh. dysenteriae, Entamoeba histolitica, Balantidium coli, Lamblia intestinalis.
3 Source of infection and factors of transmission.
4 Pathogenesis of shigellosis, amebiasis, balantidiasis, giardiasis.
5 Classification of shigellosis, amebiasis, balantidiasis, giardiasis.
6 Basic clinical syndromes of shigellosis, amebiasis, balantidiasis, giardiasis.
7 Clinical displays depending on severity of course.
8 Specific complications of shigellosis, amebiasis, balantidiasis, giardiasis.
9 Differential diagnosis of shigellosis, amebiasis, balantidiasis, giardiasis.
10 Plan of inspection of patient with shigellosisом, amebiasisом, balantidiasisом, giardiasis.
11 Methods of specific diagnostics of shigellosis, amebiasis, balantidiasis, giardiasis. Interpretation of results of laboratory research.
12 Specific therapy of shigellosis, amebiasis, balantidiasis, giardiasis: doses, duration of treatment.
13 First aid to the patient with shigellosis, amebiasis, balantidiasis, giardiasis.
15 Rules of discharge of reconvalescents from an in-patient department.
16 Prophylaxis and measures in a hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 Dysentery belongs to:
A - food toxicoinfection;
B - blood infections;
C - enteroideas;
D - viral diarrhoea;
E - food intoxications.
2 causative Agent of shigellosis :
A pale treponema;
B fusiform stick;
C - Sh. Dysenteriae;
D - Clostridium perfringens;
E - Clostridium botulinum.
3 Source of infection at shigellosis:
A food;
B man;
C water;
D grazing animals;
E canned foods.
4 Factors of transmission at shigellosis:
A foods, articles of way of life, which are muddy faeces of patient;
B poor quality vegetables;
C unwashed fruit;
D - all mentioned;
E milk products.
5 Duration of latent period of acute dysentery :
A - 2 weeks;
B from 1 to 7 days;
C - all right;
D - 2-3 hours;
E - 6-24 hours, continuation is possible to 10 days.
6 What preparation is mostly used for antibiotic therapy shigellosis:
A - Bicillini - 5 intramuscular for 1500000 ME 1 time per day;
B - Sol. gentamуcini sulfatis 4 % intramuscular 1 ml 3 times per day;
C - Тab. Tetracyclini 0,25 4 times per days;
D - Laevomycetini succinatis solubil.0,5 intramuscular 4-6 times per day;
E - Тab. Rovamicini 3000 МЕ 3 times per day?
7 Differential diagnostics at shigellosis:
A - all mentioned;
B unspecific ulcerous colitis;
C amebiasis;
D dysbacteriosis.
8 Complications of shigellosis :
A- intensifying of piles, crack of anus, bleeding (rarely);
B- acute appendicitis, enterorrhagia;
C- perforation of ulcers, peritonitis;
D- the expressed cachexy.
9 What complications of shigellosis can arise up for children:
A bronchopneumonia, infections of urinary ways;
B mixedema;
C ichtiosis;
D artralgia?
10 Duration of dispansery observation at shigellosis:
A - 12 months;
B - 3 days;
C - 3 months after discharge from an in-patient department;
D 1 month.
Variant 2
1 Amebiasis belongs to:
A - enteroideas;
B - viral diarrhoea;
C - to food intoxications;
D - food toxicoinfection;
E - infectious protosoal infection.
2 causative Agent of amebiasis :
A pale treponema;
B fusiform stick;
C - Sh. Dysenteriae;
D - Entamoeba histolitica;
E - Clostridium botulinum.
3 Source of infection at amebiasis:
A food;
B sick man, cystocarrier;
C water;
D greeze animals;
E canned foods.
4 Factors of transmission at amebiasis:
A foods, articles of way of life, which are muddy faeces of patient;
B poor quality vegetables;
C water, foods which are not exposed to the thermal heating;
D milk products.
5 Duration of latent period of intestinal amebiasis :
A - from 1-2 weeks to 3 months;
B - from 1 to 7 days;
C - all right;
D - 2-3 hours;
E - 6-24 hours, continuation is possible to 10 days.
6 What preparation is most often used for antibiotic therapy amebiasis:
A - Bicillini - 5 intramuscular 1500000 ME 1 one time per day;
B - Sol. gentamуcini sulfatis 4 % intramuscular 1 ml 3 times per day;
C - Tab. Tetracyclini 0,25 4 times per day;
D - Tab. Metronidasoli 0,5 4 times per day
E - Tab. Rovamicini 3000 МЕ 3 times per day?
7 Intestinal complications of amebiasis :
and is a perforation with peritonitis;
B – amoeboma of bowels;
in amoeba appendicitis;
D - all mentioned.
8 What clinical forms are distinguished at amebiasis:
A - all mentioned;
B - dermic;
in - intestinal;
D – out-intestinal?
9 To out-intestinal amebiasis attribute:
A amoeba hepatitis;
B amoeba abscess of different organs (lungs, brain, spleen);
C amebiasis of skin;
D - all answers are true.
10 Differential diagnostics at amebiasis:
A unspecific ulcerous colitis;
B - all answers are true;
C dysentery;
D dysbacteriosis;
E balantidiasis.
Variant 3
1 To what group of infectious diseases balantidiasis belongs:
A - intestinal;
B - transmissive;
C - respiratory tracts;
D - external covers;
E - wound?
2 Source of infection at balantidiasis:
A pigs;
B is a man;
C cows;
D sheep;
E - all answers are true.
3 Way of infection balantidiasis :
A - fecal-oral;
B - transmissible;
C - contact;
D drop, respiratory;
E - all answers are true.
4 Passing of cystic form to vegetative at balantidiasis takes place in:
A - ascending departments of colon;
B - stomach;
C - small intestine;
D - descending departments of colon;
E - all answers are true.
5 Reproduction of B. coli takes place :
A - caecum;
B - in a rectum;
C - in an iliac bowel;
D - in a sigmoid bowel;
E - all answers are true.
6 Ulcers at balantidiasisе localized:
A - in the places of bends of intestinal wall, in a colon;
B - in the place of transition of iliac bowel in a blind;
D - in appendix;
E - all answers are true.
7 Features of ulcers at balantidiasisе:
A - located along folds, laciniate, a bottom is covered by the necrotizing masses;
B - located across folds, laciniate, bottom clean;
C - with even edges, a bottom is covered by the necrotizing masses, located across folds;
D is a bottom clean, with even edges, located along folds;
E are ulcers shallow, covered by a fibrinous raid, located across folds.
8 whether the defeat of myocardium is Possible at balantidiasis:
A - yes;
B - no?
9 Clinical forms of balantidiasis all, except:
A - subacute;
B - acute;
C - subclinical;
D - chronic continuous;
E - chronic recrudescent.
10 Latent period at balantidiasis:
A - 1-3 weeks;
B - 2-3 days;
C - 14-28 days;
D - 1-2 months;
E - 3-5 weeks.
Variant 4
1 causative Agent of giardiasis is:
A - Lamblia intestinalis (Giardia lamblia);
B - Lamblia lumbricalis;
C - Lamblia coli;
D - B.cereus;
E - Cytrobacter.
2 Lamblia intestinalis belongs to:
C - bacteria;
B - protosoa, exists in vegetative and cystic forms;
C - riccketsia;
D - mycoplasma;
E - protosoa, exists only in a vegetative form.
3 Vegetative forms of lamblias parasitize in:
A - colon;
B - duodenum;
C - small intestine;
D - rectum;
E - caecum.
4 Cystas of lamblias are in:
A - stomach;
B - small intestine;
C - caecum;
D - colon;
E - duodenum.
5 Source of infection at giardiasis:
A insects;
B people and rodents;
C rodents (mise, rats);
D snakes;
E - only people.
6 Mechanism of transmission at giardiasis:
A - fecal-oral;
B - contact;
C - alimentary;
D domestic;
E - wound.
7 whether Can to the lamblia exist in bilious ways:
A - can not;
B - can only in a gall-bladder;
C - can as cystas;
D - can as a vegetative form;
E - yes, always?
8 Clinical forms of giardiasis :
A - transitory, latent, subclinical;
B - septic, generalized;
C - latent, acute, chronic;
D - chronic, septicopiemic, generalized;
E - latent, subclinical, initially-recrudescent.
9 Latent period at giardiasis:
A - 1-3 weeks;
B - 2-3 days;
C - 1-3 months;
D - 10 weeks;
E - 30-60 days.
10 For a giardiasis characteristically:
A acute beginning, watery excrement without mucus, pain in an epigastrium, subfebrility;
B gradual beginning, flatulence, watery excrement with the admixtures of mucus;
C constipations, flatulence, febrile temperature, pain in the left iliac area;
D subfebrility, constipations, gradual beginning, flatulence.
Standards of right answers
Variant 1: 1 - A; 2 - C; 3 - A; 4 - A; 5 - B; 6 D; 7 - A; 8 - A; 9 - A; 10 C
Variant 2: 1 - E; 2 D; 3 - B; 4 - C; 5 - A; 6 D; 7 D; 8 - A; 9 D; 10 - B.
Variant 3: 1 - A; 2 - A; 3 - A; 4 D; 5 - E; 6 - E; 7 - A; 8 - A; 9 - A; 10 - A.
Variant 4: 1 - A; 2 - B; 3 - C; 4 D; 5 - E; 6 - A; 7 - A; 8 - C; 9 - A; 10 - A.
3.4.3 Tasks for self-control
Task 1
The patient С., 45 years, appealed to the doctor with complaints about a general weakness, paroxysmal pains in the left half of stomach, especially in an iliac area, tenesmas, frequent false urges to defecation, mucosanguineous excrement. At examination: temperature of body 38,4 °C, spasmated, acutely sickly sigmoid bowel.
1 What disease can be suspected?
2 With what diseases is it necessary to differentiate?
3 Work out a plan of inspection.
Task 2
The patient E., 47 years, worker of milk plant, treated oneself concerning acute dysentery, colitic form on the extent of 4 days. A stool and temperature of body was normalized. The single bacteriologic examination of excrement is conducted - a negative result is got.
Is it possible to discharge patient from a hospital?
Task 3
The patient L., 26 years, entered infectious department on the 2nd day of disease with complaints on pain at the bottom of abdomen of paroxysmal character, frequent liquid stool, false urges to defecation, admixtures of mucus and blood in an excrement. Disease began acutely with the increase of temperature to 38,5° C, stomach-aches, diarrhoea. It is set from epidemiological anamnesis, that 4 days prior to a disease ate unwashed apples. At inspection: the common condition of intermedius severity, temperature of body 38° C, arterial TENSION is 120/70 mm Hg, hearts Sounds are clear. Tongue is covered by a white raid. Abdomen at palpation is soft, painfull in area of sigmoid bowel. Sigma-meson is spasmated. In an excrement – admixtures of mucus and bloodstreaks.
1 Preliminary diagnosis.
2 Plan of inspection.
3 Treatment.
Task 4
The patient А., 46 years, entered infectious department on the 3th day of disease with complaints about paroxysmal stomach-aches, nausea, vomiting and frequent liquid stool to 15 times per day. Became ill acutely, from the increase of temperature to 38 °C, stomach-aches and diarrhoea. Sanitary-hygenic terms of life are satisfactory. Feeds at home and in a dining-room. On the eve of disease drank unboiled milk. There is the common condition severe at a receipt. Temperature of body 38,5 °C, skin is pale. Pulse 100 in min, arterial TENSION is 100/70 mm Hg, heart sounds are muffled. A tongue is incrustated by a white raid. Abdomen is pulled in, at palpation painfull along the whole length, especially in area of sigmoid bowel. Stool scanty, with the admixture of mucus.
1 Clinical diagnosis.
2 Work out a plan of inspection.
Task 5
The patient К., 39 years, entered clinic on the 3th day of disease with complaints about a general weakness, increase of temperature to 37,8 °With, stomach-aches, diarrhoea to 10 times per day. In course of time a stool lost excrement character, amount of mucus and admixture of blood increased. During examination temperature is 37,5 °C, tongue is covered by a white raid. Abdomen at palpation is sickly on motion a colon. Defecating as "raspberry jelly".
From anamnesis: a week ago returned from Tadjikistan
1 What disease can be suspected?
2 With what diseasees is it necessary to differentiate?
3 Work out a plan of inspection.
Task 6
The patient К., 40 years, works on pig farm. Entered infectious hospital with complaints about nausea, frequent vomiting, stomach-aches, diarrhoea 8-10 one time per days. Temperature of body 37,6 °C, a stomach is swollen, sickly on motion a colon, defecating frequent, with the admixtures of blood and pus.
1 Preliminary diagnosis.
2 Differential diagnosis.
Task 7
For patient 25 years during few months diarrhoea is marked. Disease began gradually. Stool 10 times per day, sometimes as "raspberry jelly". Colon is painfull. Rectometer found 2 large ulcers with deminded edges. Patient is from Intermedius Asia.
1 Differential diagnosis.
2 Laboratory researches.
Task 8
Patient 38 years, pig-worker, acted with complaints about a weakness, becoming thin, bad appetite, pains in the left half of abdomen. Stool pappy, with the admixture of mucus.
1 Preliminary diagnosis.
2 What additional researches are necessary to be conducted for confirmation of diagnosis?
3 Prescribe treatment.
Task 9
The patient А., 40 years, pig-worker, entered hospital on a 30th day from the beginning of disease in grave condition. At examination: pains in colon, skin covers pale, excrement watery, with the admixture of pus, fetid.
1 Preliminary diagnosis.
2 Plan of inspection of patient.
Task 10
A patient 20 years appealed to the infectious hospital concerning a fervescence to 37,8°With, weakness, pains in the overhead departments of stomach, watery stool to 4раз in days.
A disease binds to the reception of poor quality water.
1 Preliminary diagnosis.
2 How to confirm this diagnosis?
Standards of answers to the tasks
Task 1
1 Acute dysentery, colitic form, intermedius severity
2 With cholera, amebiasis, food toxicoinfection, campilobacteriosis, rotavirus gastroenteritis, heterospecific ulcerous colitis.
3 bacteriologic examination of excrement, RIHA with dysenteric diagnosticum, rectometer.
Task 2
No. It is necessary to provide the bacteriologic examination of excrement twice; there must be a negative result.
Task 3
1 Acute dysentery, colitic form, intermedius course.
2 bacteriologic examination of excrement, RIHA, coprocytoscopia.
3 Diet N 4; rehydron, glucosolan per os; furasolidon 0,1х 4 times per day during 5 days; enterosgel 15,0 twice in a day.
Task 4
1 Acute dysentery, gastroenterocolitic form of intermedius weight.
2 bacteriologic examination of the vomitive masses, scourages of stomach, excrement. RIHA. Coprocytoscopia.
Task 5
1 Intestinal amebiasis.
2 Dysentery, salmonellosis, balantidiasis, food toxicoinfection, campilobacteriosis, unspecific ulcerous colitis.
3 Microscopy of excrement; rectometer.
4 Treatment: Monomycinum intramuscular 4 times per days, 5 days; metronidazol 0,5 3 times per days 5 days.
Task 6
1 Balantidiasis, acute form, intermedius severity .
2 Shigellosis, salmonellosis, food toxicoinfection, intestinal amebiasis, giardiasis, NUC.
Task 7
1 Amebiasis, shigellosis, balantidiasis, NUC.
2 Coprogramm, bacteriologic examination of excrement on shigellas, salmonellas, UPP.
Task 8
1 Balantidiasis, acute form, intermedius severity .
2 Scatoscopy, rectometer.
3 Monomycinum, oxitetracyclinum of 0,25 4 t/d 5 days. Aminarsone 0,25 g 2 t/d 10 days.
Task 9
1 Balantidiasis, acute form, severe course.
2 Scatoscopy, rectometer, bacteriologicexamination of excrement on shigellas, salmonellas, UPP.
Task 10
1 Manifest giardiasis, enterocolitic form.
2 Research of excrement in the presence of cystas of lamblias or their vegetative forms (scatoscopy).
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class :
• to capture the methods of inspection of patient of shigellosisом, amebiasisом, giardiasis, balantidiasisом;
• to provide curation of patient with shigellosis, amebiasis, giardiasis, balantidiasis;
• to provide differential diagnostics;
• to work out a plan of laboratory inspection;
• to interpret the results of specific inspection of patient with shigellosis, amebiasis, giardiasis, balantidiasis;
• to recognize complication of shigellosis, amebiasis, giardiasis, balantidiasis;
• to work out a plan of treatment of patient with shigellosis, amebiasis, giardiasis, balantidiasis;
• to define a medical tactic in case of origin of the urgent conditions;
• to draw medical documentation.
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis
|№ |Task |Sequence of implementation|Remarks, warnings in relation to |
| | | |self-control |
|1 |2 |3 |4 |
|1 |To capture the methods of |I to Find out the |To distinguish complaints which |
| |clinical inspection of |complaints of patient |characterize syndromes : |
| |patient with shigellosisом, | |- - general intoxication; |
| |amebiasisом, giardiasis, | |- - organ defeats; |
| |balantidiasisом | |- - additional defeats |
| | | | |
| | | | |
| | | | |
| | |II to Find out anamnesis: |To pay attention on gradual beginning; |
| | |- anamnesis of disease; |term, sequence of origin, dynamics: |
| | | |- fever; |
| | | |- - chill; |
| | | |- - diarrhoea; flatulence, vomiting, |
| | | |decline of mass of body |
| | | | |
| | | |To find out the carried diseases |
| | |-anamnesis of life | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
| | | | |
| | |3 Epidemiological |To find out data in relation to |
| | |anamnesis |realization of fecal-oral mechanism of |
| | | |transmission, to pay attention on |
| | | |contact of patient with animals (pigs, |
| | | |dogs), failure to observe of rules of |
| | | |the personal hygiene |
| | | | |
| | | | |
| | | | |
| | | |To remember: presence, expression, |
| | | |dynamics of symptoms caused by duration|
| | |III to Provide an |and severity of course of disease, |
| | |objective inspection |depend on age, concomitant pathology |
| | | | |
| | | |To pay attention on: |
| | | |--stuffines, adynamics, dormancy of |
| | | |patient; |
| | |1 General examination: |- - temperature of body; |
| | |- common condition of |- pallor of skin; |
| | |patient; | |
| | |- skin, mucous membrane of| |
| | |oropharynx | |
| | | |To pay attention on: |
| | |2 the Digestive system: |- dry incrustated tongue; |
| | |- glossoscopy; |- enlargement of liver; |
| | |- percussion of abdomen; |- flatulence; |
| | |- palpation of |- pain in area of caecum and ascending |
|1 |2 |3 |4 |
| | |stomach; |department of colon; |
| | |- description of |- colitis, enterocolitis; |
| | |defecating |- excrement of liquid consistency, has |
| | | |strong smell, with the admixtures of |
| | | |pus, blood, mucus |
| | | | |
| | | |To pay attention on: |
| | |3 Cardiovascular system: | |
| | |- pulse; |- - considerable tachycardia testifies |
| | | |to complication!; |
| | | |- - moderately decreased arterial |
| | |- arteriotony; |TENSION; |
| | | |- - moderate deafness of tones of heart|
| | |- cardiophony |At severe course headache, dizziness, |
| | | |is possible |
| | |4 Nervous system | |
|2 |To prescribe laboratory and |1 General analysis of |To pay attention on typical changes: |
| |additional researches, |blood |- moderate anaemia; |
| |interpret their results | |- eosinophilia (7-10 %); |
| | | |- increase of ESR. |
| | | |Absence of considerable changes at |
| | |2 the General analysis of |typical course. |
| | |urine |Hepatolienal syndrome |
| | |3 US of OAC | |
| | | | |
| | |4 Serum methods: CFT, | |
| | |precipitation in agar | |
| | | | |
| | |5 Microscopy of |Living balantidiums, |
|1 |2 |3 |4 |
| | |fresh defecating |which move fast. |
| | |6 Parasitology research |Determination of balantidiums on |
| | | |Pavlova’s medium |
| | | | |
| | |7 Rectoromanoscopia |Hearth or diffuse |
| | | |infiltrative-erosive-ulcerous colitis |
5 Materials of after-class free work Subjects Research work :
• Modern methods of diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis.
• Problems of etiotropic therapy of protosoonosis.
• Modern methods of specific diagnostics of shigellosis, amebiasis, giardiasis, balantidiasis.
• Modern looks on pathogenesis of shigellosis, amebiasis, giardiasis, balantidiasis.
VI IERSINIOSIS : PSEUDOTUBERCULOSIS, INTESTINAL IERSINIOSIS
Duration - 2 hours.
1 Actuality of theme: iersiniosis is enough widespread diseases, occupy the third place in the group of acute enteroideas. Tendency to the height of number of diseases which are stipulated iersinia, registers almost in the entire countries of the world. Characterized by extraordinary polymorphism of clinical displays, high-frequency of the low-grade and subclinic course of disease, considerable percent (3-50%) of relapses. Thus, life puts the important problem of study of Iersiniosis of physicians, researchers, search of ways of fight against this infection.
Pseudotuberculosis is a zoonotic bacillosis with the fecal-oral mechanism of transmission, caused by Y. pseudotuberculosis, flows in noncommunicative and generalized forms and characterized by large polymorphism of clinical displays with the prevailing signs of defeat of digestive tract, locomotorium and skin.
Intestinal Iersiniosis is a zoonotic bacillosis with the fecal-oral mechanism of transmission, caused by Y. enterocolitica, characterized by the primary defeat of bowels, with tendency to generalisation of process with the defeat of different organs and systems, polymorphism of clinical symptoms, propensity to the protracted and chronic course.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology, epidemiology of Iersiniosis;
• basic links of pathogenesis at intestinal Iersiniosis, pseudotuberculosis;
• clinical classification of Iersiniosis;
• basic clinical symptoms of intestinal Iersiniosis (gastroenterocolitic, appendicular, septic forms of disease) and pseudotuberculosis;
• features of rash at pseudotuberculosis;
• differential diagnostics of intestinal Iersiniosis with shigellosis, salmonellosis, campilobacteriosis, balantidiasis, viral diarrhoea, appendicitis; pseudotuberculosis with scarlatina, ARVI, german measles, typhoid, paratyphoids A and B, HFRS, leptospirosis;
• methods of specific diagnostics, their clinical estimation;
• etiotropic therapy of Iersiniosis;
• methods of detoxication and desensitizing therapy;
• terms of discharge of patients from an in-patient department;
• basic antiepidemic measures;
• rules of observation of reconvalescents.
2.2 A student must be able:
а- 3
• to observe the basic rules of work at a sick-bed;
• to take the case history with the estimation of epidemiology data;
• to inspect a patient and determine basic symptoms and syndromes of intestinal Iersiniosisа, pseudotuberculosis, to ground a clinical diagnosis for timely direction of patient in an in-patient department;
• to provide differential diagnostics of Iersiniosis;
• to draw medical documentation in connection with establishment of preliminary diagnosis of intestinal Iersiniosis or pseudotuberculosis (urgent notification in SES);
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, severity of the condition, presence of complications, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
• to work out plan of antiepidemic and prophylactic measures in the hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, examination in a reconvalescence.
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of Y.|To interpret results of specific |
| |pseudotuberculosis, Y. |methods of diagnostics of Iersiniosis |
| |enterocolitica, methods of specific | |
| |diagnostics of Iersiniosis | |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes |inspection |
| |of laboratory inspection in a norm | |
| |(general analysis of blood, urines, | |
| |biochemistry | |
| |to blood, parameters of AAC, | |
| |electrolytes etc.) | |
|Physiopathology |Mechanism of violation of functions |To interpret pathological changes on |
| |of organs and systems at the |results of clinical and laboratory |
| |pathological conditions of different|inspection |
| |genesis | |
|Immunology and allergology|Basic concepts of object, role of |To estimate data of immunological |
| |the system of immunity in infectious|researches |
| |process, influence on term of | |
| |elimination of causative agent from | |
| |the organism of man | |
|Epidemiology |Epidemic process (source, mechanism |To take the epidemiology history, |
| |of infection, ways of transmission) |provide antiepidemic and prophylactic |
| |at Iersiniosis; prevalence of |measures in the hearth of infection |
| |pathology in Ukraine and in the | |
| |world | |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical inspection of |
| |disease |patient with the defeat of the nervous|
| | |system |
|Propaedeutics of internal |Basic stages and methods of clinical|To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms and |
| | |syndromes. To analyse received data |
| | | |
| | | |
|Clinical pharmacology |Pharmakokinetics and |To prescribe treatment depending on |
| |pharmacodynamics, side effects of |the degree of severity, individual |
| |facilities of specific and |features of patient. |
| |pathogenetic therapy |To write recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, |To provide differential |
| |dynamics of clinical displays, |diagnostics of diseasees of |
| |possible complications of |different genesis. To recognize |
| |infectious diseases. Principles |an infectious disease, his |
| |of prophylaxis and treatment |complication; to interpret data |
| | |of laboratory inspection. In good|
| | |time to hospitalize a patient in |
| | |an infectious in-patient |
| | |department. To render the first |
| | |aid in the case of |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential |
| |Principles of diagnostics, |diagnostics of diseasees of |
| |treatment, prophylaxis of |different genesis. To recognize |
| |infectious diseases. |an infectious disease, his |
| |Pathogenesis, epidemiology, |complication; to interpret data |
| |dynamics of clinical displays, |of laboratory inspection. To |
| |laboratory diagnostics, possible |prescribe treatment. To render |
| | |the |
| |complications of infectious diseases|before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
Chart of diagnostics and treatment of Iersiniosis (Yersiniosis)
Epidemiology anamnesis:
yes. Clinical signs: it is not
not
so
:
yes, intestinal Iersiniosis. Verification of diagnosis it is not
yes. A diagnosis is confirmed: no
and Treatment:
Recovery: discharge
Observation:
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - p. 433-457.
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of causative agent of intestinal Iersiniosis, pseudotuberculosis.
2 Source of infection and factors of transmission.
3 Pathogenesis of Iersiniosis.
4 Classification of Iersiniosis.
5 Basic clinical syndromes of intestinal Iersiniosis, pseudotuberculosis.
6 Clinical displays depending on severity of process.
7 Specific complications of Iersiniosis.
8 Differential diagnosis of intestinal Iersiniosis, pseudotuberculosis.
9 Plan of inspection of patient of Iersiniosis.
10 Methods of specific diagnostics of Iersiniosis. Interpretation of results of laboratory research.
11 Rules of discharge of reconvalescents from an in-patient department.
12 Prophylaxis and measures in hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 What methods are used for diagnostics of Iersiniosis:
A - all answers are true;
B bacteriological method;
C serum researches;
D immunoenzyme analysis;
E - bioassey?
2 causative Agent of intestinal Iersiniosis:
A - Y.psevdotuberculosis;
B - Y.pestis;
C - Y.multocidi;
D - all answers are true;
E - Y.enterocolitica.
3 Who can be the source of infection at Iersiniosis:
A soil;
B - all answers are true;
C domestic animals, wild and synanthropic rodents;
D wild animals;
E birds, cattle?
4 What mechanism of transmission at Iersiniosis:
A - fecal-oral;
B - contact;
C - transmissible;
D airi;
E - percutaneous?
5 To what group of infections Iersiniosis behave:
A - to the helminthisms;
B - to the infections of respiratory tracts;
in - to the blood infections;
D - to the group of enteroideas;
E - to the extrahazardous infections?
6 Duration of acute intestinal Iersiniosis:
A - to 2 months;
B - 1-3 months;
C - 1-3 weeks;
D - to 1,5 month;
E - 3-5 weeks.
7 What diagnostic titrus of RIHA at Iersiniosis:
A - 1:200 and higher;
B - 1:500 and higher;
C - 1:250 and higher;
D - 1:100 and higher;
E - 1:300 and higher?
8 What reactions are applied for diagnostics of Iersiniosis :
A immunoenzyme analysis;
B - RIHA;
C - all answers are true;
D - reaction of braking of migration of leucocytes;
E - reaction agglutination?
9 On what day provide an discharge from a hospital at Iersiniosis:
A - not early than a 21th day after two negative results of bacteriologic examination of excrement;
B - not early than a 25th day after two negative results of bacteriologic examination of excrement;
C - on a 21th day on condition of two negative results of bacteriologicexamination of excrement;
D - on a 18th day on condition of two negative results of bacteriologicexamination of excrement;
E - does not matter?
10 What features of rash at intestinal Iersiniosis:
A - spotted, feel like confluence on the symmetric areas of trunk and extremities, disappears during a 3-4 days;
B rash of papullar-roseollar character on the sides of trunk, on the extensoric surfaces of upper extremities;
C - a rash is punctulate, scarlatiniform, on the underbody of abdomen, feel like confluence, symmetric, disappears in 3-4 days;
D - a rash is small macullar, feel like confluence on the bottom areas of abdomen and on overhead part of thighs, disappears in 3 days;
E – small macullar, point, on the symmetric areas of trunk and extremities, does disappear on the extent of 3-4 days?
Variant 2
1 causative Agent of pseudotuberculosis :
A - Y.pestis;
B - Y.enter;
C - Y.psevdotuberculosis;
D - Y.multocidi;
E - all answers are true.
2 On what day, rash at pseudotuberculosis appear:
A 5-8th day;
B 2-4th day;
C 1-5th day;
D 3-5th day;
E 2-8th day?
3 What features of rash at pseudotuberculosis:
A - punctulate, brightly-pink, abundant, n hyperemic background, sometimes has downlow character, thick on the extensoric surfaces of joints, person, sticks to 6-7 days;
B - a rash is papular-hemorragic, on the sides of trunk, stomach, on the bend surfaces of joints, has a sense to confluence, sticks to 7-8 days;
C macullar-papullous rash on abdomen and back, sticks to 4-5 days;
D - true answer is not present;
E - scarlatiniform, roseollar, noncommunicative on the skin of overhead and bottom extremities, underbody of abdomen and sides of trunk, condensing in folds round joints?
4 Defeat of what organs is characteristic for the icteric form of pseudotuberculosis :
A spleen;
B liver and spleen;
C liver;
D - pancreas;
E - liver and pancreas?
5 What seasonality is characteristic for pseudotuberculosis:
A July-August;
B February-May;
C May-June;
D August-September;
E September-October?
6 Classification of pseudotuberculosis :
A - all answers are true;
B - on forms;
C - on stream;
D - on the degree of severity;
E - on complications.
7 What forms of pseudotuberculosis behave to typical:
A - aedematous;
B - icteric;
C – influenza-like;
D - low-grade;
E - subclinical?
8 Duration of latent period at pseudotuberculosis:
A - 18-30 days;
B - 18-48 days;
C - 2-10 days;
D - 40-60 days;
E - 3-18 days.
9 As hyperemia shows up at pseudotuberculosis:
A - by the symptoms of "hood", "blow by a whip", hyperemia of mucous membranes;
B injection of scleras, hyperemia of mucous membranes, symptom of "socks", as a "blow by a whip";
C petechias, ecchymosis, positive symptom of Pasthia;
D - symptom of "gloves", "hood", "socks", injection of scleras;
E - all answers are true?
10 For the patient of pharyngalgia at swallowing, in a stomach, in knee and ulnar joints, temperature 38,0 °С. On 4th day, scleras and skins appeared yellow. A tongue is incrustated, "raspberry". Preliminary diagnosis:
A acute viral hepatitis A;
B acute viral hepatitis B;
C pseudotuberculosis;
D scarlatina;
E kissing disease
Standards of right answers
Variant 1: 1. A; 2. E; 3. C; 4. A; 5. D; 6. D; 7. A; 8. C; 9. A; 10. E.
Variant 2: 1. C; 2. A; 3. E; 4. C; 5. A; 6. A; 7. B; 8. E; 9. D; 10. C
3.4.3 Tasks for self-control
Task 1
The patient М., 29 years, became ill suddenly: great head pain, chill, frequent vomiting, temperature of body 39,4 °С. a dry cough, rheum, joined in a Day. Hospitalized in a grave condition. On the skin of trunk, hands, thighs numerous menocelis measuring 0,4 sm, dim, here and there comes forward above the surface of skin, single hemorrhages. Conjunctiva is hyperemic. Peripheral lymphonodes are megascopic, paste, painless. Liver +2-3 sm, Spleen is palpated. In 2 days rash increased and became more bright round ulnar and knee joints. Abdomen at palpation is painful along the whole length. Stool to 8-10 one time per day, watery.
1 Diagnosis.
2 Name the basic sources of infection.
3 Name the possible ways of transmission.
4 Specify the possible factors of transmission of infection.
5 What duration of latent period?
6 Name the clinical forms of disease.
7 Work out a plan of inspection.
8 Work out a plan of treatment.
Task 2
The patient Н., 20 years, appealed to the hospital with complaints on the presence of rash on the sides of trunk, pain in area of right subcostal arc, fervescence to 380 С.
Objectively: scarlatiniform rash on the sides of trunk. Sounds of heart are rhythmic. Pulse 77 in min, arterial TENSION is a 120/70 mm Hg. Stomach soft, pain in area of right subcostal arc. Liver +1,5 sm. Icteric color of skin and mucous membranes is observed.
1 About what disease is it necessary to think?
2 What clinical form is observed in this case?
3 What system is most often struck in the period of intensifying?
4 When does a rash appear?
5 What serum methods used for diagnostics?
6 What form of this disease is most severe?
7 Basic prophylactic measures at this infection.
Task 3
The patient E., 35 years, appealed to the infectious hospital with complaints about a fervescence, weakness, hyperemia of face, neck, hands, feet, pains in joints.
On the skin of stomach, bend surfaces of extremities in area of knee and talocrural joints small papullar rash, insignificant slight swelling. There is vesicular breathing in lungs. Heart sounds are rhythmic, pulse 76 in min, arterial TENSION is a 110/80 mm Hg. Liver and spleen are not enlarged.
1 About what disease is it necessary to think?
2 Name the source of infection.
3 What duration of latent period at this disease?
4 What clinical form is observed at patient?
5 What way mostly is there an infection of people?
Standards of answers to the tasks
Task 1
1 Intestinal Iersiniosis, abdominal form, gastroenterocolitic variant, severe course.
2 Rodents, agricultural animals (cows, pigs, goats, calfs, horse).
3 Mainly alimentary.
4 Water, food foods (meat, milk, vegetables).
5 From 12 hours to 6 days.
6 Abdominal, generalized (icteric, artralgitic, exematous, septic).
7 General, bacteriological hemanalysis, excrement, urine, scourage from nose, back wall of gullet, amygdales. Serum research: RA, RIHA.
8 Regimen is bed. Diet № 4. Antibacterial therapy (chloramphenicol, Tetracyclinum), Detoxication therapy (enterosorbents, glucose, rheopolyglucin, solution of Ringer), desensitizing facilities, glucocorticoids.
Task 2
1 Pseudotuberculosis.
2 Mixed form.
3 Hepatobilliar system.
4 On the 1-3th day of disease.
5 RA, RIHA.
6 Generalized.
7 Fight against rodents.
Task 3
1 Pseudotuberculosis.
2 Rodents, domestic animals, poultries.
3 3-18 days.
4 Mixed.
5 Alimentary.
4 Materials for audience independent work
4.1 List of educational practical tasks which must be executed on practical class :
• to capture the methods of inspection of patient of Iersiniosis;
• to provide curation of patient of Iersiniosis;
• to provide differential diagnostics of Iersiniosis;
• to work out a plan of laboratory inspection;
• to interpret the results of specific inspection of patient of Iersiniosis;
• to recognize complications of Iersiniosis;
• to work out a plan of treatment of patient with intestinal Iersiniosis, pseudotuberculosis;
• to draw medical documentation in connection with diagnosed "intestinal Iersiniosis, pseudotuberculosis".
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of Iersiniosis
|№ pores|Task |Sequence of |Remarks, warnings in relation to self-control |
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the |І Complaints of |To distinguish complaints which characterize the |
| |methods of clinical |patient |clinical forms of pseudotuberculosis : |
| |inspection of | |- - abdominal; |
| |patient of | |- - icteric; |
| |Iersiniosisом. | |- - artralgia; |
| | | |- - exanthema. |
| | | |Intestinal Iersiniosis: |
| | | |- - abdominal; |
| | | |- - generalized; |
| | | |- - time-hearth |
| | | | |
| | | |To pay attention on beginning, duration, sequence of |
| | |ІІ Anamnesis |origin of symptoms, their dynamics |
| | |diseasees | |
| | | | |
| | | |To determine the carried diseasees |
| | | | |
| | |ІІІ Anamnesis of life | |
| | | |To determine data in relation to realization of |
| | |ІV Epidemiological |fecal-oral mechanism of transmission : the use of meat, |
| | |anamnesis |milk, vegetables, root crops, fruit a patient |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
|2 |To provide curation |To provide an |To remember: expressed, dynamics of symptoms conditioned|
| |of patient |objective inspection |by duration and severity of course of disease |
| | | | |
| | |General examination |To pay attention at pseudotuberculosis on: |
| | | |- it is a presence of scarlatina-like rash; |
| | | |- symptoms of "hood", "gloves", "socks"; |
| | | |- - hyperemia and puffiness of face; |
| | | |- it is a pallor of nasolabial triangle; |
| | | |- - icterus |
| | | | |
| | | |To pay attention on: |
| | | |- - mucous membrane of cavity of mouth, tongue; |
| | |Digestive system |- displays of abdominal form; |
| | | |- presence of acute appendicitis; |
| | | |- increase of liver |
| | | | |
| | | |To pay attention on: |
| | | |- deafness of tones of heart; |
| | |Cardiovascular system |- - tachycardia or bradycardia; |
| | | |- decline of arterial TENSION; |
| | | |- ECG signs of myocardial dystrophy |
| | | | |
| | | |To pay attention to signs: |
| | |Respiratory system |- - rhinitis; |
| | | |- - nasopharyngitis; |
| | | |- - bronchitis |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
|3 |To prescribe |1 General analysis of |To pay attention on: |
| |laboratory and |blood |- neutrophilic leukocytosis, change of leukocytar |
| |additional | |formula to the left; |
| |researches | |- - increased ESR |
| | |2 General analysis of |Absence of considerable changes |
| | |urine | |
| | |3Serum hemanalysis | |
| | |Bacteriologicexaminati|Since a 1th and 3th week, specific АТ determine in the |
| | |on of defecating, the |serum of blood of patient |
| | |vomitive masses, | |
| | |urine, bile, blood, | |
| | |washing off from the | |
| | |mucous membrane of | |
| | |epipharynx | |
| | |4 IEA, PLR | |
Materials of after-class free work
Subjects of Research work :
Features of course of Iersiniosis in modern terms.
Modern methods of specific diagnostics of intestinal Iersiniosis, pseudotuberculosis.
Problems of etiotropic treatment of Iersiniosis.
VII HELMINTHISMS.
ASCARIDOSIS. ENTEROBIASIS. TRICHOCEPHALLOSIS. ANCILOSTOMIDIASIS. STRONGYLOIDOSIS. STRONGYLOIDOSIS AS AIDS-ASSOCIATED INVASION. TRICHINOSIS. DIROPHYLLARIOSIS
Duration - 2 hours.
1 Actuality of theme: 342 types of helmints which can cause diseases for a man are known. About 30 types of helmints discover in Ukraine. Among all helminthisms, registered in Ukraine, from data of official statistics, in 2009 most widespread were nematodosiss, namely: enterobiasis - 74,8 %, ascaridosis - 21,08 %. the Ponderable value is occupied: Ancilostomidiasis, Dirophyllariosis, trichinosis, strongyloidosis.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of nematodosis (ascaridosis, enterobiasis, Trichocephallosis, Ancilostomidiasis, strongyloidosis, strongyloidosis as AIDS-associated invasion, trichinosis, dirofilariasis), and also factors of pathogenicity of these causative agents;
• epidemiology of nematodosis;
• pathogenesis of nematodosis;
• clinical displays of enterobiasis, Trichocephallosis, ascaridosis, Ancilostomidiasis, strongyloidosis, trichinosis, dirofilariasis;
• clinical-epidemiological features of nematodosis;
• pathogenesis, terms of origin and clinical displays of complications of nematodosiss;
• laboratory diagnostics of nematodosiss;
• principles of treatment;
• principles of prophylaxis;
• prognosis of disease;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation of reconvalescents.
2.2 A student must be able:
а- 3
• to observe the basic rules of work at a sick-bed;
• to take the case history with the estimation of epidemiology data;
• to inspect a patient and determine basic symptoms and syndromes of nematodosiss, ground a clinical diagnosis;
• to provide differential diagnostics of ascaridosis, enterobiasis, Trichocephallosisа, Ancilostomidiasisа, strongyloidosis, trichinosis, dirofilariasis;
• on the basis of clinical inspection in good time to recognize possible complications of nematodosiss;
• to draw medical documentation at establishment of preliminary diagnosis of ascaridosis, enterobiasis, Trichocephallosis, Ancilostomidiasis, strongyloidosis, trichinosis, dirofilariasis (urgent notification in SES);
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, severity of condition, presence of complications, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
• to work out plan of antiepidemic and prophylactic measures in the hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, observation in reconvalescence.
3 Materials to audience independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Biology |Properties of Enterobius vermicularis,|To interpret the results of specific|
| |Trichocephalus trichiurus, Ascaris |methods of diagnostics of |
| |lumbricoides, Ancylostoma duodena - |enterobiasis, Trichocephallosisа, |
| |le, Strongyloides stercoralis, |ascaridosis, Ancilostomidiasis, |
| |Trichinella spiralis, Dirofilaria |strongyloidosis, trichinosis, |
| |immitis, methods of specific |dirofilariasis |
| |diagnostics of the diseases caused by | |
| |them | |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of |inspection |
| |laboratory inspection are in a norm | |
| |(general analysis of blood, urines, | |
| |biochemistry of blood, parameters of | |
| |AAC, electrolytes etc.) | |
|Physiopathology |Mechanism of violation of functions of|To interpret pathological changes on|
| |organs and systems at the pathological|results a clinical and laboratory |
| |conditions of different genesis |inspection |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Immunology and allergology|Basic concepts of object, role of the |To estimate data of immunological |
| |system of immunity, in an infectious |researches |
| |process, influence on the term of | |
| |elimination of causative agent from | |
| |the organism of man. | |
|Epidemiology |Epidemic process (source, mechanism of|To collect epidemiology |
| |infection, ways of transmission) at an|anamnesis, to provide antiepidemic |
| |enterobiasis, Trichocephallosisе, |and prophylactic measures in the |
| |ascaridosis, Ancilostomidiasisах, |hearth of infection |
| |strongyloidosis, trichinosis, | |
| |dirofilariasis; prevalence of | |
| |pathology in Ukraine and in the world | |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical inspection |
| |disease |of patient with the defeat of the |
| | |nervous system |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms and |
| | |syndromes. To analyse finding |
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics,|To prescribe treatment depending on |
| |side effects of facilities of specific|the degree of severity, individual |
| |and nosotropic therapy |features of patient. To write |
| | |recipes |
|1 |2 |3 |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics |To provide differential diagnostics |
| |of clinical displays, possible |of diseasees of different genesis. |
| |complications of infectious diseases. |To recognize an infectious disease, |
| |Principles of prophylaxis and |his complication; to interpret data |
| |treatment |of laboratory inspection. In good |
| | |time to hospitalize a patient in an |
| | |infectious in-patient department. To|
| | |render the first aid in the case of |
| | |necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential diagnostics |
| |Principles of diagnostics, treatment, |of diseases of different genesis. To|
| |prophylaxis of infectious diseases. |recognize an infectious disease, his|
| |Pathogenesis, epidemiology, dynamics |complication; to interpret data of |
| |of clinical displays, laboratory |laboratory inspection. To prescribe |
| |diagnostics, possible complications of|treatment. To render the first aid |
| |infectious diseases |on the before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
Epidemiology anamnesis:
no
yes. Clinical signs:
н not
not
not
yes, nematodosiss. Verification of diagnosis : yes
not
and Diagnosis is confirmed: it is not
Treatment:
Recovery: discharge
Observation:
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - С. 433-457.
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. it is Rostov: Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : Guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of causative agents of ascaridosis, enterobiasis, Trichocephallosis, Ancilostomidiasis, strongyloidosis, trichinosis, dirofilariasis.
2 Source of infection and factors of transmission.
3 Pathogenesis of nematodosis.
4 Classification of nematodosis.
5 Basic clinical syndromes of ascaridosis, enterobiasis, trichocephalosis, Ancilostomidiasis, strongyloidosis, strongyloidosis as AIDS-associated of invasion, trichinellosis, dirofilariasis.
6 Clinical displays depending on severity of course of disease.
7 Specific complications of nematodosiss.
8 Differential diagnosis .
9 Plan of inspection of patient with ascaridosis, enterobiasis, Trichocephallosis, Ancilostomidiasis, strongyloidosis, trichinosis, dirofilariosis.
10 Methods of specific diagnostics of nematodosis. Interpretation of results of laboratory research.
11 Etiotropic therapy of nematodosiss : doses, ways of introduction, duration of treatment.
12 Rules of discharge of reconvalescents from an in-patient department.
13 Prophylaxis and measures in a hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 causative Agent of ascaridosis is:
A - Askaris lumbricoides;
B - Taenia saginata;
C - Hymenolepis nana;
D - Enterobius vermikularis.
2 How many phases are distinguished in pathogenesis of ascaridosis?
A - 1;
B - 2;
C - 3;
D - 4.
3 Mechanism of infection at ascaridosis:
A - respiratory;
B - transmissible;
C - fecal-oral;
D - all answers are correct.
4 Syndrome, characteristic for ascaridosis :
A - allergic;
B - respiratory;
C - meningeal;
D diarrhoea.
5 Persons excrete eggs of ascarids in the late stage with:
A - excrement;
B - sputum;
C - vomitive masses;
D - urine.
6 the Most frequent complication of ascaridosis :
A mesadenintis;
B hydroperitoneum;
C appendicitis;
D pneumonia.
7 What serum tests do they use for diagnostics of ascaridosis?
A REEF;
B - RIHA;
C - REMA;
D - all answers are true.
8 Hospitalization of patients :
A - obligatory;
B - not obligatory.
9 Preparations which use for treatment of ascaridosis, except:
A - mintesole;
B - vermox;
C - levamisole;
D - albendasole.
10 Who is more frequent ill on ascaridosis:
A adults;
B are children;
C pensioners;
D - there is no right answer?
Variant 2
1 What is the causative agent of enterobiasis :
A - Enterobius vermicularis;
B - Staphylococcus aureus;
C - Trichinella spiralis;
D - Taenia saginata?
2 Source of infection at an enterobiasis:
A pigs;
B cows;
C sheep;
D sick man.
3 Place of maturation of eggs of enterobius :
A rectum;
B iliac bowel;
C perineal area;
D small intestines.
4 Clinical displays will be through:
A - 10-15 days after an infecting;
B - 2-3 days;
C 1 month;
D 6 months
5 Basic complaint at enterobiasis:
A headache;
B flatulence;
C rash;
D itch in area of perineal folds.
6 Most frequent complication of enterobiasis for girls:
A metroendometritis;
B vaginitis, vulvovaginitis;
C endometriosis;
D - all answers are correct.
7 Most frequent complication of enterobiasis :
A pneumonia;
B mesadenintis;
C enterocolitis;
D appendicitis.
8 Method of diagnostics of enterobiasis :
A general analysis of blood;
B analysis of medullispinal liquid;
C microscopic research of scrape from perianal folds;
D analysis of sputum.
9 Who is most often ill on enterobiasis:
A men;
B children;
C adults;
D women?
10 Control of efficiency of treatment is conducted:
A - in 4 weeks;
B - in 1 week;
C - in 2 days;
D - through 6 months
Variant 3
1 In what climatic belts is trichinosis met?
A - in moderate;
B - in tropical;
C - in subtropical;
D - in all belts.
2 Source of infection at trichinosis:
A man;
B saltwater fish;
C domestic and wild animals;
D river fish.
3 What immunity is formed after the carried trichinosis:
A - proof lifelong;
B - untense, unstable;
C - proof;
D - compound-specific antitoxic?
4 In development of invasion distinguish the stages:
A - intestinal and generalized;
B - intestinal and stomach;
C - lung and cardiac;
D - there is not a right answer.
5 Latent period at trichinosis:
A - 4-5 weeks;
B - 1-2 hours;
C – 2 years;
D – 14 days.
6 What character a skin rash has:
A - vesicular;
B - hemorragic;
C - macullar-petechial;
D erytematous-papullar?
7 What complications are more frequent brought to death of patients with trichinosis:
A defeat of heart;
B - lungs;
C - CNS;
D - all answers are true.
8 Cardinal signs of trichinosis :
A myalgias;
B edema of eyelids and face;
C polymorphic rash;
D - all answers are true.
9 Specific diagnostics is based on the exposure of larvae in:
A - meat of patients of animals, biopsy material of muscles of patient;
B - neurolymph;
C - sputum;
D - all mentioned is right.
10 Clinical observation:
A – 6 months.;
B – 1 year;
C – 1 month.;
D – 8 months.
Standards of right answers
Variant 1: 1. A; 2. B; 3. C; 4. A; 5. B; 6. C; 7. D; 8. A; 9. A; 10. B.
Variant 2: 1. A; 2. D; 3. C; 4. A; 5. D; 6. B; 7. D; 8. C;9. B; 10. A.
Variant 3: 1. D; 2. C; 3. B; 4. A; 5. A; 6. D; 7. D; 8. D;9. A; 10. C
3.4.3 Tasks for self-control
Task 1
The mother of boy 4,5 years appealed to the district doctor with complaints about appearance for him irritability, parahypnosis, itch in perianal area, crotch, genital organs.
1 Formulate a preliminary diagnosis.
2 What is necessary for confirmation of diagnosis?
3 What preparations are used for treatment, their dose?
Task 2
Girl 8 years became ill 7 days back. Complaints about a general weakness, fervescence to 37,6-37,8 0С, hypersalivation, decline of appetite, nausea, disfunction of bowels, pains in the different departments of abdomen of spastic character.
It is known from anamnesis, that a child often eats unwashed fruit and vegetables.
Objectively: child of the lowered feed. Skin pale. There is the vesicular breathing in lungs. Abdomen is soft, sickly at palpation.
1 What is preliminary diagnosis?
2 Prescribe treatment.
Task 3
The patient E. produces complaints about the itch of skin, periodic
hives, erytematous rash out in area of bottom third of shin. Marks that on a 4-5th day from the beginning of the first displays of disease appeared cough with sputum. Objectively: dry and moist wheezes in lungs, in blood increase of eosinophyles, leukocytosis, increasing of ESR.
1 Your preliminary diagnosis.
2 Stage of pathogenesis of this disease.
Task 4
For the worker of food industry during prophylactic examination in an excrement were found out the eggs of ascarids. On the extent of the last month a patient complains about an insignificant stomach-ache, diarrhoea, decline of appetite.
1 What is characteristically for the early stage of invasion?
2 Roentgenologic sign of defeat of lungs at this disease.
Task 5
Patient Т., 42 years, complains about headache, sickliness of muscles of extremities. A general weakness, heat, edema of eyelids appeared a week ago. District doctor diagnosed a flu and prescribeed an amidopyrine. There was no efficiency. Wife which marked pain in muscles, bad feel, became ill at the same time. 12 days prior to beginning of disease they ate roastpig, meat was purchased by casual salesman. Common condition of intermedius severity. Temperature of body 38,70С. Edema of face; eye cracks are narrowed. Muscles of extremities painfull at palpation. Cardiac activity is not broken. Stomach soft. Excrement pappy, stool 2 times per day. Blood test: Er-4,2х1012/l, Нb -133g/l, L-11,5х109/l, B- 1%, e- 40%, band- 7%, s- 37%, l- 8%, m- 7%, ESR- 25 mm/ hour
1 Your preliminary diagnosis.
2 To what class does a causative agent behave?
3 Source of invasion, mechanism of transmission.
Task 6
The patient B., 46 years, appealed to the policlinic with complaints about an itch, rash in the areas of feet and shins, pain in an epigastrium and area of belly-button. It is known from anamnesis, that a week ago returned from Turkey.
1 Your preliminary diagnosis.
2 Specific methods of diagnostics.
Task 7
The patient of 22 years appealed to the policlinic with complaints about irritability, insomnia, diarrhoea, paroxysmal pains in a right iliac area. Objectively: a skin and mucous membranes are pale. Blood test: eosinophilia, hypochrome anaemia.
1 Your preliminary diagnosis.
2 Provide differential diagnostics.
Task 8
The patient А., 36 years, appealed to the policlinic with complaints about tubercles on a skin, which periodically disappear and appear on the different areas of body, fervescence, to the subfebrile numbers, itch of skin.
1 Your preliminary diagnosis.
2 Observation.
Standards of answers to the tasks
Task 1
1 Enterobiasis.
2 It is Necessary to take scrabe from perianal folds to the morning rest room with a subsequent microscopy.
3 Vermoxum 2,5-3 mg/kg are single before or after eating; pyrantel singly in a dose 10 mg/kg during a meal or in 30 minutes after it.
Task 2
1 Ascaridosis.
2 Vermoxum 2,5-5 mg/kg through 1 hour after eating, course 2 days.
Task 3
1 Strongyloidosis.
2 Stage of early migration.
Task 4
1 Dry or moist cough.
2 Single or plural infiltrations.
Task 5
1 Trichinosis.
2 Eelworms.
3 Wolves, foxes, wild boars, wild pigs, dogs, rats. Fecal-oral.
Task 6
1 Ancilostomidiasis.
2 Eggs of helmints in faeces, larvae in blood and sputum in the phase of migration.
Task 7
1 Trichocephallosis.
2 Gastritis, gastroenteritis, gastroenterocolitis, heterospecific ulcerous colitis, adnexitis, mesadenintis.
Task 8
1 Dirophyllariosis.
2 Supervision on the extent of year. An inspection is single at clinical testimonies. In the case of absence of complaints and at normalization of indexes of blood of patients strike off the clinical register.
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class
• To capture the methods of inspection of patients nematodosiss.
• To provide curation of patients nematodosiss.
• To provide differential diagnostics.
• To work out a plan of laboratory inspection.
• To interpret the results of specific inspection of patients nematodosiss.
• To recognize complication of nematodosiss.
• To work out a plan of treatment of patient.
• To define a medical tactic in the case of origin of the urgent conditions.
• To draw medical documentation.
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of nematodosiss
|№ pores. |Task |Sequence of |Remarks, warnings in relation to self-control |
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the methods|1 Complaint |To distinguish complaints which characterize |
| |of clinical inspection| |syndromes : |
| |of patient by | |- - intoxication; |
| |nematodosiss | |- defeat of gastrointestinal tract; |
| | | |- defeat of respiratory |
| | | |ways; |
| | | |- are allergic displays |
| | | | |
| | | | |
| | |2 Anamnesis of |To pay attention on beginning, term, sequence of |
| | |disease |origin of symptoms, their dynamics: |
| | | |--gradual began; |
| | | |--rash; |
| | | |--unstable stool; |
| | | |--cough; |
| | | |--weakness, parahypnosis |
| | | | |
| | | |To determine the carried diseases |
| | | | |
| | |3 Anamnesis of |--unobservance of rules of the personal hygiene; |
| | |life |--using of the treated meat not enough; |
| | | |--using of unwashed vegetables, fruit, greenery; |
| | |Epidemiological |--visiting of endemic locality; |
| | |anamnesis |--work, related to agriculture |
|1 |2 |3 |4 |
|2 |To provide curation of|To provide an |Intensity, dynamics of symptoms, conditioned by a |
| |patient |objective |term and severity of course of disease |
| | |inspection: | |
| | | |To pay attention on: |
| | |1 General |- languor; |
| | |examination |- pallor and dryness of skin covers; |
| | | |- rash |
| | | | |
| | | |To pay attention on: |
| | | |- are stomach-aches; |
| | |2 Digestive system|- - nausea; |
| | | |- - vomiting; |
| | | |- - diarrhoea; |
| | | |- swelling of abdomen |
| | | | |
| | |3 Nervous system |To pay attention on: |
| | | |- parahypnosis; |
| | | |- irritability; |
| | | |- decline of memory |
| | |4 Cardiovascular | |
| | |system |To pay attention on: |
| | | |- it is muffling of tones of heart; |
| | | |- - bradycardia; |
| | |5 Respiratory |- - hypotension; |
| | |system |- - cardiodynia |
| | | | |
| | | |To pay attention on: |
| | | |- cough with a sputum; |
| | | |- stethalgia; |
| | | |- - shortness of breath; |
| | | |- Lefflers syndrome |
| | | | |
| | | | |
|1 |2 |3 |4 |
|3 |To prescribe |1 General analysis|To pay attention on: |
| |laboratory and |of blood |--eosinophyllia; |
| |additional researches | |--leukocytosis; |
| | | |--hypochrome anaemia; |
| | |2 General analysis|- increase of ESR. |
| | |of urine |Absence of changes |
| | |3 Serum | |
| | |hemanalysis. | |
| | |4 Ovoscopia of |Presence of antibodies in CFT, RIHA, reactions of |
| | |sputum, |latex aglutination |
| | |defecating, scrape| |
| | |of perianal folds | |
Materials of after-class free work
Subjects of Research work :
Features of course of nematodosiss in modern terms.
Modern methods of specific diagnostics of nematodosis.
Problems of etiotropic treatment of nematodosiss.
VIII HELMINTHISMS.
TOXOCAROSIS. DIPHYLLOBOTHRIASIS, BEEF TAPEWORM INFECTION, TENIASIS And CYSTICERCOSIS, HYMENOLEPIASIS, ECHINOCOCCOSIS, ALVEOCOCCOSIS, OPISTHORCHIASIS, SCHISTOSOMIASISS
Duration – 2 часа.
1 Actuality of theme. 342 types of helmints which can cause diseases for a man are known. In Ukraine from them found out about 30 kinds. Among all helminthisms, registered in Ukraine, a ponderable value is occupied by Ancilostomidiasis, Dirophyllariosis, trichinosis, strongyloidosis, Toxocarosis, opisthorchiasis, alveococcosis, diphyllobothriasis, teniasis, hymenolepiasis.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis, and also factors of pathogenicity of these causative agents;
• epidemiology of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis;
• pathogenesis of these helminthisms;
• clinical displays;
• clinical-epidemiological features of these helminthisms;
• pathogenesis, terms of origin and clinical displays of complications;
• laboratory diagnostics;
• principles of treatment;
• principles of prophylaxis;
• prognosis of disease;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation of reconvalescents.
2.2. A student must be able:
а- 3
• to observe the basic rules of work at a sick-bed;
• to take the case history with the estimation of epidemiology data;
• to inspect a patient and determine basic symptoms and syndromes, ground a clinical diagnosis;
• to provide differential diagnostics of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis;
• on the basis of clinical inspection in good time to recognize possible complications;
• to draw medical documentation at establishment of preliminary diagnosis (urgent notification is in SES);
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, weight of the condition, presence of complications, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
• to work out a plan of antiepidemic and prophylactic measures in the hearth of infection;
• to give recommendations in relation to the regimen, diet, inspection, observation in a reconvalescence.
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of Toxocara canis, |To interpret the results of specific|
| |Echinococcus мultilocularis, |methods of diagnostics of |
| |Schistosoma, Opisthorchis felineus, |toxocarosis, diphyllobothriasis, |
| |Diphyllobotrium latum, Taeniarhynchus |beef tapeworm infection, teniasis |
| |saginatus, Taenia solium, Hymenolepis |and cysticercosis, hymenolepiasis, |
| |nana; methods of specific diagnostics |echinococcosis, alveococcosis, |
| |of the diseases caused by them |opisthorchiasis, schistosomiasis |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of |inspection |
| |laboratory inspection in a norm | |
| |(general analysis of blood, urines, | |
| |biochemistry of blood, parameters of | |
| |AAC, electrolytes etc.) | |
|Physiopathology |Mechanism of violation of functions of|To interpret pathological changes on|
| |organs and systems at the pathological|results of clinical and laboratory |
| |conditions of different genesis |inspection |
| | | |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Immunology and allergology|Basic concepts of object, role of the |To estimate data of immunological |
| |system of immunity, are in an |researches |
| |infectious process, influence on the | |
| |term of elimination of causative agent| |
| |from the organism of man | |
|Epidemiology |Epidemic process (source, mechanism of|To collect epidemiology |
| |infection, ways of transmission) at |anamnesis, to provide antiepidemic |
| |toxocarosis, diphyllobothriasis, beef |and prophilactic measures in the |
| |tapeworm infection, teniasis and |hearth of infection |
| |cysticercosis, hymenolepiasis, | |
| |echinococcosis, alveococcosis, | |
| |opisthorchiasis, schistosomiasis; | |
| |prevalence of pathology in Ukraine and| |
| |in the world | |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical inspection |
| |disease |of patient with the defeat of the |
| | |nervous system |
|Propaedeutics of internal |Basic stages and methods of clinical |To take the history, provide the |
|diseasees |inspection of patient |clinical inspection of patient, |
| | |determine pathological symptoms and |
| | |syndromes. To analyse finding |
| | | |
| | | |
|1 |2 |3 |
|Clinical pharmacology |Pharmakokinetics and pharmacodynamics,|To prescribe treatment depending on |
| |side effects of facilities of specific|the degree of severity, individual |
| |and nosotropic therapy |features of patient. |
| | |To write recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics |To provide differential diagnostics |
| |of clinical displays, possible |of diseasees of different genesis. |
| |complications of infectious diseases. |To recognize an infectious disease, |
| |Principles of prophylaxis and |its complication; to interpret data |
| |treatment |of laboratory inspection. In good |
| | |time to hospitalize a patient in an |
| | |infectious in-patient department. To|
| | |render the first aid in the case of |
| | |necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential diagnostics |
| |Principles of diagnostics, treatment, |of diseasees of different genesis. |
| |prophylaxis of infectious diseases. |To recognize an infectious disease, |
| |Pathogenesis, epidemiology, dynamics |its complication; to interpret data |
| |of clinical displays, laboratory |of laboratory inspection. To |
| |diagnostics, possible complications |prescribe treatment. To render the |
| | |first aid |
| |infectious diseases |on the before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
Epidemiology anamnesis:
3.3 List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2001. - P. 433-457.
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis.
2 Source of infection and factors of transmission.
3 Pathogenesis.
4 Classification.
5 Basic clinical syndromes of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis.
6 Clinical displays depending on severity of course of disease.
7 Specific complications.
8 Differential diagnosis .
9 Plan of inspection of patient with toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis.
10 Methods of specific diagnostics. Interpretation of results of laboratory research.
11 Etiotropic therapy: doses, ways of introduction, duration of treatment.
12 Rules of discharge of reconvalescents from an in-patient department.
13 Prophylaxis and measures in a hearth.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 Final host of causative agent of diphyllobothriasis is:
A - all answers are true;
B man;
C dog;
D cat.
2 causative Agent of diphyllobothriasis is:
A - Diphyllobothrium latum;
B - fluke;
C catliver fluke;
D - solitary tapeworm.
3 Source of invasion at a diphyllobothriasis is:
A man, mammals which use fish;
B cattle;
C copepoda;
D fish.
4 Basic clinical symptoms of diphyllobothriasis :
A - all mentioned right;
B Gunter glossitis;
C increase of temperature to the subfebrile indexes;
D stomach-aches.
5 causative Agent of opisthorchiasis is:
A – catliver fluke;
B - Chinese fluke;
C – common liver fluke;
D - hookless tapeworm.
6 Factor of transmission of opisthorchiasis is:
A fresh fish;
B beef;
C ducks;
D chicken eggs.
7 For the late chronic stage of opisthorchiasis such signs are characteristic, except:
A defeats of Kidneys;
B pains in an epigastrium and right subcostal area;
C - dyspepsia disorders;
D enlargement of liver.
8 Etiotropic treatment of opisthorchiasis:
A - biltricide;
B - metronidazol;
C - Tetracyclinum;
D - tarividum.
9 For the early stage of opisthorchiasis all signs are characteristic, except:
A pains in the left iliac area, tenesmas;
B - fever, muscular pains;
C - allergic rash on skin;
D enlargement of liver and its sickliness.
10 Mechanism of transmission at beef tapeworn infection:
A - fecal-oral;
B - parenterally;
C - contact;
D transmissible.
Variant 2
1 To what class of helmints does the causative agent of diphyllobothriasis behave?
A - Cestoda;
B - Trematoda;
C - Nematoda.
2 causative Agent of diphyllobothriasis parasitizes in:
A - small intestine;
B - colon;
C - liver and billiary ways;
D - muscles.
3 There are such complications at diphyllobothriasis:
A dynamic or obturational bowel obstruction;
B - -peritonitis;
C appendicitis;
D hepatic colic.
4 Final host of opistorchias all, except:
A fishes;
B - cats;
D - dogs;
E - man.
5 Etiotropic treatment of opisthorchiasis is provided with:
A - biltricide;
B - metronidazole;
C - Tetracyclinum;
D - Tarividum.
6 Final host of solitary tapeworm is:
A man;
B sheep;
C fishes;
D cattle.
7 Latent period at beef tapeworm infection is:
A - 2-3 months;
B - 10-20 days;
C 1 month;
D - 180 days.
8 Dose of phenasalum for treatment of beef tapeworm infection :
A - 2-3 g;
B - a 0,5-1 g;
C - 1-2 g;
D - 3-4
9 causative Agent of teniasis and cysticercosis is:
A - solitary tapeworm;
B - hepatic fluke;
C - catliver fluke;
D - dwarf tapeworm.
10 Basic clinical symptoms of teniasis :
A - all answers are true;
B dyspepsia syndrome;
C astenovegetative syndrome;
D pain syndrome.
Variant 3
1 In hemography of patient with an opisthorchiasis is the most characteristic:
A considerable eosinophilia;
B hypochrome anaemia;
C leukocytosis;
D lymphocytosis to 50-60 %.
2 causative Agent of beef tapeworm infection is:
A - solitary tapeworm;
B - catliver fluke;
C – common liver fluke;
D – dwarf tapeworn.
3 At beef tapeworm infection there are such complications:
A - all mentioned is right;
B perforation of intestinal wall;
C bowel obstruction;
D obturation icterus.
4 Duration of treatment of beef tapeworm infection is:
A non-permanent reception of preparation after a supper or in the morning on an empty stomach;
B one-day course of treatment of phenasalum;
C five-day course of treatment of phenasalum and purgative;
a D is ten days' course of treatment of phenasalum and dichlosalum.
5 Dose of dichlosalum and trichlosalum for treatment of beef tapeworm infection :
A - 0,5-1 g;
B - 2-3 g;
C - 3-4 g;
D - 1-2 g
6 Solitary tapeworn parasitizes in:
A - small intestine;
B - stomach;
C - colon;
D liver;
7 Clinical signs of cysticercosis :
A - conditioned by localization of cysticercus;
B paresises and paralyses;
C muscular weakness;
D artralgia.
8 Most typical symptoms of teniasis are:
A - all answers are true;
B decline of appetite;
C nausea;
D hypersalivation.
9 Intermediate host of solitary tapeworn is:
A pig
B is a cattle
C wild animals
D man
10 In what case treatment of beef tapeworm infection is considered to be effective:
A - at excretion of helmint and his head;
B - in default of clinical displays;
C - in default of eggs of helmint in an excrement;
D - at excretion of helmint?
Standards of right answers
Variant 1: 1. A; 2. A; 3. A; 4. A; 5. A; 6. A; 7. A; 8. A; 9. a; 10. A.
Variant 2: 1. A; 2. A; 3. A; 4. A; 5. A; 6. A; 7. A; 8. A;9. A; 10. A.
Variant 3: 1. A; 2. A; 3. A; 4. A; 5. A; 6. A; 7. A; 8. A;9. A; 10. A.
3.4.3 Tasks for self-control
Task 1
The habitant of the Sumy area often uses fresh fish. For the last months marks a general weakness, dizziness, pain in a tongue, muscles, becoming thin, excretion with the excrement of particles of helmints. At examination: a patient is pale, edema on shins and small of back, decline of sonority of cardiac tones, systole murmur on an apex, arterial TENSION is 100/70 mm. Hg. Liver + 2 sm, tongue bright red with cracks. Blood test: haemoglobin - 50, red corpuscles - 1,3 х 1012, GV 1,2. In colouring: megacariocytes, macrocytes, red corpuscles with the tauruses of Golie and Cabot.
1 Make a preliminary diagnosis.
2 Specify the possible source of causative agent, mechanism and ways of transmission of infection.
3 What is duration of latent period?
4 Specify the method of confirmation of diagnosis.
5 Work out a plan of treatment.
6 What is volume of the observation?
Task 2
Patient В., 42, the habitant of the Tyumen area of singly treated oneself concerning gastritis, hypochrome anaemia, nervous breakdown. A month ago the condition of patient became worse : except for the pain feeling in an epigastric area and dyspepsia disorders, dizziness, subfebrile temperature, somnolence, decline of ability to work, paresthesias appeared. Liver and spleen are enlarged. Megaloblasts, megacariocytes are determined in blood film. Red corpuscles - 2,9х1012, haemoglobin - 80 g/l, leucocytes - 4х109, relative lymphocytosis, neutropenia, ESR 33 mm/hour.
1 Put a preliminary diagnosis.
2 Specify the possible source of causative agent, mechanism and ways of transmission of infection.
3 What is duration of latent period?
4 Specify the method of confirmation of diagnosis.
5 Work out a plan of treatment.
6 is the observation Necessary?
Task 3
Habitant of Nedryhailiv district often used fresh fish. On the extent of the last months marks a general weakness, pain in right subcostal area, headache, a week ago noticed the ochrodermia of skin covers.
1 About what diseases is it necessary to think?
Task 4
For a patient with ulcerous disease of duodenum at research the eggs of catliver fluke were found in an excrement and bile.
1 Diagnosis.
2 Medical tactic.
Task 5
The patient М. entered infectious hospital with suspicion on an opisthorchiasis.
1 How to confirm a diagnosis?
Standards of answers to the tasks
Task 1
1 Diphyllobothriasis, anaemia of 3th degree.
2 Men, cat, dog, pig, camels. Fecal-oral. Food.
3 3-6 weeks.
4 Scatoscopy.
5 Phenasalum 0,25 g 2 pills in 2 hours 4 times per day, in 4 days to repeat course. Cyanocobolamin 1 ml i\m on the extent of 3-4 weeks. Ferrum-lek - 5,0 i\m in a day, two weeks.
6 During 4-6 months in 2-3 months after treatment provide double research of excrement.
Task 2
1 Diphyllobothriasis, anaemia.
2 Men, cat, dog, pig, camels. Fecal-oral, food.
3 3-6 weeks.
4 Scatoscopy.
5 Phenasalum 0,25 g 2 pills in 2 hours 4 times per day, in 4 days to repeat course. Cyanocobolamin 1 ml i\m on the extent of 3-4 weeks. Ferrum-lek - 5,0 i\m in a day, two weeks. Vitamin С 5% 5ml i\v
6 During 4-6 months, in 2-3 months after treatment provide double research of excrement.
Task 3
1 Differential diagnosis between an opisthorchiasis and viral hepatitis.
Task 4
1 Opisthorchiasis chronic. Biltricide in dose 40 mg/kg in three receptions on the extent of 1 day, bile-expelling.
Task 5
1 Scatoscopy and research of bile of patient in the presence of eggs of catliver flukeа.
4 Materials for audience independent work
4.1 List of educational practical tasks which must be executed on practical class
• To capture the methods of inspection of patients of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis.
• To provide curation of patients of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis.
• To provide differential diagnostics.
• To work out a plan of laboratory inspection.
• To interpret the results of specific inspection of patients.
• To recognize complication of these helminthisms.
• To work out a plan of treatment of patient.
• To define a medical tactic in the case of origin of the urgent conditions.
• To draw medical documentation in fact of establishment of diagnosis.
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of helminthisms
|№ п/п |Task |Sequence of |Remarks, warnings in relation to self-control |
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the methods of |1 Complaint |To distinguish complaints which characterize |
| |clinical inspection of | |syndromes : |
| |patient of toxocarosis, | |- - intoxication; |
| |diphilobothriasis, beef | |- defeat of gastrointestinal tract; |
| |tapeworm infection, | |- defeat of respiratory |
| |teniasis and cysticercosis| |ways; |
| |hymenolepiasis, | |- allergic displays |
| |echinococcosis, | | |
| |alveococcosis, |2 Anamnesis of |To pay attention on beginning, term, sequence of |
| |opistorchiasis, |disease |origin of symptoms, their dynamics |
| |shistosomosis | |- gradual beginning; |
| | | |- rash; |
| | | |- unsteady stool |
| | | |- cough; |
| | | |- weakness, parahypnosis |
| | | | |
| | | |To determine the carried diseases |
| | |3 Anamnesis of life | |
| | | | |
| | |4 Epidemiological |Failure to observe of rules of the personal |
| | |anamnesis |hygiene; |
| | | |- use of not enough heated meat; |
| | | |- use of unwashed vegetables, fruit, greenery;. |
| | | | |
|1 |2 |3 |4 |
| | | |- stay in endemic locality; |
| | | |- work, related to agriculture |
|2 |To provide curation of |To provide an |Intensity, dynamics of symptoms conditioned by a |
| |patient |objective |term and severity of course of disease. |
| | |inspection: |To pay attention on: |
| | |1 General |- languor; |
| | |examination |- pallor and dryness of skin covers; |
| | | |--rash |
| | | | |
| | | |To pay attention on: |
| | |2 Digestive system |- stomach-aches; |
| | | |- - nausea; |
| | | |- - vomiting; |
| | | |- - diarrhoea; |
| | | |- swelling of abdomen |
| | | | |
| | |3 Nervous system |To pay attention on: |
| | | |- parahypnosis; |
| | | |- irritability; |
| | | |- decline of memory |
| | |4 Cardiovascular | |
| | |system |To pay attention on: |
| | | |- deafness of tones of heart; |
| | | |- - bradycardia; |
| | | |- - hypotension; |
| | | |- - cardiodynia |
| | |5 Respiratory system| |
| | | |To pay attention on: |
| | | |- cough with a sputum; |
| | | |- stethalgia; |
| | | |- - shortness of breath; |
| | | |- Leffler’s syndrome |
| | | | |
|1 |2 |3 |4 |
|3 |To prescribe laboratory |1 General analysis |To pay attention on: |
| |and additional researches |of blood |- - eosinophilia; |
| | | |- leukocytosis; |
| | | |- - hypochrome anaemia; |
| | | |- increase of ESR |
| | |2 General analysis | |
| | |of urine |- absence of changes. |
| | | | |
| | |3 Serum hemanalysis.| |
| | | | |
| | | |A presence of antibodies is in CFT, RIHA, reactions|
| | |4 Ovoscopy of |of latex-aglutination. |
| | |sputum, faeces, | |
| | |scrape of perianal | |
| | |folds | |
Materials of after-class of free work
Subjects of Research work :
- Feature of course of toxocarosis, diphyllobothriasis, beef tapeworm infection, teniasis and cysticercosis, hymenolepiasis, echinococcosis, alveococcosis, opisthorchiasis, schistosomiasis in modern terms.
Modern methods of specific diagnostics of helminthisms.
Problems of etiotropic treatment of helminthisms.
IX BOTULISM
Duration - 2 hours.
1 Actuality of theme. In spite of that botulism is registered much rarer, than many other enteroideas, he constantly comes into to itself the notice of researchers and clinicians. It is related to the severe course of disease, insufficient knowledge of many parties of his pathogenesis, high lethality.
In our country, where traditionally widely use the canned foods of home-made (including. meat), without the observance of corresponding technology make a saltfish, botulism takes on the special significance. Last years appear report about the uctus of diseases, arising up as a result of the use in food of salt and smoked fish of factory preparation.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• etiology of botulism, factors of pathogenicity of causative agent;
• epidemiology of botulism;
• pathogenesis;
• clinical displays of botulism at typical course;
• clinical-epidemiological features of botulism;
• pathogenesis, terms of origin and clinical displays of complications of botulism;
• laboratory diagnostics of botulism;
• principles of treatment;
• principles of prophylaxis;
• tactic in case of origin of the urgent conditions;
• prognosis of botulism;
• rules of discharge of reconvalescents from an in-patient department;
• rules of the observation of reconvalescents.
2.2 A student must be able:
а- 3
- to observe the basic rules of work at a sick-bed;
- to take the history of disease with the estimation of epidemiology data;
- to inspect a patient and determine basic symptoms and syndromes of botulism, ground a clinical diagnosis for timely direction of patient in an in-patient department;
- to provide differential diagnostics of botulism;
- on basis of clinical inspection in good time to recognize possible complications of botulism, urgent conditions;
- to draw medical documentation in fact of setting of preliminary diagnosis "botulism" (urgent notification is in SES);
- to work out plan of laboratory and additional inspection of patient;
- to interpret the results of laboratory inspection;
- to work out an individual plan of treatment taking into account epidemiology data, presence of complications, severity of condition, allergist anamnesis, concomitant pathology; to render the first aid on the before-hospital stage;
- to work out a plan of antiepidemic and prophylactic measures in the hearth of infection;
- to give recommendations, touching the regimen, diet, inspection, supervision in a reconvalescence .
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know | Able |
|1 |2 |3 |
| Preceding disciplines |
|Microbiology |Properties of Cl. botulinum, |To interpret the results of specific |
| |methods of specific |methods of diagnostics of botulism |
| |diagnostics of botulism | |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes of|inspection |
| |laboratory inspection are in a norm | |
| |(CBC, urines, biochemistry of blood, | |
| |parameters of AAC, electrolytes of | |
| |and other) | |
|Physiopathology |Mechanism of violation of functions |To interpret pathological changes on |
| |of organs and systems at the |results a clinical and laboratory |
| |pathological conditions of different |inspection |
| |genesis | |
|Immunology and allergology|Basic concepts of object, role of the|To estimate data of immunological |
| |system of immunity, in infectious |research |
| |process, influence on the term of | |
| |elimination of causative agent from | |
| |the organism of man | |
|Epidemiology | Epidemic process (source, mechanism|To take the epidemiology history, |
| |of infection, ways of transmission) |provide antiepidemic and |
| |at | |
|1 |2 |3 |
| |botulism; prevalence of disease in |prophylactic measures in |
| |Ukraine and in the world |hearth of infection |
|Neurology |Pathogenesis, clinical syndromes of |To provide the clinical inspection of |
| |disease |patient with the defeat of the nervous |
| | |system |
|Propaedeutics of internal |Basic stages and methods of clinical|To take the history, provide the |
|diseasees | |clinical inspection of patient, |
| |inspection of patient |determine pathological symptoms and |
| | |syndromes. To analyse finding |
|Clinical pharmacology |Pharmakokinetics and | To prescribe treatment depending on |
| |pharmacodynamics, side effects of |the degree of severity of disease, |
| |facilities of specific and |individual features of patient. To |
| |nosotropic therapy |write recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics |To provide differential diagnostics of |
| |of clinical displays, possible |diseasees of different genesis. To |
| |complications of infectious diseases.|recognize an infectious disease, its |
| |Principles of prophylaxis and |complication; to interpret data of |
| |treatment |laboratory inspection. In good time to |
| | |hospitalize patient in an infectious |
| | |in-patient department. To render urgent|
| | | |
| | |help in the case of necessity |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential diagnostics of |
| |Principles of diagnostics, treatment,|diseasees of different genesis. To |
| |prophylaxis of infectious diseases. |recognize an infectious disease, his |
| |Pathogenesis, epidemiology, dynamics |complication; to interpret data of |
| |of clinical displays, laboratory |laboratory inspection. To prescribe |
| |diagnostics, possible complications |treatment. To render the first aid on |
| |of infectious diseases |the before-hospital stage |
3.2 Structure-logical chart of maintenance of theme of class
3. List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b. - K.:Health, 2000. - B. 1. - 904 p.
2. Guidance on infectious diseases / under cor. Yu. V. Lobzin - SPb: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. Rostov: Phoenix, 2001. - 953 p.
Additional
4. Gavrisheva O.N., Antonova Т. В. Infectious process. Clinical and physiopathology aspects. - SPb.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: Folio, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 Feature of causative agent of botulism.
2 Description of botulotoxine.
3 Source of infection and factors of transmission.
4 Pathogenesis of botulism.
5 Classification of botulism.
6 Basic clinical syndromes of botulism.
7 Clinical displays depending on severity of course.
8 Specific complications of botulism.
9 Differential diagnosis of botulism.
10 Plan of inspection of botulism patient.
11 Methods of specific diagnostics of botulism.
12 Interpretation of results of laboratory research.
13 Specific therapy of botulism : doses, ways of introduction, duration of treatment.
14 First aid to the patient with botulism.
15 Rules of discharge of reconvalescents from an in-patient department.
16 Prophylaxis and measures in a hearth.
3.4.2 Tests for self-control
To choose right answers
1 Botulism belongs to:
A - food toxicoinfection;
B - blood infections;
C - enteroideas;
D - viral infections;
E - food intoxications.
2 causative Agent of botulism :
A pale treponema;
B fusiform stick;
C - Vibrio comma;
D - Clostridium perfringens;
E - Clostridium botulinum.
3 What toxins are distinguished by the causative agent of botulism?
A endotoxin;
B neurophilic exotoxin;
C anatoxin;
D is not distinguished;
E exotoxin + endotoxin.
4 Source of infection at botulism:
A food;
B people;
C water;
D grazing animals;
E canned foods.
5 Factors of transmission at botulism:
A - foods, infected by the spores of causative agent of botulism, at anaerobic terms;
B poor quality vegetables;
C unwashed fruit;
D - all mentioned;
E are dairies.
6 What is a starting mechanism in pathogenesis of botulism?
A - toxin oppresses tissue breathing;
B defeat by toxin of cholinergic departments of nervous system;
C defeat by toxin of digestive system;
D penetration of vegetative forms of causative agent from bowels in organs and tissues;
E defeat b toxin of adrenergic departments of nervous system.
7 Duration of latent period at botulism:
A - 2 weeks;
B 1 month;
C - all right;
D - 2-3 hours;
E - 6-24 hours, an extension is possible to 10 days.
8 What research is basic for confirmation of diagnosis of botulism:
A hemanalysis of presence of botulotoxine;
B research of urine for the exposure of botulotoxine;
C hemanalysis, vomitive masses, scourage of stomach, defecating, bits and pieces of food with the purpose of exposure of botulotoxine;
D research of foods for the exposure of Cl. Botulinum;
E bacteriologic examination of blood, vomitive masses, scourage of stomach, defecating, bits and pieces of food by sowing on Hottinger’s broth?
9 Dose and composition of polyvalent antibotulinic serum :
A - 10000 МЕ type A and Е, 5000 type C;
B - 5000 МЕ type C and Е, 10000 type A;
C - 5000 МЕ type A and C, 10000 type C;
D - 10000 МЕ type B and Е, 5000 type A;
E - 5000 МЕ type A and Е, 10000 type В.
10 What preparation is used for etiotropic therapy at botulism:
A - Bicillini - 5 intramuscular 1500000 ME 1 one time per day;
B - Sol. gentamуcini sulfatis 4% intramuscular 1 ml 3 times per day;
C - Тab. Tetracyclini 0,25 g 4 times per day;
D - Laevomycetini succinatis solubilі 1,0 intramuscular 3 times per day;
E - Тab. Rovamicini 3000 МЕ 3 times per day?
Standards of right answers
1. C; 2. E; З. B; 4. D ; 5. A; 6. B; 7. E; 8. C; 9. A; 10.
3.4.3 Tasks for self-control
Task 1
In a hospital by an ambulance the patient Н. 22 years was delivered. Common condition is severe, patient is adynamic. Overhead eyelids are tomentous, a patient can not unassisted hands open eyes. Skin pale, with a cyanochroic tint, tone of skeletal muscles is decreased, sounds hearts are muffled, extrasystolie, HR 130 in min, RR 40 in min, breathing superficial. The day before used the canned cucumbers in food. Other family members have clinic of the food poisoning, disorders of sight.
1 Formulate a preliminary diagnosis.
2 Plan of inspection.
3 Treatment.
Task 2
The patient К., 38 years, is hospitalized in a hospital with complaints about a headache, dizziness, general weakness, "net", "fog", doubling of objects in eyes, loop of vision. The laboured swallowing, dryness in mouth appeared in future. On the eve patient used the canned fungi in food. Objectively: Ptimalum, mydriasis, anisocoria, nasal voice, hoarse, speech inexpressive. At an auscultation in lungs - hard breathing, RR 28 in min Hearts Sounds are muffled, expansion of borders of relative dullness of heart to the left, HR 95 in min, arterial TENSION is 140/95 mm Hg
1 Formulate preliminary diagnosis.
2 Plan of inspection.
3 Treatment.
Task 3
In an infectious hospital a patient is delivered in grave condition. Became ill suddenly: pain in an epigastric area, appeared weight in stomach, muscular weakness. Temperature is normal. Moderate Ptimalum of eyelids, mydriasis, nystagmus, strobismus, getting of voice hoarse, joined in 5-6 hours. Internal organs: expansion of borders of heart, deafness of cardiac tones, bradycardia. It is set from epidemiological anamnesis, that 18 hours back ate the smoked sausage, caviar, pickled fungi. Two men, which ate the same foods, are in hospital in grave condition with similar symptoms.
1 Formulate diagnosis.
2 Name a causative agent.
3 With what diseases is it necessary to differentiate this pathology?
Task 4
In an infectious department patient 32 years is delivered in a day after the use of the pickled fungi. Became ill suddenly: vomiting, nausea, diarrhoea. Later on background of disappearance of nausea and vomiting complaints appeared about swelling of stomach, constipation, dryness in to the mouth, "fog" in eyes, doubling of objects, violation of swallowing. Objectively: consciousness is stored, temperature normal, arterial TENSION 160\100 mm Hg. Muffled cardiac tones, moderate tachycardia are determined. In lungs changes are not present. RR 22 in min. Take place Ptimalum, anisocoria, mydriasis, nystagmus, getting of voice hoarse. Stomach is swollen, a liver and spleen is not enlarged. Excrement without the pathological admixtures. In blood moderate leukocytosis with the change of formula to the left, speed-up ESR.
1 Formulate diagnosis.
2 What factors of transmission possible?
3 What duration of latent period?
4 What materials must be collected for specific diagnostics?
5 Prescribe specific diagnostics of disease.
6 Plan of treatment.
Standards of answers to the tasks
Task 1
1 Botulism, ophthalmoplegic, myasthenic syndromes, severe course.
2 General hemanalysis, urines. Authentication of botulotoxine in blood of patient (bioassay on white mise).
3 Lavage of stomach and intestines by solution of soda. Antibotulinic serum A, Е 10000 ME and B 5000 ME interval at 12 o'clock. Detoxication therapy, chloramphenicol 0,5 4 times per day during 5 days, oxygen therapy (hyperbaric oxygenation), symptomatic treatment.
Task 2
1 Food botulism, ophthalmoplegic, phonolaryngoplegic and phagoplegic syndromes, severe course.
2 Blood on the reaction of neutralization on white mise (bioassay).
3 Lavage of stomach, intestines by solution of soda. Antibotulinic serum A, Е 10000 ME and B 5000 ME interval at 12 o'clock. Detoxication therapy. Chloramphenicol 0,5 g 4 times per day in course 5 days. Symptomatic treatment. Oxygen therapy.
Task 3
1 Botulism, ophthalmoplegic, myasthenic syndromes, severe course.
2 Clostridium botulinum.
3 Food toxicoinfection, poliomyelitis, viral encephalitis, Guillain-Barre syndrome, poisoning of POS.
Task 4
1 Food botulism, ophthalmoplegic, phonolaryngoplegic syndromes, severe course. Myocarditis.
2 Food, infected by the spores of causative agent of botulism and anaerobic terms.
3 6-24 hours, an extension is possible to 10 days.
4 Hemanalysis, vomitive masses, scourages of stomach, defecating, bits and pieces of food with the purpose of exposure of ботулинического toxin.
5 Blood on the reaction of neutralization on white mise (bioassay).
6 Lavage of stomach, intestines by solution of soda. Antibotulinic serum A, Е 10000 ME and B 5000 ME interval at 12 o'clock. Detoxication therapy. Chloramphenicol 0,5 g 4 times per day in course 5 days. Symptomatic treatment. Oxygen therapy.
4 Materials for audience independent work
4.1 List of educational practical tasks which must be executed on practical class
• To capture the methods of inspection of patient botulism.
• To provide curation of patient botulism.
• To provide differential diagnostics of botulism.
• To work out a plan of laboratory inspection.
• To interpret the results of specific inspection of patient botulism.
• To recognize complications of botulism.
• To work out a plan of treatment of patient botulism.
• To define a medical tactic in the case of origin of the urgent conditions.
• To draw medical documentation in fact of establishment of diagnosis "botulism".
4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of botulism
|№ |Task |Sequence of |Remarks, warnings in relation to self-control |
|pores | |implementation | |
|1 |2 |3 |4 |
| 1 |To capture the methods of |Complaints |To distinguish complaints which characterize |
| |clinical inspection of | |syndromes : |
| |patient by botulism | |- - dyspepsia; |
| | | |- - ophthalmoplegic; |
| | | |- - phagoplegic; |
| | | |- - phonolaryngoplegic |
| | | | |
| | |Anamnesis of |To pay attention on beginning, term, sequence of |
| | |disease |origin of symptoms, their dynamics: |
| | | |- diplopia; |
| | | |- odynophagia; |
| | | |- diartria; |
| | | |- violation of salivation; |
| | | |- violation of breathing |
| | | | |
| | | | |
| | | |To determine the carried diseasees |
| | |Anamnesis of life | |
| | |Epidemiological |To determine given, about |
| | |anamnesis |realization of fecal-oral mechanism of |
| | | |transmission. |
| | | |Use of the canned foods, sausage, smoked, salt fish|
| | | |by patient |
| | | | |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
| | | | |
| 2 |To provide curation of |To provide an |Expressed, dynamics of symptoms conditioned by |
| |patient |objective |duration and severity of course of disease |
| | |inspection | |
| | | |To pay attention on: |
| | |General examination|- cross-eye; |
| | | |- Ptimalum of eyelids; |
| | | |- - anisocoria; |
| | | |- nystagmus; |
| | | |- - hoarse voice, diartria. Speech not expressive |
| | | | |
| | | |To pay attention on: |
| | |Digestive system |- - mucous membrane of cavity of mouth; |
| | | |- flatulence; |
| | | |- constipation; |
| | | |- absence of peristaltic murmurs |
| | | | |
| | | |To pay attention on: |
| | |Nervous system |- doubling in eyes; |
| | | |- - "net", "fog" in eyes; |
| | | |- mydriasis; |
| | | |- - strobismus; |
| | | |- violation of swallowing; |
| | | |- allolalia; |
| | | |- - miastenia; |
| | | |- violation of breathing |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
| | |Cardiovascular |To pay attention on: |
| | |system |- muffled tones; |
| | | |- - tachycardia; |
| | | |- expansion of borders of relative dullness of |
| | | |heart; |
| | | |- systole murmur on apex |
| | | | |
| | |Respiratory system |To pay attention on: |
| | | |- oppressing of tussive reflex; |
| | | |- limitation of function of intercostal muscles; |
| | | |- violation of breathing (apnoea) rhythm; |
| | | |- frequenting of breathing |
| 3 |To prescribe laboratory |General analysis of|To pay attention on: |
| |and additional researches|blood |- neutrophilic leukocytosis with the change of |
| | | |leukocytar formula to the left; |
| | | |- increase of ESR. |
| | | | |
| | |Hemanalysis, the |Presence of botulotoxine |
| | |vomitive masses, | |
| | |scourages of | |
| | |stomach, defecating| |
Materials of post-audience independent work
Subjects of Research work :
Features of course of botulism in modern terms.
Modern methods of specific diagnostics of botulism.
Problems of etiotropic treatment of botulism today.
Modern looks to pathogenesis.
X URGENT CONDITIONS For PATIENTS WITH INFECTIOUS DISEASES WITH FECAL-ORAL MECHANISM of TRANSMISSION. DEHYDRATION SHOCK. ENTERORRHAGIA AND OTHER SURGICAL COMPLICATIONS. PRINCIPLES OF DIAGNOSTICS AND HELP.
CONCLUDING SESSION of RICH in content MODULE 1
Duration - 2 hours.
1 Actuality of theme. The urgent CONDITIONS for infectious patients develop often, especially at the severe course of disease. Wrong diagnostic decisions result not only in ineffective and uneffective medical measures, but present a threat for life of patient. What a presence or threat of development is before diagnosed at a sick critical condition and realization of reanimation measures is before begun, the greater probability of success is in treatment.
Knowledge of the urgent conditions for infectious patients is necessary for doctors of all specialities, especially those, who works in multi-field and rural medical establishments. They often remain in private with problems which arise up for a patient suddenly. From speed of decision-making, the rightness of actions of doctor life of man depends.
2 Educational aims of class (with pointing of mastering level which is planned)
2.1 A student must know:
а- 2
• determination of dehydration shock;
• pathogenesis of dehydration shock;
• clinical and laboratory diagnostics of aquatic-electrolyte violations at the different degrees of dehydration;
• differential diagnostics of dehydration shock with the shock conditions of other genesis;
• principles of treatment, first aid to patient on the before-hospital stage;
• pathogenesis of enterorrhagias;
• clinic and laboratory diagnostics of enterorrhagias;
• differential diagnosis of enterorrhagias;
• principles of treatment, first aid a patient on the before-hospital stage.
2.3 A student must be able:
а- 3
• to observe the basic rules of work at a sick-bed with the urgent conditions;
• to take the case history;
• to inspect a patient, ground a diagnosis for timely direction of patient in an in-patient department;
• to provide differential diagnostics of the urgent conditions;
• to work out a plan of laboratory and additional inspection of patient;
• to interpret the results of laboratory inspection;
• to work out an individual plan of treatment taking into account epidemiology data, stage of disease, to render the first aid on the before-hospital stage;
• to give recommendations in relation to the regimen, diet, inspection, supervision in the period of reconvalescence.
3 Materials of before class of independent work
3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)
|Discipline |To know |Able |
|1 |2 |3 |
|Previous disciplines |
|Microbiology |Properties of S. typhimurium, S. |To interpret the results of |
| |typhi, Vibrio cholerae. Methods of |specific methods of diagnostics |
| |specific diagnostics |of salmonellosis, cholera, |
| | |typhoid |
|Physiology |Parameters of physiological norm of |To estimate data of laboratory |
| |organs and systems of man; indexes |inspection |
| |of laboratory inspection are in a | |
| |norm (general analysis of blood, | |
| |urines, parameters of AAC, | |
| |electrolytes et cetera) | |
|Physiopathology |Mechanism of violation of functions |To interpret pathological |
| |of organs and systems at the |changes on results a clinical |
| |pathological conditions of different|and laboratory inspection |
| |genesis | |
|Immunology and allergology|Basic concepts of object, role of |To estimate data of |
| |the system of immunity, are in an |immunological researches |
| |infectious process, influence on the| |
| |term of elimination of causative | |
| |agent from the organism of man | |
| | | |
| | | |
| | | |
|1 |2 |3 |
|Epidemiology |Epidemic process (source, mechanism |To take the epidemiology |
| |of infection, ways of transmission) |history, provide antiepidemic |
| |at salmonellosis, cholera, typhoid; |and prophylactic measures in the|
| |prevalence of pathology in Ukraine |hearth of infection |
| |and in the world | |
|Propaedeutics of internal |Basic stages and methods of clinical|To take the history, provide the|
|diseasees |inspection of patient |clinical inspection of patient, |
| | |define pathological symptoms and|
| | |syndromes. To analyse finding |
|Clinical pharmacology |Pharmakokinetics and |To prescribe treatment depending|
| |pharmacodynamics, side effects of |on the degree of severity of |
| |facilities of specific nosotropic |course, individual features of |
| |therapy |patient. To write recipes |
|Subsequent disciplines |
|Domestic medicine |Pathogenesis, epidemiology, dynamics|To provide differential |
| |of clinical displays, possible |diagnostics of diseasees of |
| |complications of infectious |different genesis. To recognize |
| |diseases. Principles of prophylaxis |infectious disease, its |
| |and treatment |complication; to interpret data |
| | | |
| | | |
| | | |
| | | |
|1 |2 |3 |
| | |laboratory inspection. In good |
| | |time to hospitalize a patient in|
| | |an infectious in-patient |
| | |department. To render the first |
| | |aid in the case of necessity |
|Intrasubject integration |
|Infectious diseases |Features of infectious diseases. |To provide differential |
| |Principles of diagnostics, |diagnostics of diseasees of |
| |treatment, prophylaxis of infectious|different genesis. To recognize |
| |diseases. Pathogenesis, |an infectious disease, its |
| |epidemiology, dynamics of clinical |complication; to interpret data |
| |displays, laboratory diagnostics, |of laboratory inspection. To |
| |possible complications of infectious|prescribe treatment. To render |
| |diseases. |the first aid on the |
| | |before-hospital stage |
2. Structure-logical chart of maintenance of theme
3. List of the recommended literature
Basic:
1. Voizianova ZH.I. Infectious and parasitogenic diseases: in 3 b –K.: Health, 2002. - B. 3. - P. 354-389
2. Guidance on infectious diseases / edited Yu. V. Lobzin.- SPb.: Folio, 2003. - 1040 p.
3. E.P. Shuvalova Infectious diseases. - Rostov: Phoenix, 2001 - 953 p.
Additional:
4. N.A. Gavrisheva, Antonova Т. В. the Infectious process. Clinical and physiopathology aspects. - СП.B.: Special literature, 1999. - 255 p.
5. Clinical-laboratory diagnostics of infectious diseases : guidance for doctors. - SPb.: FOLIO, 2001. - 384 p.
3.4 Materials for self-control
3.4.1 Questions for self-control
1 What diseases are accompanied by the syndrome of dehydration?
2 Stages of pathogenesis of syndrome of dehydration.
3 Basic clinical symptoms at the syndrome of dehydration.
4 Name the degrees of dehydration depending on the loss of liquid.
5 Basic cause of lethality at the syndrome of dehydration.
6 Plan of inspection of patient with the syndrome of dehydration.
7 Hemography of patient with the syndrome of dehydration.
8 Differential diagnosis of dehydration shock.
9 Determination of dehydration shock.
10 Clinic of dehydration shock.
11 Estimation of degree of dehydration on the before-hospital stage for a patient with diarrhoeaй.
12 Stages of provide of patient with dehydration.
13 Complex of medical measures at syndrome of dehydration.
14 What solutions need to be used for rehydration.
15 Perforation of bowel and enterorrhagia. Determination, etiology.
16 Pathogenesis, clinical displays of perforation of small intestine, term of origin .
17 Pathogenesis, clinical displays of enterorrhagia, term of origin.
18 First aid in the case of perforation of small intestine.
19. First aid in the case of enterorrhagia.
20 Plan of treatment of patient with an enterorrhagia and perforation of small intestine.
3.4.2 Tests for self-control
To choose right answers
Variant 1
1 pathological condition which develops because of the catastrophic diminishing of volume of circulatory liquid and loss of electrolytes:
A. dehydration shock;
B. anaphylactic shock;
C. infectiously-toxic shock;
D. hemorragic shock.
2 Hypovolemic shock:
A. dehydration of ІV level;
B. dehydration of І level;
C. dehydration of ІІ level;
D. dehydration of ІІІ level
3 Hypovolemic shock develops because of loss of liquid at:
A. all answers are true;
B. bleeding (hemorragic shock);
C. vomiting and diarrhoea;
D. the long fever.
4 Mostly dehydration shock develops at:
A. acute intestinal diseases;
B. respiratory diseases;
C. blood infections;
D. diseases of external covers.
5 Diarrhoea syndrome and vomiting are reason:
A. dehydration shock;
B. anaphylactic shock;
C. infectiously-toxic shock.
6 Compensated dehydration shock develops:
A. at lack of changes of hemodynamics at ward;
B. there is decline of systole arterial TENSION;
C. hypotermia;
D. at hypohemoglobinaemia.
7 the Subcompensated dehydration shock develops at:
A. decline of systole arterial TENSION;
B. increase of systole arterial TENSION;
C. decline of diastole arterial TENSION;
D. increase of diastole arterial TENSION.
8 Normal index of imperceptible losses of liquid for the grown man with mass of body 70 kg:
A. 1000 ml in days;
B. 500 ml in days;
C. 700 ml in days;
D. 1500 ml in days;
9 What type of diarrhoea is characteristic for salmonellosis:
A. secretory;
B. exsudate;
C. osmotic;
D. mixed?
10 Normal concentration of sodium in plasma of blood :
A. 135-150 mmole/l;
B. 125 mmole/l;
C. 170 mmole/l;
D. 110 mmole/l.
11 Normal concentration of potassium in plasma of blood :
A. 3,5-5,5 mmole/l;
B. 2,5 mmole/l;
C. 2,0 mmole/l;
D. 4,5 mmole/l.
Variant 2
1 Collapse, severe intoxication at typhoid develops on:
A - on the 1-2th week of disease;
B - on the 3th week of disease;
C - on the 4th week of disease;
D - on the 4-5th week of disease.
2 Bleeding at typhoid arises up on:
A - on the 3-4th week of disease;
B -на to the 2nd week of disease;
C - on the 1st week of disease;
D - on the 1-2 week of disease.
3 Bleeding at typhoid is accompanied:
A - by the decline of temperature of body;
B - by fervescence;
C - temperature does not change.
4 Excrement at an enterorrhagia:
A melena;
B - fetid;
C - an excrement does not change.
5 For an enterorrhagia at typhoid characteristically:
A tachycardia;
B bradycardia;
C asystole;
D diapulse.
6 In a blood test at an enterorrhagia:
A violation of coagulability of blood;
B hyperhemoglobinemia;
C leukocytosis;
D - normocytosis.
7 Enterobrosia at typhoid can come:
A - on the 3th week of disease;
B - on the 1st week of disease;
C - on the 2nd week of disease;
D - on the 5th week of disease.
8 Peritonitis at typhoid is accompanied by appearance:
A - protective tension of muscles of stomach;
B - absence of respiratory excursion of abdominal wall;
C stomach-aches;
D disappearances of hepatic dullness at percussion;
E - all answers are true.
9 Peritonitis at typhoid is accompanied by appearance:
A - Blumberg's sign;
B - Mayo-Robson's symptom;
in - symptom of Voskresensky;
D - symptom of Krymov.
10 Can the symptoms of acute appendicitis appear as complications of typhoid?
A - yes;
B - no;
C - not always;
D - often.
Standards of right answers
Variant 1: 1. A; 2. A; 3. A; 4. A; 5. A; 6. A; 7. A; 8. A; 9. A; 10. A; 11. A.
Variant 2: 1. A; 2. A; 3. A; 4. A; 5. A; 6. A; 7. A; 8. E; 9. A; 10. A.
3.4.3 Situational tasks
Task 1
To the infectious hospital two girls appealed with complaints about fervescence to 38 0С, headache, weakness, dizziness, pain in epigastrium and round belly-button, nausea, triple vomiting, stool to4 times per night, excrement watery, foamy, fetid, with the admixtures of mucus. It is known from anamnesis of disease, that on the eve of girl ate pastries with cream, which was not kept in a refrigerator. Objectively: tongue dry, incrustated by a white raid, a stomach is mildly swollen, rumbles at palpation, sickly in an epigastrium, pulse 80 in min, arterial TENSION is 110/70 mm Hg
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 2
The patient А., 40 years, is delivered in an infectious hospital. Objectively: apathetical, adynamic, consciousness is dulled. Tongue with the imprints of teeth on sides, incrustated by grey-brown raid. A stomach is swollen, sickly at palpation, enlargement of liver and spleen. It is known according to a wife, that her husband is ill already 4 days. Became ill acutely, a temperature rose to 38,5 0С, frequent vomiting by a bile, was pain in an epigastrium and paraumbilical area, a diarrhoea appeared then, a stool was to 10 times per day, excrement watery, foamy, fetid, with the admixtures of mucus. Day prior to disease man used goose-eggs, light-boiled, mayonnaise.
1 Formulate a diagnosis.
2 Work out a plan of inspection of patient.
3 Work out a plan of treatment.
Task 3
The patient С., 18 years, grumbles about a frequent stool. Diarrhoea began acutely, unexpectedly. Stool to 20-25 times per day, watery, a "rice-water" reminds. Then the frequent vomiting joined without preceding nausea. The vomitive masses remind a "rice-water" also. There is a weakness, dryness in to the mouth, thirst. Temperature of body 36,5 0С. It is known from epidemiological anamnesis, that patient 2 days ago had a rest in village for a grandmother, where used water from an open reservoir. At examination: skin acquires a cyanotic tint, cold to the feel, turgor is decreased. Abdomen is pulled in, painless. Tachypnea, tachycardia, decline of arteriotony, oliguria, cramps of sural muscles.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 4
The patient К., 38 years, is delivered by an ambulance in a grave condition in 4 hours from the beginning of disease. Disease began with nausea, frequent vomiting (10 times), abundant watery stool (8 times). Temperature of body 37,8 0С. Development of disease binds to the use of duck eggs, cooked a week ago. During hospitalization felt thirst. Paid attention itself pallor of skin, the lines of face are sharp, getting of voice hoarse. Skin cold to the feel, pulse of weak filling, frequent 120 in min. Temperature of body of patient in the moment of entering department of 36,0 0С. Arteriotony is 80/40 mm Hg. Breathing 24 in min. The turgor of skin is decreased, folds fall out slowly. Acute pain and cramps are in sural muscles. There is the poured out rumbling at palpation of stomach. Intensive diarrhoea and vomiting, vomitive masses watery, whitish, turbid proceed. After massive rehydration therapy the condition of patient became considerably better.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 5
The patient К., 20 years, grumbles about a diarrhoea without a stomach-ache, which began acutely day ago. Stool more than 20 times per day, excrement watery, reminds "rice-water", frequent vomiting, without preceding nausea. There are a weakness, dryness in mouth, thirst. Temperature of body 36,0 0С. It is known from epidemiological anamnesis, that 2 days prior to a disease socialized with a patient which had a similar clinic. At examination: skin pale with a cyanotic tint, a turgor is decreased, "hands of laundress", the lines of face are sharp, voice getting hoarse, cramps of sural muscles. Arterial TENSION is 70/50 mm Hg, pulse of the weak filling, 130 in min, tachypnea.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Task 6
There is a patient in the induction centre of infectious hospital. He has sharp lines of face, round eyes black circles, on face expression of suffering, a body is covered by cold then. A skin easily going to the fold which is not smoothed out. Abdomen falling back. Myotonias of extremities. An arteriotony is decreased. Heart sounds are deaf. Pulse threadlike. Temperature of body 35 0С. According to relatives. at home he had the frequent vomiting and diarrhoea. A patient 2 days back returned from India.
1 Formulate diagnosis.
2 Work out plan of inspection of patient.
3 Work out plan of treatment.
Standards of answers to the tasks
Task 1
1 Salmonellosis clinically, gastrointestinal form, gastroenterocolitic variant, intermedius severity, dehydration of І degree.
2 bacteriologic examination of excrement, vomitive masses, bits and pieces of food (pastry); RIHA with salmonellosis diagnosticum, coprogramm.
3 Diet № 5, rehydron to 1 l per day, polyfepam 1 l. 1 hour prior to eating three times in day, enzymes (mesim, pancreatin, pepsim etc.) during eating.
Task 2
1 Salmonellosis, generalized form, typhoid variant with intestinal displays, severe course.
2 bacteriologic examination of excrement, scourages of stomach, blood, bits and pieces of food (goose-eggs, mayonnaise).
3 Detoxication therapy (salt solutions, rheopolyglucin, glucose 5 %), chloramphenicol succinate 6 g per day, ampicillin 4,0-6,0 in days.
Task 3
1 Cholera, typiform, gastroenteritis, severe course. Dehydration of III degree.
2 bacteriologic examination of excrement, vomitive masses. RA, RIHA, IEA.
3 In/salt solutions (threesol, acesol, quartasol and other) to stopping of vomiting, diarrhoea, renewal of hemodynamics, diuresis. In course of time Tetracyclinum 1,2 g per day or doxycyclin 0,2 g per day during 5 days.
Task 4
1 Salmonellosis, gastrointestinal form of severe degree, dehydration shock of ІІІ degree.
2 CBC with determination of hematocritis and closeness of plasma, biochemical blood test with an ionogram; bacteriologic examination of excrement, vomitive masses, RA with salmonellosis diagnosticum.
3 I/v introduction of salt solutions (threesol, acesol, quartasol et cetera) to 10 % mass of patient, heparin 100 ME/kg, prednisolon 3 mg/kg in day, trasilol, chloramphenicol succinate 1,0 i/m 4 times per day.
Task 5
1 Cholera, typiform, gastroenteritis, severe course. Dehydration of ІІІ degree.
2 bacteriologic examination of excrement, the vomitive masses. RA, RIHA, IEA. Speed-up methods: immobilization and microagglutination of 0-vibrios with anticholeric serum, REEF.
3 Rehydration infusional therapy by salt solutions (threesol, bisol, quartasol etc.) to stopping of diarrhoea and vomiting, antibacterial therapy (Tetracyclinum 0,3 g of х 4 in day or doxycyclin 0,1 g x 2) whereupon possible during 5 days.
Task 6
1 Cholera, typiform, algide. Dehydration shock of ІІІ level
2 Clinical hemanalysiss, urine, coprogramm, hematocritis, relative closeness of plasma. Bacteriologic examination of excrement, vomitive masses (classic and speed-up).
3 Rehydration therapy by crystalloid solutions (threesol, bisol, chlosol et cetera), rehydron, heparin 150 ME/kg, prednisolon 5 mg/kg i/v, aminocaproic acid.
4 Materials for audience free work
4.1 List of educational practical tasks which must be executed on practical class
• To capture the methods of inspection of patients with the urgent conditions.
• To provide differential diagnostics of dehydration shock, enterorrhagia.
• To work out a plan of laboratory inspection.
• To interpret the results of specific inspection of patient with an enterorrhagia, dehydration shock.
• To define a medical tactic in the case of origin of the urgent conditions.
• To draw medical documentation.
4.2 Professional algorithm for forming of skills and ability of diagnostics of the urgent conditions
|№ pores|Tasks |Sequence of |Notes, warnings in relation to self-control |
| | |implementation | |
|1 |2 |3 |4 |
|1 |To capture the methods|I Find out the |To distinguish complaints, which characterize|
| |of clinical inspection|complaints of patient |the syndrome of dehydration, enterorrhagia. |
| |of patient with | | |
| |typhoid, paratyphoids |II Find out anamnesis: | |
| |A and B, patient with |1 Anamnesis of disease |To pay attention on sequence of origin, |
| |dehydration shock | |dynamics of symptoms, peculiar for |
| | | |dehydration shock, enterorrhagia |
| | | | |
| | |2 Anamnesis of life |To find out the carried diseases |
| | | | |
| | |3 Epidemiological | |
| | |anamnesis |To find out data in relation to realization |
| | | |of fecal-oral mechanism of transmission, to |
| | | |pay attention to stay of patient in regions |
| | | |with the increased risk of typhoid infection,|
| | | |paratyphoids A and B, of acute enteroideas |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|1 |2 |3 |4 |
|2 |To provide curation of|II to Provide an |To remember: presence, expressed, dynamics of|
| |patient |objective inspection |symptoms is conditioned by term and severity |
| | | |of course of disease, depends on age sick, |
| | | |concomitant pathology |
| | | | |
| | | |To pay attention on: |
| | |1 General examination: | |
| | |- common condition of |- - languor, adynamy, dormancy of patient; |
| | |patient; |- - temperature of body; |
| | |- skin, mucous membrane |- cyanosys of skin, acutely decreased turgor |
| | |of guttur. | |
| | |2 Digestive system: |To pay attention on: |
| | |- glossoscopy; |- - tongue is incrustated by white raid; |
| | | |- it is dryness of tongue. |
| | |- percussion of abdomen;|- symptoms of peritonitis (presence testifies|
| | |- palpation of stomach; |to the perforation of small intestine). |
| | |- description of stool | |
| | | |- amount, character, propensity to |
| | |3 Cardiovascular system:|constipations (appearance of melena testifies|
| | |- it is a pulse; |to the enterorrhagia) |
| | |- it is an arteriotony; |To pay attention on: |
| | |- it is an auscultation |- - tachycardia; |
| | |of |- - mildly decreased arterial TENSION |
| | | |(considerable decline testifies to |
| | | |complications); |
| | | |- moderate deafness of tones of |
|1 |2 |3 |4 |
| | |heart |Heart |
|3 |To prescribe |1 General analysis of |To pay attention on typical changes: |
| |laboratory and |blood |- leukopenia, or leukocytosis, lymphocytosis,|
| |additional researches,| |aneosinophylia, thrombocytopenia |
| |interpret results | |(leukocytosis, anaemia, increase of ESR, |
| | | |arise up in the case of development of |
| | | |enterorrhagia) |
| | | |Absence of considerable changes at typical |
| | | |course |
| | |2 General analysis of | |
| | |urine | |
Materials of after-class of free work
Subjects of Research work :
• Pathogenesis of hypovolemic shock.
• DIC syndrome. Etiopathogenesis, clinics, intensive therapy.
REFERENCE LIST of QUESTIONS To CONCLUDING SESSION of content MODULE 1
1. A concept "infection", "infectious process", "infectious disease". Features of infectious diseases.
2. Basic stages of development of INFECTIOUS DISEASES science. Scientific contribution of domestic and foreign scientists to the study of infectious diseases.
3. History of department of infectious diseases and epidemiology of Sumy State University.
4. Classification of infectious diseases.
5. Principles of diagnostics of infectious diseases.
6. Methods of specific diagnostics of infectious diseases.
7. Principles of prophylaxis of infectious diseases.
8. Principles of treatment of infectious diseases.
9. Structure and regimen of operations of infectious in-patient department. Testimonies to hospitalization, rules of inspection and discharge of patients from an infectious in-patient department. Features of draw of medical documentation.
10. General description of infectious diseases with the fecal-oral mechanism of transmission.
11. Typhoid, paratyphoids A and B: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
12. Cholera: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
13. Dehydration shock: determination of concept, pathogenesis, clinic, differential diagnosis. Clinical and laboratory diagnostics of aquatic-electrolyte violations at the different degrees of dehydration. First aid.
14. Salmonellosis: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
15. Food toxicoinfection: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
16. Rotavirus infection: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
17. Enterovirus diseases: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
18. Poliomyelitis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, prognosis, treatment, prophylaxis.
19. Intestinal Iersiniosis: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
20. Pseudotuberculosis: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
21. Shigellosis: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
22. Amebiasis: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
23. Giardiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
24. Balantidiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
25. Botulism: etiology, epidemiology, classification, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis. Order of hospitalization, rules of discharge of patients from an infectious in-patient department.
26. Classification of helminthisms. Influence of helmints on the organism of man. Methods of laboratory diagnostics of helminthisms.
27. Ascaridosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
28. Enterobiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
29. Трихоцефаллез: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
30. Ancilostomidiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
31. Strongyloidosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
32. Trichinosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
33. Dirophyllariosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
34. Toxocarosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
35. Diphyllobothriasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
36. Beef tapeworm infection: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
37. Teniasis, cysticercosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
38. Hymenolepiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
39. Echinococcosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
40. Alveococcosis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
41. Opisthorchiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
42. Schistosomiasis: etiology, epidemiology, pathogenesis, clinic, laboratory diagnostics, differential diagnosis, complications, treatment, prophylaxis.
LIST of PRACTICAL SKILLS, OBLIGATORY To MASTERING
1 Testimony to hospitalization of patients in an in-patient department.
2 Methods of introduction of medical serums.
3 Sampling of blood on hemoculture.
4 Sampling of blood for serum researches.
5 Sampling of material (urine, excrement, bile) for bacteriologic examination.
6 Fence of material for research on viruses.
7 Lavage of stomach.
8 Lavage of intestines.
9 Rectometer.
10 Ovoscopy of excrement.
Educational edition
Methodical recommendations for before class preparation to practical classs on infectious diseases (content module 1)
for the students of senior courses of higher medical establishments of formation of ІІІ - ІV levels of accreditation
Accountable for producing by M.D. Chemich
Editor Chernyshova
Computer make-up by I.V. Pavlovska
|It is signed in printing 012.11.2009,. |
|Format of 60х84/16. Rel. print. l. 12,3. Study publl. of l. 7,94. Drawing 50 copies. Order № |
|Prime price of edition of hrn. of к. |
| |
| |
|Publisher and manufacturer |
|Sumy state university, |
|Rimskiy Corsakov street., 2, Sumy, 40007 |
|Certificate of subject of publishing business SCN 3062 from 17.12.2007. |
| |
| |
-----------------------
Differential diagnostics with poisoning by spiritus methylicus, belladona, mushrooms, bulbar form of poliomyelitis
Yes, diagnosis is confirmed
Recovery; discharge
Лечение
Disappearance of clinical symptoms
After clinical prescriptions together ophthalmologist and neurologist inspect
- determination of severity, type of botulotoxine, complications
- gastric and intestinal lavage;
- antibotulinic serums (types А, В, С);
- detoxication therapy;
- chloramphenicol, ampicylline;
- cholinestherase inhibitors;
- symptomatic therapy
Ophtalmoplegic symptom
Phonoplegic syndrome
синдром
Pharyngoplegic
syndrome
-observation during 2-3 weeks
-control research of faeces.
- clinical recovery;
- three negative analyses of faeces through 2-3 weeks after treatment
- hospitalization of patients with severe complications;
- vermox, thiabendazol, decaris, combartrin;
- desensitizinf therapy;
- vitamine therapy;
- detoxication therapy( under prescriptions)
-formulation of diagnosis;
-determination of form, complication
Differential diagnosis with ARVI, pneumonia, appendicitis, nedicinak allergy, gastritis, colitis, cancer of rectum, adnexitis, hemorrhoid.
-allergic reactions;
- general clinical symptoms: hypertermia , artralgia, myalgia, general weakness;
- symptoms of violation of respiratory ways : bronchitis, laryngitis, pneumonia, rhinopharyngitis;
- characteristic Leffler’s syndrome – composition of several infiltrations in lungs with eosinophylia in blood;
-decresing of appetitis, nausea, regurgitation, flatulence, constipation, stomachache;
-fatigability, bad sleep, decreasing of memory;
- pruritus in anal region.
- during 3months in CID with providing through 1 and 3 months of clinical inspection, biochemical analysis of blood, bacteriologic research of faeces; reconvalescents, which suffered by easy or intermedius form, are free of work on 10 days, after severe form - to 30 days
-using of unwashed fuits and vegetables;
-using of low heated meat;
-unobserving of personal hygiene;
-sting of mosqito
-
- disappearance of clinical symptoms, normalization of laboratory researches, two negative results of bacteriologic examination of faeces
- hospitalization in infectious department, at easy course – treatment at home; diet № 4; antibacterial medications (chloramphenicol, tetracyclinum, gentamycinum, bactrim, furasolidon); pathogenetic therapy; hormonal therapy at generalized form; symptomatic therapy at artralgia
- formulating of full clinical diagnosis (form, variant, level of severity)
- bacteriologic examination (blood, faeces, urine, sputum, scourage of nasopharynx, vomittive masses) by method of Petersen-Koch: material is kept 7-28 days at temperature 3-40 С at standart phosphor-buffer solution (рН 7,6) or in 1% peptone water with 0,5% solution of glucose, phenol (рН 7,4-7,6), every 3-5 day they reseed on medium of Endo, Levin with later incubating in thermoregulator at temperature 20-250 С; serologic research of blood: RA, RIHA (diagnostic titrus 1:280 and higher); biological method (white mouse, guinea pigs); skin test with aulysed 4-week culture of causative agent (0,1 ml), result is observed in 24 hours
- during 3 months – acute, 6 months – chronic (inspection, bacteriologic research of faeces)
- disappearance of clinical symptoms;
- normalization of stool;
- negative results of faeces research (decreed goup)
- general regimen, diet № 4;
- detoxication therapy (enterosorbents);
- rehydration therapy (glucose-salt solutions);
- antibacterial drugs (nitrofurans, fluorquinolones);
- substitutive enzyme therapy;
- probiotics, eubiotics
Differential diagnosis with salmonellosis, escherichiosis, balantidiasis, amoebiasis, food toxicoinfection, mesenterial thrombosis, shistosomosis, NUC
- determination of form, level of severity, level of dehydration
- bacteriologic research of faeces, vomiting masses, scourage, food; RIHA with dyentheria diagnosticum; coprocytogram; rectomanoscopia
- symptoms of gastroenteritis, gastroenterocolitis, colitis; hypertermia; tenesmas, fault defecating motions, "rectal spib"; spasmed, paiful (at palpation) sigmoid intestine; presence of catarhal, catarhal-erosive, catarhal-ulcerous proctosigmoiditis
For the patients without decree: during 3 months in RID (thermometria, at the end – the bacteriologic examination of evacuation, urine, gall); on the inspection of SES – for 2 years. For patients with decree: during 2 years in RID (thermometria, bacteriological examination of evacuation, urine, gall); on the inspection of SES – during all life
- the clinical recovery on 21 day of normal temperature; the negative results of third times bacteriological examination of stool, urine and ones bile; for positive bacteriological analysis – treatment in stationary; with permission of epidemiological doctor there is the writing out of bacteriocarrier
- the hospitalization is necessary; the bed regime (to 10 day of normalization of body’s temperature); the diet № 4, 4B; the antibiotic therapy till 10 day of normal temperature (levomycetine, Ampicilline, Bactrime, Ryfampicine); the pathogenetic therapy: dysintoxicative (in veins: the solution of Ringer, 5 % solution of glucose, reopoliglucine, polialment solutions); the rise of resistance of organism (immunomodulative therapy, vitamins); treatment of complications
The differential diagnosis with flu, swarm typhoid fever, paratyph no uses, Brucellosis, miliar tuberculosis, sepsis, pneumonia, leptospirosis, infectional mononucleosis, malaria
- connection of disease with food, water;
- non-observance of rules of personal hygiene;
- using of unwashed fruits and vegetables;
- contact with diarrhoea patients
METHODICAL RECOMMENDATIONS FOR BEFORE CLASS PREPARATION TO PRACTICAL CLASSES OF
INFECTIOUS DISEASES
(MODULE 1)
MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE
sUMY STATE UNIVERSITY
mEDICal INSTITUTE
INFECTIOUS DISEASES AND EPIDEMIOLOGY DEPARTMENT
-the formation with definition of forms, severity, complications
- the bacteriological examination (haemoculture, copro-, urino-, bili-, roseolo-, mieloculture, vomit, pus, liquor);
- the serological examination: RА of Vidal (the diagnosticlevel with О- and Н-Аg is 1:200; with Vi-Ag is 1:40); RIHA the method of paired serum (the increase of level of antititre in 4 and more times)
- during last 3 weeks there are no consumption of water from exit reservoirs, wellss, technical water; the consumption of unboiled milk, washed fruits and vegetables; the contact with persons had the fever state
- 1 week (the gradual start): graded rise of temperature, pale face, faint, adenamia; the typhoid tongue (large, dry, with white and grey covering, with prints of teeth on the limbs); the ulcer’s tonsillitis Duge; the characteristics of vagotonia: the concerning bradycardia with dicrotia of pulse; diffusion bronchitis, the symptom of Filipoveech (yellow colour of palms and phleghms); the symptom of Kotlarenko 1 (the phenomenon of crepitation in right a region under armpits); the symptom of Padalka (the dulling of percussion sound in ileocaecum region); ”the cross” symptom of Shtenberg (ache during the palpation on the pace of bruga from right region under armpits to left region under ribs).
2 week (the period of heat): fever (the temperature lines as a type of Vunderlih, Botkin, Kildushevskii); status typhosus – the turbidity of consciousness, ”quiet” speaking; swarm: roseolosis with appearance on the 7 – 10 days of illness; and localization predominate on stomach and by sides; the quantity of roseoles is less – 5 – 15; monomorphia, roseola elevata; is added; conserved more then fever and disappear with out pigmentation; the fuligulosis tongue; the symptom of Kotlarenko 2 (the smell of amiak near the bed); the increase of liver, spleen, meteorism, constipatiti.
3 week (the period of complications): the intestinal bleeding, perforation of intestine with evolution of peritonitis the infectious and toxic shock.
Violation of cardiovascular system
Paresis of intestines
Suppression of parasympatic nervous system
Violation of transition in neuromuscular synapsis
Violation of producing of acetylcholine
Botulotoxine
Pathogenesis
Epidemiology
- Using of food, especially canned, without adequate heating;
- presence of wounds, wasted with ground;
- interruption of samitary-hygienic norms at cooking of canned products, butchering
Clostridium botulinum
- biologic test (neutralization reaction), research of blood, vomittive masses, scourage, parts of food, faeces, urine;
- bacteriological research of vomitive masses, faeces, scourage, products, wound content
Etiology
Medical observation
no
- acute beginning, fever, intoxication, abdominal pain, diarrhoea, exanthema, myalgia, artralgia, polyadenitis. Gastrointestinal form: gastroenteritic variant: acute beginning, increasing of temperature to febrile, tonsillitis, rash rash on 3-5 day (maculo-papullar, predefined to interlocking, on background of pale skin), stomach-ache, diarrhoea; gastroenterocolitic variant: acute beginning, fever, headache, weakness, intensive colicky pain in abdomen, nausea, recurrent vomitting; after 8-12 hours after beginning of disease - diarrhoea, faeces of green-brown color, fetid, hydrous at beginning, large quantity, later – decreasing of quantity with appearance of blood, mucus, to 10 times a day, tenesmas, painful defecation urge. Abdominal form: fever 39-400 С, but general toxicosis is not expressed, main symptom – stomach ache, nausea, vomitting, diarrhoea, positive peritoneal signs , appendicitis, terminal ileitis, mesadenitis. Generalized form: expressed intoxication, dyspepsia, enlargement of lymphatic nodes, liver, spleen, exanthema, vegetative disorders, intermittent course; mixed variant: local symptoms and symptoms generalized course; septic, septicopiemic variants: acute beginning from gectic fever, chill, intensive sweating, dyspeptic symptoms, hemorrhagic rash, hepatosplenomegaly, polyartritis, carditis, pneumonia, pyelonefritis, meningoencephalitis, long recovery. Secondary-focal form: hepatitis, nodal erythema
- using of infected products (milk products, vegetables, meat, water);
- using of water from free reservoirs; presence of rodents
- absence of clinical symptoms, cystas of lamblias in duodenal content and faeces (three negative analyses with interval 3 days)
- in ambulatory conditions: intilamblious drugs: metronidazol, clion-D, metrogil, trychopol, ornidazol, tinidazol; symptomatic therapy; substitutive medications; antihystamine drugs
- to differentiate with gastrointestinal form of salmonellosis, amebiasis, shigellosis, acute appendicitis, syndrome of malapsorption etc.
- formulating of diagnosis with determination of form, level of severity
- parasitoscopia: determination of vegetative forms of lamblias in duodenal content or cystas in faeces; determination of lamblial antigens in faeces (RIIF);IEA
- beginning is acute at massive invasion;
- acute form: stool without mucus and blood appears, decreasing of appetite, nausea; flatulance, borbogour; belchng with gase.
Chronic form: diskinesia of intestines of hypo- or hypermotoric type; pain in epigastrium, right subcostal region; stool is not stabile (diarrhoea interchanges with constipation); diskinesia of billiary ways; decreasing of weight, feeling disorders, often at children intolerability of lactose
- visiting of places with bad sanitary conditions, using of water,vegetables, fruits without adequate heating; unobservance of rules of personal hygiene
– observation during year;
– control research of faeces on balantidiasis (triple a year)
– Clinical recovery;
– Three negative researches of faeces during week
- all patients undergo hospitalization;
- antibiotics - monomycin, oxitetracyclin;
- antiprotosoal – metragil, delagil, aminarson;
- antihistamine drugs;
- vitamine therapy;
- detoxication therapy on prescriptions
- formulating of diagnosis;
- determination of form, complications
Differential diagnosis with disenteria, amebiasis, disbacteriosis etc.
- parasitoscopia of fresh faeces (live balantidiums, which move quickly);
- serologic reaction: CFT, precipitation in agar, immobilisation;
- determination of balantidiums on Pavlova’s medium;
- rectoromanoscopia: focal or diffuse infiltrative-erosive-ulcerous colitis
Acute course:
- at beginning: fever, chill, headache, flatulance, sometimes nausea, vomitting;
- at height of disease: diarrhoea to 15-20 times a day, plentifull faeces, fluid, mephitic, with addition of mucus and blood, sometimes pus;
- Decereasing of weight.
Chronic recidive balantidiasis:
- abdomen is flatulated, painfull in region of caecum and colon ascendance;
- hepatomegaly;
- stool 2-3 times a day;
- чередование обострений (10-30дней) и ремиссии на протяжение 3-6 месяцев
Inspection during 6-12 months; research of faeces on cysts – monthly; medical examination – one time in three months; sanation of carriers – 2 times a year; decreed group on dispensary observation – till full sanitation
-clinical recovery; at absence of parasites in faeces (3 negative results of analysis with interval 2-3 days)
- hospitalization of patient; amoebocides: indirect action (tetracyclinum), direct (yatren, diiodochin), tissue (delagil, ambilgar, dihydroementin), universal (metronidazol, fazizhin); vitamine therapy; immune stimulators; desensibilizating medications. At skin form: local treatment - 10 % chiniaphone
- formulating of final diagnosis with determining of form, level of severity, complications
- parasitoscopia of faeces, material from bottom of ulcer, sputum (tissue form of amoeba at acute and subacute form of disease);
- serological methods RIHA, IEA, CFT (at growing of antibodies titrus in 4 and more times);
- rectomanoscopia (at intestinal form): ulcers diameter 10-20 mm, edges are undermined, surrounded with zone of hyperemia, bottom is covered with pus necrotic masses
Differential diagnosis with shigellosis, balantidiasis, trichocephallosis, hymenolepidiasis, strongiloidosis, appendicitis, disbacteriosis, NUC, cancer and pliposis of large intestine, secondary enterocolitis, echinococcus, cancer of liver, abscedding pneumonia
- intestinal form: graduate beginning (low expressed symptoms of general intoxication, temperature is subfebrile);moderate pain (mostly in right iliac area), borborygmus in abdomen (on 5-7th day of disease), decreasing of appetite; diarrhoea to 10-20 times a day; faeces like “magenta jelly” (a lot of glazen mucus with blood); spasmus of cecum and colon ascendens; tenesmas, fault urges; incorrect between intestinal disorders and satisfactory feeling.
Out-intestine form – abscess of liver: acute beginning, high fever of hectic or allorytmic type, chill, sweating, liver is enlrarged, painful; right side pneumonia or exudative pleuritis; abscess of lungs: fever, pain in thorax, cough, blood spitting, a lot of sputum of chocolate color; skin form: in perineal region and on buttocks there are erosions and ulcers (deep, with undermined edges, painless, mephitic). Rarely there ar abscesses of brain, kidneys, meningoencephalitis
- contact with amebiasis patients; visiting of countries with tropical and subtropical climat, in population place with bad sanitary conditions (Crimea, Georgia, Armenia, Turcmenistan, Kirgizstan); using of water, vegetables, fruits without adequate heating; unobservance of personal hygiene rules
- children, which suffered from severe form, are under clinical review
- - disappearance of clinical symptoms;
normalization of laboratory indexes.
- Hospitalization after clinicak data, isolation on 10-15 days;
- diet: abuse of milk and products of milk, abuse of carbohydrates;
- pathogenetic therapy – rehydration (at first and second levels - oral (rehydron, glucosolan, tea, fruit-drink, mineral water); at severe dehydration – i/v rehydration therapy);
- polyenzyme medications: mexase, festal, pancreatine;
- enterosorbents
- -formulating of final diagnosis (clinically, epidemiologically, bacteriologically, serologically) with determination of form, level of severity, dehydration
Differential diagnosis with cholera, shigellosis, eschrichiosis, adenovirus infection, intestinal iersiniosis, protosoal diseases (lambliasis, criptosporidiosis, balantidiasis)
- Virological research – determination of rotaviruses in faeces during first 6-8 days of disease with electronic IEA, RCoA, RIA;
- Serologic research: RN, RIHA with rotavirus AG (diagnostic titrus 1:16 and more);
- In general blood analysis in acute period – leucopenia with decrewasing of quantity of band cells, with relative lympho- monocytosis;
- coprogram: in faeces a lot of indigested cellulose, starch kernel, indigested muscular fibres
- Acute beginning, watery discharge without pathological addtions with frequency to 10-15 times a day, nausea, vomitting; dehydration at moderate termal reaction and symptoms of general intoxication;
- Symptoms of rhinitis, pharyngitis, enlargement of cervical lymphatic nodes;
- Pain in epigastric and umbilical region, strong borbogrymgus in right iliac region;
- Duration of disease 2-7 days
- using of food products, which didn’t get heating : non-watered vegetables and fruits;
- contact with patients with diarrhoea and catarrhal violations of upper respiratory ways;
- children before 3 years are ill oftener;
- often disease has character of group erruption;
- winter seasonality
- after clinical prescriptions
- disappearance of clinical symptoms;
- normalization of laboratory indexes.
- hospitalization at severe course and after epidemiological prescriptions;
- pathogenetic theraphy: interferon, desoxiribonuclease, detoxication, rehydration;
- symtomatic therapy: desensitizing therapy, anticonvulsant, sedative;
- severe and complicated forms: glucocorticoids – 1-2 mg/kg;
- serosal meningitis: lumbal punction, dehydration
- determination of virus from nasopharynx, stool, at serosal meningitis – from cerebrospinal fluid;
- CFT, RIHA (increasing of titrus in 4 ones);
- biological research (mousekins-suckers, hamsters);
Dynamics of changes of blood: at first – moderate leukocytosis, later lymphocytosis, eosinophylia
- enterovirus diarrhoea: low catarrhal symptoms (stuffiness in nose, cough, hyperemia of mucous membranes), and through 2-3 days dyspeptic symptoms (pain in stomach, diarrhoea, stool 2-7 times a day, sigmoid bowel isn’t in spasm).
- Respiratory (catarhal) form: hyperthermia, muscle pain, stuffiness in the nose, hyperemia in oropharynx.
- Serosal meningitis: general cephalic, hypertensive, focal disorders, meningeal, liquor syndromes.
- Epidemic pleurositis (thoracal form, abdominal form): beginning is acute, headache; pain in extremities prevails, pain gets stronger at change of body position, at respiration.
- Paralytic (polio-like) form: flaccid paresis during 2-8 weeks.
- Epidemic exanthema: maculo-papular rash on face, body, which arises up on 1-2 day of disease on background of fever, pain in muscles.
- Hemorrhagic conjuctivitis: hyperemia, hemorrhages, pruritus, dacryops.
- Herpangina: hyperemia of mucous membranes of soft palate, arches, often small vesiculas with pellucid content, surrounded by red corolla
- monitoring during 3 months. (sanitary epidemic station); 1st month – three times (review and research of faeces; next 2 months – once a month (review and research of faeces)
- dispanserisation doesn’t provided
- clinical recovery;
- decreed group – once bacteriological research of stool
- scorage of stomach;
- prescribing of enterosorbents;
- rehydration therapy;
- diet № 4;
-substitutional therapy (enzymes)
Differential diagnosis with cholera, salmonellosis, escherichiosis, poisoning, pancreatitis
-formulating of final diagnosis (clinically, epidemiologically, bacteriologically, serologically) with determination of form, level of severity, dehydration
- bacteriological research of, vomit masses, scourage, parts of food (expressed semination of 1 g of research material, more than 1х10 6/g); determination of one causative agent from different fluids of patient;
- serological research (RA with autostamm);
- - coprogramm (erythrocytes, leukocytes, mucus);
- hemogramm (clotting of blood)
- acute beginning of disease;
- syndrome of gastroenteritis (nausea, vomitting, diarrhoea);
- pain syndrome (epi-, meso-, hypogastrium);
- dehydration syndrome (loss of weight, pallor of skin, contractures, tachycardia, hypotonia, oliguria);
- short duration of disease (1-4 days)
- during 3 months. (persons of decreated group) monthly inspection and bacteriologic research
- clinical recovery;
- decreed group: twice bacteriological research of faeces with negative result, once - bile
- gastric? Intestinal lavage;
- rehydration therapy;
- detoxication therapy (enterosorbents);
- diet № 4;
- substitutional threapy (enzymes);
- etiotropic threapy (severe course, generalized)
Differential diagnosis with shigellosis, cholera, FTI, typhus-paratyphoid diseases, thrombosis of mesenteric vessels
Formulating of final diagnosis: form, course, severity, etiology, level of dehydration, presence of complications
- bacteriologic research of stool, vomiting content, scourage, parts of food, blood;
- RIHA and RA salmonellosis diagnosticum;
- immune fluorescence method;
- coprogramm (erythrocytes, leukocytes, mucus)
- clinical recovery;
- negative results of triple bacteriological research of faeces,
At decreed group – also portions В and С of bile one time
- acute beginning of disease – from nausea, numerous vomitting;
- syndrome of gastroenteritis, rarer – syndrome of gastroenterocolitis, gastritis;
- dehydration syndrome;
- pain syndrome (epigastrium→ umbilicalis region→ right iliac region);
- symptoms of generalized forms (typhus-like and septicopiemic)
- hospitalization into in-patient institution
- rehydration (salt solutions);
- pathogenetic drugs;
- antibiotic therapy
- using of bad meat products;
- using meat, eggs of water birds;
- contact with persons, which had violation of defecating.
Differential diagnosis with other diseases
- forming of EAEC, information into WHO, measures for localization of hearth, quarantine measures
-determination of form, level of severity level of dehydration
- determination of causative agent (vibrio) from faeces, vomiting masses (with classic or speed method); positive serological reactions;
- clotting of blood;
- hypoelectrolyteaemia;
- increasing of relative density of plasma
- acute beginning;
- absence of fever, pain syndrome;
- diarrhoea before vomitting, frequent hydrous faeces;
- vomiting without nausea;
-fast development of dehydration (dryness of mucous membranes, violation of turgor, contractures, tachycardia, hypotonia, Algover’s index is more than 1)
- being in endemic on cholera region;
- using of water from free water-body;
- contact with cholera patients or with patients with the same clinics; persons from problem groups (vagrants, alcoholics)
-
- контакт с больными холерой или с больными с подобной клиникой; - особы из неблагополучных груп (бездомные, алкоголики)
Supporting of adequate feeding for patient
Prescribing of antibacterial medicine drug orally
Support of water balance, compensation of loss of fluid
Determination of level of dehydration, regeneration of water balance and durable control of its condition
Treatment
Electrolytes of blood plasma
рН of capillaries blood
General blood analysis
Diagnostics
Thirst, dryness of mucous membranes, vomitting, diarrhoea, contractures, tachycardia
Clinical picture
Isotonic dehydration
Polyorganic deficiency
Vomitting, diarrhoea
Hypoxy
acidosis
Secretion of fluid into intestine
Disorders in MCB
Activation of cAMP
DIC
ITS
Exo- , endotoxin , enterotoxin
Pathogenesis
Shigellosis, cholera, salmonella, FTI, echerichiosis etc.
Etiology
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.