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CLASSES OF
INFECTIOUS DISEASES
((M
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E 22))
for the students of senior courses of higher medical
establishments of formation of III-IV of levels of
accreditation
DEPARTMENT OF EDUCATION AND SCIENCE OF
UKRAINE
SUMY STATE UNIVERSITY
MEDICAL INSTITUTE
DEPARTMENT OF INFECTIOUS DISEASES AND
EPIDEMIOLOGY
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CLASS PREPARATION TO PRACTICAL CLASSSE
ESS
O
OFF
INFECTIOUS DISEASES
((M
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for the students of senior courses of higher medical establishments of
formation of III-IV of levels of accreditation
SUMY
Publishing house SUMDU
2009
2
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REPARATION TO PRACTICAL CLASSES OF IN
NFFEEC
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(
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DISEASES (MODULE 2) / M.D.Chemych,
N.I.Ilina,V.V.Zakhlebaeva. Sumy: Publishing house SUMDU, 2009.
– 165 p.
Department of infectious diseases and epidemiology
3
Contents
1
2
3
4
General description of group of infectious diseases is with the airdrop mechanism of transmission. Flu. Other acute respiratory
viral infectious: parainfluenza, аdenovirus illness, RS-іnfectious,
rhinovirus infection. Determination of concepts of „acute
respiratory disease” and „acute respiratory viral infectious”. A
concept about bird flu................
Infectious diseases which run across with the clinic of аtypic
pneumonia: respiratorial micoplasmosis, psittacosis, legonelosis.
A concept about SARS......................
Herpesvirus infection.
General description of herpesvirus infections, etiologic structure,
place, is in infectious pathology. Infections, conditioned the viruses
of simple герпесу of HSV-1 and HSV-2. Windy pox and girdle
herpes..........
Herpesvirus infection.
EBV-іnfection and СМV-іnfectioon. Infectious mononucleosis.
5
27
55
77
Children’s drop infections in adults. Measles. German measles.
Mamps ...................
93
6
Diphtheria. Differential diagnostics of syndrome a «quinsy»....
113
7
A meningeal syndrome in the clinic of infectious diseases.
Differential diagnostics of serosal and festerings meningitis.
Meningococus infection.............
136
Exigent states for patients with infectious diseases with the
respiratory mechanism of transmission. ITSH. Real croup. Unreal
croup. Acute respiratory infections..........
153
Concluding session of the semantic module 2..........
171
5
8
9
4
Topic. GENERAL DESCRIPTION OF GROUP OF
INFECTIOUS
DISEASES
WITH THE
AIR-DROP’S
MECHANISM OF TRANSMISSION. FLU. OTHER ACUTE
RESPIRATORY VIRAL INFECTIOUS: PARAINFLUENZA,
АDENOVIRUS ILLNESS, RS-ІNFECTIOUS ,RINOVIRUS
INFECTION. DETERMINATION OF CONCEPTS „ACUTE
RESPIRATORY ILLNESS” AND „ACUTE RESPIRATORY
VIRAL INFECTIOUS ”. A CONCEPT ABOUT BIRD FLU
Duration - 2 hours.
1 Actuality of theme. From data of many specialists, a flu and
other respirator viral infections (Acute respiratory viral infectious) is
the most mass diseases which occupy a leading place in the structure
of infectious diseases and are 80-90 % from all of cases of infectious
pathology. Only one pandemic of flu spanish «woman» in 1918-1920
р.р. took away more human lives, than all of last epidemics, together.
Unique change ability of superficial antigens of virus of flu hinders
creation of effective antiviral vaccine. Except for it, in the last years
constantly information act about circulation of animal influenzal
viruses –reasortantes , to the group of which the virus of bird flu
belongs. The special alarm is caused by the local flashes of his
motion with mortal consequences at Hong Kong and other countries
of Asia, Europe and America, which are caused the viruses of bird
flu And (H5N1). Flashes highly of pathogenic bird flu of H5N1, that
began in South-east Asia in a middle in 2003 and spread in our time
on some regions of Europe, are the large and serious registered
flashes. On a present day the flashes of illness were incorporated in
nine Asiatic countries (transferred in the order of registration): To the
republic Korea, Vietnam, Japan, Thailand, Cambodia, Laos People's
democratic Republic, Indonesia, China and Malaysia. In three from
them - to Japan, to Republic Korea and to Malaysia - flash of illness
were liquidated and presently these countries are considered free of
illness. In some countries of Asia a virus became endemic.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
5
 etiology of flu, parainfluenza, RS-infectious, rhinovirus,
adenovirus infection, bird flu; factors of pathogenicity of exciters;
 epidemiology of flu, parainfluenza, RS-іnfectious, rhinovirus,
аdenovirus infection, bird flu;
 pathogenesis;
 clinical displays of flu, parainfluenza, RS-іnfectious,r
hinovirus, аdenovirus infections with typical motion;
 clinical-еpidemiology features of acute respiratory viral
infectious;
 pathogenesis, terms of appearance and clinical displays of
complications of flu, parainfluenza, RS-іnfectious, rhinovirus,
аdenovirus infections, laboratory diagnostics of acute respiratory
viral infectious;
 principles of treatment;
 principles of prophylaxis;
 tactic in the case of origin of the exigent states;
 prognosis of acute respiratory viral infectious.
2.2 A student must be able:
 to adhere to the basic rules of work at a bed sick;
 to collect anamnesis of disease and estimate epidemiology
information;
 to inspect a patient and find out basic symptoms and
syndromes acute respiratory viral infectious, ground a clinical
diagnosis for timely direction of patient in permanent establishment;
 to conduct differential diagnostics of flu, parainfluenza, RSinfectious, аdenovirus,rhinovirus infections;
 on the basis of clinical inspection in time to recognize possible
complications of acute respiratory viral infectious, exigent states;
 to design a medical document in fact of establishment of
previous diagnosis of «acute respiratory viral infectious»;
 to work out a plan of laboratory and additional inspection of
patient;
 to interpret the results of laboratory inspection;
6
 to work out an individual plan of treatment taking into account
epidemiology information, degree of weight, complications, allergist
anamnesis; to render the first aid on the before hospitalisation stage;
 to work out a plan of disease and prophylactic measures, give
recommendations in relation to the mode, diet, inspection,
supervision, in the period reconvalescent
3 Materials before audition independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties of virus of flu,
To interpret the results
parainfluenza, RS-infekcii, of specific methods of
аdenovirus and rhinovirus diagnostics
infections
bird flu, methods of
specific diagnostics
Physiology
Parameters of physiology To estimate
norm of organs and systems information of
of man; indexes
laboratory inspection
laboratory inspection in a
norm (clinical blood, urine
test, biochemistry of blood,
parameters of acid-basic
status, electrolytes and
other)
Physiopathology A mechanism of violation
of functions of organs and
systems is at the pathosiss
of different genesis
7
To interpret
pathological changes
as a result of clinical
and laboratory
inspection
Immunology and Basic concepts of object,
allergology
role of the system of
immunity in an infectious
process, influence on the
term of еlimination of
exciter from the organism
of man
To estimate
information of
immunological
research
Epidemiology
Epidemic process (source,
mechanism of infection,
ways of transmission);
prevalence of disease in
Ukraine and in the world
To collect
epidemiology
anamnesis, conduct
disease and
prophylactic measures
in the hearth of
infection
Neurology
Pathogeny, clinical
syndromes of disease
To conduct the
clinical inspection of
patient with the defeat
of the nervous system
Propedevtika of Basic stages and methods To collect anamnesis,
internal illnesses of clinical inspection of conduct the clinical
patient
inspection of patient,
find out pathological
symptoms
and
syndromes.
To
analyse findings
Clinical
pharmacology
Pharmakokinetics and
pharmacodynamics, side
effects of facilities
specific and nosotropic
therapy
8
To appoint treatment
depending on the
degree of weight of
disease, individual
features of patient. To
write recipes
Next disciplines
Family medicine Pathogeny, epidemiology,
dynamics of clinical
displays, complications of
infectious diseases are
possible. Principles of
prophylaxis and treatment.
To conduct
differential
diagnostics of
illnesses of different
genesis. To recognize
an infectious disease,
his complication; to
interpret information
of laboratory
inspection. In good
time to hospitalize a
patient in infectious
permanent
establishment. To
render the first aid in
the case of necessity.
intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics, treatment,
prophylaxis of infectious
diseases. Pathogeny,
epidemiology, dynamics of
clinical displays, laboratory
diagnostics, complications
of infectious diseases are
possible.
9
To conduct
differential
diagnostics of
illnesses of different
genesis. To recognize
an infectious disease,
its complications; to
interpret information
of laboratory
inspection. To appoint
treatment. To render
the first aid on the
before hospitalisation
stage.
3.2 Structurally logical charts of maintenance of theme of employment
Chart of diagnostics and treatment of аdenovirus infection (Morbus of adenoviralis)
Epidemiology anamnesis:
- a presence of contact with patients , which have a fever and catarrhal displays; a stay in
the endemic cell of acute respiratory viral infectious
- sharp beginning; subfebril fever 1-2 weeks, two-wave;limphadenitis,
hepatosplenomegalia;signs of pharyngitis,rhinitis,conunctivitis.
pharingoconunctival fever: catarrh, swollen person, dacryagogue
- luminescent microscopy; cultivation of viruses is on the kidneie’s cells of
human embryo; serum methods: CFT (with аdenovirus’s antigens, diagnostic
increase of title in 4 times and anymore),imuno enzyme analysis
- determination of final diagnosis is
taking into account a syndrome,
weight, form
Differential diagnostics is with hemorragic
fevers,measles, leptospirosis, infectious
mononucleosis, diphtheria, sharp
enteroideas, acute respiratory viral
infectious, flu, spotted fever
- hospitalization is after epidemic and clinical testimonies; etiotropic therapy – 0,05 %
solution Desoxyribonucleasa for 1-2 drops in nasal motions, 0,02 % solution in a
conunctival furrow; nosotropic therapy: inductors of endogenous formation interferon
(mefenam acid and other ),desintoxication,desensibilization preparates; symptomatic
therapy; vitaminotherapy
- disappearance of clinical symptoms;
- normalization of laboratory indexes
- for clinical requirementes ( for presence of complications)
10
Chart of diagnostics and treatment of flu and parainfluenza (Grippus, Paragrippus)
Epidemiology anamnesis:
- a contact with patients which have a fever and catarrhal displays; stay in the
endemic cell of flu and parainfluenza; seasonality is the winter
- for a flu is the sharp beginning, increase of temperature to 39-400С for 2-3 hours, gectic
temperature’s curve, falling of temperature is critical or a lysis a speed-up, the syndrome of
intoxication prevails, the catarrhal phenomena are expressed insignificantly, symptom of Fezana: a
language is covered a white-blue raid with porcelain оpalescencia; Morozkin’s symptom: grittiness of
sky, back wall of pharynx, hyperemia and point hemorrhages , at once; duration of illness is to 3-5
days.
-for a parainfluenza – the catarrhal syndrome prevail above intoxication, duration of illness to 2
weeks, temperature to 38 0С; laryngitis, often for children stenosis of larynx:I stage – respiratory
insufficiency is not; ІІ stage is the stenosis breathing, shortness of breath, pallor and cyanosys of
nosolabial triangle;ІІІ stage is the loudly stenosis breathing, anxiety, involvement intercostal intervals;
IV stage – consciousness, breathing Cheyn-Stoks, asphyxia, loses
- a selection a virus from washings off by
infecting
сhicken
embryos;
an
immunofluorescent method - curing of strokesimprints from mucus wheys with the marked
antibodies; serum diagnostics – reaction
undirect hemaglutination, immuno enzyme
analysis, increase a title in 4 times and more,
pair wheys research on 1th and on 7-10th days
of illness
Differential diagnosis with all of group
ARD,meningococcus infection,measles,
meningitises, еncephalitis of different
etiology, by a leptospirosis, viral hepatitis in
prodromal period, by a parainfluenza, with a
diphtherial croup
- determination a final diagnosis is taking into account a
etiology, syndrome, weight, complications
- for easy forms: an isolation and treatment in home terms; for heavy forms is hospitalization and bed
mode; diet № 15, warm drink; specific : interferon, remantadini, Oxolinum, mephenam acid; nosotropic:
vitamin С, Rutinums, polivitamines; antihistaminic; symptomatic - coughings up, anticough facilities,
unnarcotic аnalgetics; for joining of bacterial complications - antibiotics; for stenosis of larynx inhalation of soda, broncholitics, аminasinum, glucocorticoids, іntubation, tracheotomy,
tranquilizers,sedative, oxygen tent
- disappearance clinical symptoms; normalization of laboratory indexes
- after the carried pneumonia supervision of district
11 doctor during a month; after complications from
the side of otholarynx’s-оrgans supervision of otolaryngologist
Health centre system:
Plan of diagnostics and treatment of respiratory-syncitial infection
(Morbus of respiratorio-syncytialis)
Epidemiology anamnesis:
- contact with a sick timber-toe by the catarrhal phenomena and fever or healthy
people,which carrying a virus 3-6 days prior to a disease; most morbidity in a winter-spring
period, children are more frequent ill
- beginning of illness is sharp or gradual: the temperature of body subfebril, rarely high, during 5-7 days;
moderate intoxication; damage of respiratory tracts: bronchiolitis, bronchitis with an asthmatic
component, pneumonia with respiratory insufficiency, Rhinitis with serosal excretions, rhinopharyngitis;
dry,prolonged, cough attacks protracted; еmphisematosis changes in lungs; insignificant hyperemia,
swelling, grittiness of mucus shell of soft palate, back wall of pharynx
- virologic research of washings from nasopharynx, excretions from the mucus shell of nose,
sputum, by infecting culture of cells (НELA, Hep-2), primary cultures kidneie’s cells of human
embryo; serum diagnostics: CFT, RN,reaction braking hemaglutination is increase title of
antibodies in 4 and more than times in the pair wheys of blood; expressdiagnostics: method
immunolumen (bright green luminescence well-educated specific complex is an antigen-аntibody);
an exposure RNK-viruses is by a polimerase chain reaction; immune enzyme analysis (exposure of
antibodies class IgM; sciagram-strengthening pulmonary picture, shallow ring-like or linear pls due
to the compression of walls bronchial tubes and еmphisemo-аtelectasis areas (changes of short
durations, disappear during 7-10 days); in blood moderate leucocytosis is with the insignificant
change leucocytic formula to the left,ESR is not changed
- formulation of final diagnosis with
determination of weight, distribution of
process, complications
Differential diagnosis with other acute respiratory
viral infectious (flu, parainfluenza, аdenovirus
infection), (vasculomotor) by a rhinallergosis,
bacterial gaimoritis,frontitis, еtmoiditius,bronchitis
abronchitis
- hospitalization patients with heavy and complicated motion of infection and after epidemiology
information ; etiotropic therapy (an interferon in the first days of disease is 2-3 drops in a nose 4-5 times
per a day); nosotropic therapy: spasmolysis respiratory muscles (ephedrine, еuphilinum, Dimedrolum),
desintoxication; washing of nose by hypertensive solution marine salt, sanorinum, galasolinum -1-2 days;
hot baths of foot; fauces-wash of calendula, camomile, eucalyptus decoction , solventias; vitaminotherapy
- disappearance of clinical symptomatic
- the clinical looking for a reconvalescentes of the complicated forms
12
A plan of diagnostics and treatment of rhinovirus infection (Rhinovirosis)
Epidemiology anamnesis:
- contact with a sick man 1-6 days before a disease;
- most morbidity in September, April-May;
- children are more frequent ill in schools
- beginning is sharp from expressed rhinorea, maximally certain on a 2-3th day; the increase of
temperature to the subfebril numbers and moderate head pain is possible, creeping in a throat, the nasal
breathing is complicated through the edema of mucus, sometimes easy catarrhal conjunctivitis with a
dacryagogue;
- at a review: moderate hyperemia of soft palate and back wall of a pharynx;
- laryngitis with coughing and wheezing voice;
- duration of illness on the average 1 week
- a selection of exciter is from epipharyngeal mucus by infecting of culture embryo cells or
kidneies of man;
- serum diagnostics: RN or CFT is an increase of antibodies in 4 times in the pair wheys of blood
(interval 2 weeks)
- determination of final diagnosis is
with pointing of weight,
complications
-differential diagnosis with other acute
respiratory viral infectious (flu, parainfluenza,
RS-іnfectious,аdenovirus infection),
meningococcus nasopharyngitis, diphtheria of
front department of nose, antritis, rhinallergosis
- hospitalization does not need;
- etiotropic therapy – absents;
- in complete absence nasal breathing are narrow-vessel drops in a nose (2 % ephedrine,
Naphthyzinum);
- home mode (in a sharp period), to avoid supercooling;
- аntibacterial preparations are at bacterial complications
- not conducted
13
3.3 Literature is made to order
Basic
• Vozianova zh.I. the Infectious and parasitogenic diseases. – In 3
т. - K.: of Health, 2001 – T 1. - P. 433 - 457
• Supervision for infectious disease / for editor U.V. Lobzina. 3th publication.,supplement and change. - Spb: Foliant, 2003. -1020
p.
• Infection disease: textbook / E.P.. Shuvalova, M.M. Antonov–
4th publication, change and supplement Mcode Medicine, 2001. 959 p.
• Infectious diseases: Textbook. / M.V. Titov, B.A.Garasun, L.Yu.
Shevchenko and other / For editor M.V. Titov – K.: Higher school,
1995. – p. 241-261.
Additional
 Gavrisheva N.A., Antonova T.V. Infektion process.
Clinical and pathophysiologic problems – Spb.; Foliant, 1999. –
255 p.
 Clinical-laboratory diagnostic infectious desease: Supervision
for a doctors. – Spb.: Foliant, 2001 -384 p.
3.4 Materials for self-control
3.4.1 A question for self-control
1 Features of exciter of flu, parainfluenza, RS-іnfectious,
аdenovirus, rhinovirus infections. A concept about bird flu.
2 Factors of pathogenicity of exciters.
3 Source of infection and factors of transmission.
4 Pathogenesis.
5 Classification.
6 Basic clinical syndromes.
7 Clinical displays are depending on weight of motion.
8 Specific complications.
9 Differential diagnosis.
10 Plan of inspection sick.
11 Methods of specific diagnostics.
12 Interpretation of results of laboratory research.
14
13 Specific therapy: doses, ways of introduction, duration of
treatment.
14 First aid to the patient.
15 Governed excerption from permanent establishment.
16 A prophylaxis and measures is in a cell.
3.4.2 Tests are for self-control
To choose right answers
Variant 1
1 source of infection of flu:
A food products;
B sick people (animals - as a reservoir of infection),viruscarry;
C water;
E canned products.
2 At the heavy forms of flu appoint:
A - all is transferred;
B are vitamins;
C are antiviral preparations;
D desensitizing;
E- desintoxication.
3 The antigen structure of virus flu changes in:
A - does not change;
B - virus of flu B;
C - virus of flu С;
D - virus of flu A, B, С;
E - virus of flu A.
4 The virus of flu is proof:
A - to the high temperatures;
B - to the low temperatures;
C - to the small concentration to the chlorine;
D - to the ultraviolet rays;
5 All belong before complications of flu, except for:
A - to the bronchitis, pneumonia;
B - to the aкtritis;
C - to the pyelonephritis;
D - myocarditis;
E - to poliomyelitis.
15
6 The virus of flu has a tropic to :
A - cylinder epithelium of overhead respiratory tracts;
B - flat epithelium;
C - lymphoid tissue;
D - аlveolocytes.
7 The prophylaxis of flu during an epidemic is provided:
A - by a vaccination;
B - stimulate of synthesis endogenous interferon;
C - by antiviral preparations;
D - antibiotics.
8 The children of early age have complication of flu:
A meningoencefalitis;
B stenosic laryngotracheitis;
C viral pneumonia;
D myocarditis.
9 Specific treatment of parainfluenza:
A vitamin С;
B the anticough mean;
C interferon,remantadinum;
D tranquilizers.
10 What family the virus of parainfluenza behaves to:
A - Paramyxoviridae;
B - Adenoviridae;
C - Pneumovirus;
D - Picornaviridae.
Variant 2
1 A mechanism of transmission is at an adenovirus infection:
A - air-drops;
B - vertical;
C - transmisive;
D - sullage-oral;
E - sexual.
2 A source of infection is at a аdenovirus infection:
A - a sick man or bacillicarrier;
B - home animals;
C - wild animals;
16
D - rodents;
E - birds.
3 Adenovirus is initially localized in:
A - epitheliums of overhead respiratory tracts;
B - to blood;
C - to cerebral tissue;
D - sexual system;
E - to the extraction system .
4 Forms of аdenovirus infection, except for:
A - effaced;
B - pharyngoconunctivitic fevers;
C - pellicle conunctivitis;
D - sharp respiratory illness;
E - аdenovirus diarea.
5 A testimony is to аntibiotictherapy at a аdenovirus infection:
A - a presence of complications;
B - a conjunctivitis;
C - pharyngitis;
D - tonsillitis.
6 For аdenovirus diarea characteristically:
A - is diarea with the admixture of mucus in incandescence;
B - is blood in incandescence;
C - a pus in incandescence;
D - excrement as «raspberry jelly»;
7 For аdenovirus pneumonia characteristic motion is in a kind:
A - hearth creeping pneumonia;
B - аbscedic;
C - іntersticial;
D - pleuropneumonias.
8 Facilities of prophylaxis of аdenovirus infection:
A - is іnternasal introduction of leucocytic interferon;
B - is active immunization;
C - desinsection and deratization;
D - desinfection.
9 With what diseases does differentiate a аdenovirus infection?
A - by a cholera:
17
B - by a plague;
C - brucellosis;
D - infectious of mononucleosis, diphtheria, acute respiratory viral
infectious.
10 At treatment a аdenovirus infection will utillize everything,
except for:
A a rinse of throat by solution of furaciline;
B - ultrasonic high frequency and ultraviolet light;
C - is burying of eyes by a 15-30% solution of albucidi;
D - antibiotics.
Variant 3
1 Hospitalization of patient is conducted after such testimonies:
A - to put to 5;
B - sear and yellow leaf;
C - heavy motion;
D - heavy motion, complication, epidemiology testimonies.
2 Indexes of blood are a RS-іnfectious:
A - not changed;
B - leucopenia, increase ESR;
C - trmbocytopenia;
D - moderate leucocytosis, ESR within the limits of norm.
3 A latent period is at a RS-іnfectious:
A - 3-6 days;
B - 10 days
C - 6 months;
D - 2 days.
4 What seasonality of RS-іnfectious?
A - summer;
B - winter - spring;
C - autumn;
D - spring - summer.
5 Who is more frequent ill a RS-іnfectious?
A – old people;
B - to put;
D - people 30-40 years;
E - all of answers are faithful.
18
6 Method of introduction and dose of interferon:
A - i/v 2-3 ml 2 times per a day;
B - inside for a 1 tablet. 2 times per a day;
C - 2-3 drops in a nose 4-5 times per a day;
D - hypodermic 1 ml 1 time per a day.
7 After whom does conduct a clinical supervision?
A - by heavy motion;
B - after children to 3;
C – with the complicated forms;
D - all of answers are faithful.
8 Who is the source of infection?
A - animals;
B - sick people and viruscarry;
C - birds;
D - rodents.
9 Nosotropic therapy of RS-іnfectious:
A - еuphilinum, Dimedrolum;
B - vitamitherapy;
C - seduxenum;
D - prednisolonum.
10 During what time does disappear x-ray photography of sign?
A - 2 months;
B - 7-10 days;
C - 1 month;
D - 6 months.
Variant 4
1 What family does rhinovirus behave to?
A - Picornaviridae;
B - Reoviridae;
C - Herpesviride;
D - there is not a right answer.
2 A latent period is at arhinovirus infection:
A - 1 month;
B - 1-6 days;
C - 14 days;
D - 2 months.
19
3 The most characteristic clinical signs for a rhinovirus infection:
A - rhinorea;
B - cough;
C - head pain;
D - all of answers are faithful.
4. typical complications of a rhinovius infection:
A - sinuitis;
B - otitis;
C - artritis;
D - all of answers are faithful.
5 Sign of diagnostics all, except for:
A - epidemiology information;
B - to the presence of rhinorea;
C - to absence of intoxication;
D - expressed intoxication.
6 Source of infection:
A - patient;
B - are animals;
C - all of answers are faithful;
D - is rodents.
7 Mechanism of transmission:
A - air-drops;
B - vertical;
C - аlimental;
D - all of answers are correct.
8 Seasonality:
A - winter;
B - summer;
C - autumn - spring.
9 Optimum terms are for a replication of exciter:
A - temperature +27-300 С;
B - temperature +33-350 С;
C - temperature 00 С;
D - all of answers are faithful.
10 Place of penetration and replication of virus:
A - flat epitheliums;
20
B - transitional epithelium;
C - prismatic blinking epithelium;
D - keratinous epithelium.
Standards of right answers
Variant 1: 1-B; 2A; 3-E;4 C ; 5-E; 6 A; 7-B; 8-B; 9-D; 10 A.
Variant 2: 1A; 2A; 3A; 4A; 5A; 6A; 7A; 8A; 9-D; 10-D.
Variant 3: 1-D; 2-D; 3A; 4-B; 5-B; 3; 3; 8-B; 9A; 10-B.
Variant 4: 1A; 2-B; 3A; 4-D; 5-D; 6A; 7A; 3; 9-B; 3.
3.4.3 A task is for self-control
Task 1
Patient A., 7 years, entered infectious separation with stenosis of
larynx of 2 degrees, temperature 38 0С, catarrhal phenomena.
1 Formulate a diagnosis.
2 With what diseases does conduct differential diagnostics?
Task 2
Infectious separation a man entered 30 years, temperature of 40 0С
(according to a patient a temperature rose hour-long), intoxication is
expressed, the catarrhal phenomena are expressed insignificantly, a
language is covered a white raid, hyperemia of глотки.
1 Formulate a diagnosis.
2 Appoint specific treatment.
Task 3
To the policlinic a girl appealed 17 years with complaints about a
fervescence to 37 0С within a week, conjunctivitis, слизуваті
excretions, from a nose, dacryagogue. Objectively: a liver and spleen
is megascopic, лімфаденіт.
1 Formulate a diagnosis.
2 Is the health centre system needed?
Task 4
To the policlinic a man appealed 28 years with complaints about
subfebril, dry cough. Intoxication is moderato expressed, displays of
bronchitis, rhinisporidios, hyperemia, and was swollen back wall of
pharynx. On the sciagram of strengthening of pulmonary picture,
shallow ring-like pls. Blood test: leucocytosis, change of formula to
the left,ESR 5 mm / hours
1 Formulate a diagnosis.
21
2 What serum tests can be conducted?
Task 5
To the policlinic a girl appealed 20 years with complaints about
the increase of temperature to 370С, закладеність nose, першіння in
a throat, слизуваті excretions from a nose, absence of sense of smell
and taste. Objectively: a skin мацерована round the nasal openings.
Hyperemia of ротоглотки, підщелепні lymphonoduss, is
megascopic. A clinical blood test is in a norm.
1 Formulate a diagnosis.
2 Additional methods of diagnostics.
Standards of answers are to the tasks
Task 1
1 Parainfluenza, stenosis of larynx 2 ст.
2 Acute respiratory viral infectious, diphtherial croup, meningitis.
Task 2
1 Flu.
2 Interferon, remantadinum.
Task 3
1 Adenovirus infection.
2 No, the health centre system is conducted at the complicated
forms.
Task 4
1 RS-іnfectious.
2 CFT, RN, RGGA,immuno enzyme analysis.
Task 5
1. Rhinovirus infection.
2. CFT.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To capture the method of inspection patient with a flu,
parainfluenza, RS-іnfectious, аdenovirus, rhinovirus infections.
 To conduct care of patient.
 To conduct differential diagnostics.
 To work out a plan of laboratory inspection.
22
 To interpret the results of specific inspection of patient.
 To recognize complication.
 To work out a plan of treatment sick.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document in fact of establishment of
diagnosis.
4.2 A professional algorithm is in relation to forming of skills
and abilities of diagnostics of acute respiratory viral infectious
№ Task
Sequence
of A remark, warning, is in
implementation relation to self-control
1
To capture the Complaints
method of clinical
inspection
a Anamnesis
of
patient on acute illness
respiratory viral
infectious
Anamnesis of life
Epidanamnesis
2
To conduct a To conduct
curation of patient objective
inspection
To select complaints and
characteristic syndromes.
To pay a regard to
beginning, term, sequence
of origin of symptoms, their
dynamics.
To find out the carried
illnesses.
To find out information
which touch realization
air-drops mechanism of
transmission
a contact is with infectious
patients.
an Expressiveness, dynamics
of symptoms, is conditioned
duration and weight of
motion of disease.
General review
To pay attention on:
- mucus shell of cavity of
mouth;
- a selection is from a nose;
23
- skin covers;
- on a conjunctiva.
To pay attention on:
-аuscultative information;
- limitation of motions of
intercostal muscles;
- violation of breathing
rhythm;
- shortness of breath.
respiratory
system
3
To
appoint General clinical
laboratory
and analysis of blood
additional
researches
To pay attention on:
- neutrophilic leucocytosis
with
the
change
of
leucocytic formula to the
left;
- increase of ESR.
Serum
hemanalysis.
Materials of after audition work independent work
Subject of UDRS and NDRS:
• Features of motion acute respiratory viral infectious are in
modern terms.
• Modern methods of specific diagnostics of acute respiratory
viral infectious.
• Problems of etiotropic treatment acute respiratory viral
infectious.
• Modern looks are to the bird flu.
24
Topic. INFECTIOUS DISEASES WHICH RUN ACROSS
WITH THE CLINIC OF АTYPICAL PNEUMONIA:
RESPIRATORMICOPLASMOSIS,PSITTACOSIS,LEGIONEL
OSIS. A CONCEPT ABOUT SARS. DIFFERENTIAL
DIAGNOSTICS
ACUTE
RESPIRATORY
VIRAL
INFECTIOUS.PRINCIPLES
OF
LABORATORY
DIAGNOSTICS, TREATMENT, AND PROPHYLAXIS OF
ACUTE RESPIRATORY VIRAL INFECTIOUS. TESTIMONY
TO HOSPITALIZATION, GOVERNED EXTRACTS OF
PATIENTS OF PERMANENT ESTABLISHMENT
Duration - 2 hours.
1 Actuality of theme. Respiratory micoplasmosis behaves to the
infectious diseases the account of which is not foreseen an official
medical document. M. pneumoniae occupy a 3 place after
pneumococcus and Legionella of pneumophila are principal reason
of respirator infections for schoolboys and young people.
Legionelezi inflict society perceptible economic losses, that
conditioned by the protracted loss of capacity, heavy motion, high(150 % ) lethality.
The flashes of psittacosis are registered on all continents. Except
for wild birds home animals and birds can be attracted in the process
of distribution of infection. Ill-timed diagnostics of psittacosis
influences on efficiency of treatment, instrumental in the origin of
relapses, transition, in the protracted and chronic form.
In the pathosis of man a large role is played by the sharp diseases
of respiratory tracts of infectious nature. They are 50-70 % all of
infectious diseases. The role of viruses is especially important: 50-60
% respirator diseases caused by them. At plenty of exciters,
polymorphism of caused by them clinical displays, varieties of
clinical forms far not always, even at the detailed inspection of
patient, it is succeeded to set etiology of exciter which caused a
respirator syndrome. For this reason it is important to know basic
principles of differential diagnostics of acute respiratory viral
infectious, it is instrumental in setting of the proper treatment and
rapid convalescence of patient.
25
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
а-2
 etiology of micoplasmosis, psittacosis,legionelosis, factors of
pathogenicity of exciters;
 epidemiology of micoplasmosis, psittacosis, legionelosis;
 pathogeny of micoplasmosis, psittacosis of,legionelosis;
 clinical displays of micoplasmosis, psittacosis, legionelosis at
typical motion;
 clinical and еpidemiological features of psitacosis, psittacosis,
legionelosis
 pathogenesis, term of origin and clinical displays of
complications of micoplasmosis, psittacosis, legionelosis;
 laboratory diagnostics of micoplasmosis, psittacosis,
legionelosis;
 principles of treatment;
 principles of prophylaxis;
 tactic in the case of origin of complications;
 prognosis of micoplasmosis, psittacosis, legionelosis;
 governed extracts of reconvalescentes from permanent
establishment;
 governed the health centre system of reconvalescentes;
 etiology, pathogenesis, clinic features, diagnostics, principles
of treatment of SARS;
 differential diagnostics of acute respiratory viral infectious;
 principles of laboratory diagnostics of acute respiratory viral
infectious;
 principles of treatment;
 principles of prophylaxis;
 a testimony is to hospitalization;
 governed extracts of patients from infectious permanent
establishment.
2.2 A student must be able:
26
а-3
 to adhere to the basic rules of work near a bed sick;
 to collect anamnesis of illness with the estimation of
epidemiology information;
 to inspect a patient and find out basic symptoms and
syndromes of micoplasmosis, psittacosis, legionelosis , acute
respiratory viral infectious; to ground a clinical diagnosis for timely
direction of patient in permanent establishment;
 to conduct differential diagnostics of micoplasmosis,
psittacosis, legionelosis ;
 to conduct differential diagnostics of acute respiratory viral
infectious;
 on the basis of clinical inspection in good time to recognize
possible complications of micoplasmosis, psittacosis, legionelosis;
 on the basis of clinical inspection in good time to recognize
possible complications of acute respiratory viral infectious;
 to design a medical document in fact of establishment of
previous diagnosis "micoplasmosis , psittacosis, legionelosis, acute
respiratory viral infectious" (an urgent report 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 information, weight of the state, presence of
complications, allergist anamnesis, concomitant pathology;
 to work out a plan of disease and prophylactic measures in the
hearth of infection;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescentious.
3 Materials are to audience independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
27
Medical biology Properties
Ch. psittaci
Mycoplasma
pneumoniae
To interpret the results of
specific
methods
of
of diagnostics of psittacosis,
micoplasmosis
Microbiology
Property of Legionella of
pneumophilia, families
of
Adenoviridae,
Picornaviridae,
Orthomyxoviridae,
Paramyxoviridae.
Methods of specific
diagnostics
of the
diseases caused by them
Physiology
Parameters
of To estimate information
physiology norm of of laboratory inspection
organs and systems of
man;
indexes
of
laboratory inspection are
in a norm (general
analysis of blood, urine,
biochemical of blood,
parameters of KOS,
electrolytes and others
like that)
Physiopathology A
mechanism
of
violation of functions of
organs and systems is at
the pathosiss of different
genesis
Immunology
To interpret the results of
specific methods
diagnostics
of
legionelosis,
flu,
parainfluenza, аdenovirus
infection,
rhinovirus
infection,
respiratorysyncitial infection
To interpret pathological
changes as a result of
clinical and laboratory
inspection
Basic concepts of object, To estimate information
28
and
allergology
role of the system of of
immunological
immunity
in
an researches
infectious
process,
influence on the term of
еlimination of exciter
from the organism of
man
Epidemiology
Epidemic
process
(source, mechanism of
infection,
ways
of
transmission)
at
legionelosis, psittacosis,
respirator
micoplasmosis,acute
respiratory
viral
infectioua; prevalence of
pathology in Ukraine
and in the world
Neurology
Pathogeny,
clinical To conduct the clinical
syndromes of disease
inspection of patient with
the defeat of the nervous
system
To collect epidemiology
anamnesis, to conduct
disease and
prophylactic measures are
in the hearth of infection
Propedevtic of Basic
stages
and To collect anamnesis,
internal illnesses methods of clinical conduct
the
clinical
inspection of patient
inspection of patient, find
out
pathological
symptoms
and
syndromes. To analyse
findings.
Clinical
pharmacology
Pharmacokinetic and
To appoint treatment
pharmacodynamics, side depending on the degree
29
effects of facilities of of weight, individual
specific and nosotropic features of patient.
therapy
To write recipes
Next disciplines
Domestic
medicine
Pathogeny,
epidemiology, dynamics
of clinical displays,
complications
of
psittacosis,
respirator
mycoplamosis
are
possible,
legionelosis,acute
respiratory
viral
infectious.
Features of motion of
these illnesses.
Principles of prophylaxis
and treatment.
To conduct differential
diagnostics of illnesses
with
a
respirator
syndrome.
To
recognize
these
illnesses,
their
complications; to interpret
information of laboratory
inspection.
In
good
time
to
hospitalize a patient in
infectious
permanent
establishment.
To render the first aid in
the case of necessity
Interdiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics, treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics
of clinical displays,
laboratory diagnostics,
complications
of
infectious diseases are
possible.
30
To conduct differential
diagnostics of illnesses of
different genesis. To
recognize an infectious
disease, his complication;
to interpret information of
laboratory inspection. To
appoint treatment. To
render the first aid on the
before
hospitalization
stage.
3.2 Structurally logical charts of maintenance of theme of employment
Chart of diagnostics and treatment of psittacosis (Ornithosis)
Еtiology
Chlamydia psittaci
-
Еpidemiology
pathogenesis
clinic
reproduction and
accumulation of
exciter is in the
epithelium of
respiratory tracts
a contact with birds, feather,excrements of birds;
work in a laboratory with contagious material.
аlergisation
disemination exciter
in organs, liberations
of toxic substances
prelum of bronchial tubes
and bronchioles
damage of cells, alveols, and
interstitium
hypoxia of internalss
- Sharp beginning, a temperature, head pain, pharyngalgia, cough,
аrtralgia, nausea, strong sweating,
rises with a chill; presence of typical original appearance of patient: puffiness of person is with cyanosys
of lips; signs of pneumonia (іntersticial,focal,lobar); defeat of the nervous system (hydromeningitis)
- extract of exciter with blood, sputum on chicken еmbriones, culture of cells; CFT or reaktion
braking hemaglutination , immune enzymes ana;lysis;Ter’s intraderma аlergic prob
Yes, a diagnosis is confirmed:
no
- determination of eventual diagnosis, pointing of
form, motion, weight, complication
.
-differential diagnosis with pneumonias, Kufever, spotted fever, typhoid fever, flu,
tuberculosis of lungs , micoplasmosis, a
leptospirosis and other.
therapy:
antibiotics of Tetracyclinum group (doxiciclinum),macrolides (аzitromicinum);
desintoxication therapy;
desensibilization, it is necessity glucocorticoids
symptomatic therapy: diuretic, brocholitics, vitamins;
- at the protracted and chronic motion conduct vaccinotherapy.
-
Convalescence; excerption
dispanserisation
-
disappearance of clinical symptomatic;
normalization of laboratory indexes.
- during 6 months
31
Plan of diagnostics and treatment of legionelosis (Legionellosis)
Еtiology
Legionella pneumophila
Еpidemiology
patogenesis
-
use of show equipment;
using room humectants, conditioners;
earthen and reclamative works;
dwelling is near the opened reservoirs;
old men and senile are more frequent ill.
reproduction
of exciter in
macrophages
penetration of
infection in alveoles
activating of heterospecific
immune is reactions
specific antibodies,
poliorgan’s impression
clinic
sharp beginning from a chill, head pain, muscular pain, ferves
cence to 38 - 400С;
clinic of pneumonia which hardness responds to treatment;
presence of catarrhal syndrome
.
reaction of immunofluorescence;
Reaction undirect hemaglutination, immuno enzyme analysis, RIA;
reaction micrо agglutination and undirect immunofluorescence (diagnostic title 1:128);
a selection of legionel from sputum, pleura liquid
Yes, a diagnosis is confirmed
no
determination of eventual diagnosis,
pointing of form, motion
weight, complication
differential diagnosis from
by pneumonias of other etiology,acute
respiratory viral infectious, оrnitosis, Kufever, tuberculosis of lungs , infarct of lungs
therapy
- аntibiotic therapy( macrolides, phtorchinolones);
- desintoxication therapy;
- antihistaminic preparations;
- symptomatic therapy
Convalescence: excerption
dispanserisation
- for clinical
requirementes
- disappearance of clinical symptomatic;
.
- normalization of laboratory information
32
Plan of diagnostics and treatment of mycoplasmosis
Еtiology
Mycoplasma pneumoniae
- a disease is during the flash of acte respiratory
viral infectious;
- group morbidity of children and young people in
establishments of the closed type
Еpidemiology
reproduction
of exciter in
place
of
penetration
patogenesis
extract of mitogenic
factor
activating of heterospecific
immunoreactions
specific antibodies,
poliоrgan’s impression
formation of toxic substances; damage
cells of bronchial tubes, alveoles
on a background of
acute respiratory
disease development
of pneumonia from
minimum phisical
information
clinic
fever
intoxication
rhinopharyngitis
tracheobronchitis
- bacteriologic examination of sputum and epipharyngeal washings off;
- serum researches( CFT,reaction undirect hemaglutination);
- PCR
. a diagnosis is confirmed
Yes,
no
підтверджена
determination of final diagnosis, pointing
of form, motion
weight, complication
differential diagnosis from
by pneumonias, Ku-fever,,flu
a leptospirosis, psittacosis
therapy
- аntibiotic( macrolides, phtorchinolones);
- desintoxication therapy;
- desensitizing;
- symptomatic therapy
disparisation
Convalescence: excerption
- disappearance of clinical symptomatic;
- normalization of laboratory information
.
33
For a clinical
requirementes
Plan of differential diagnostics of acute respiratory viral infectious
damage a respiratory ways :
rhinitis,pharingitis,
no
Acute
tonsilitis,laryngitis,tracheitis,bronchitis,
respiratory viral
бронхіоліт
yes
infectious isn’t
Seach a case of
yes
no
fever
meningeal
symptoms
diagnosis for results of research spinal liquid.
Break out hemorhage
When is Normal indexes–diagnosis
no
meningism, make diagnostic for right branch
yes
Some changes for
аuscultation of lungs
yes
Character of
cases
meningococcemia
(rarely – sepsis other
etiology )
no
fever >37,80С
yes
no
focal
difuse
Character
of
respiratory ways
pneumonia (Rhdiagnostic)
bronchiolitis
(stuffiness)
RS-infectious
.
chiefy type of
wheezing
dry
damp
RS-infectious
flu,edema
lungs
damage
pharyngo-tonsilitis with
rhinorea( + conunctivitis
limphadenopathy)
Аdenovirus infectious
Character of
respiratory ways
damage
laryngitis
(wheezing
voice)
paraflu
bronchitis
(stuffiness)
RS- infectious
of
laryngitis,tracheitis,
bronchitis,rhinitis,
brightnes difuse hyperemia
of fauce, dry mucous
influenza
Diagnosis of flu is more real when have a combinaion a temperature > 37,8 0С
and two and more symptoms:
а) dry cough with a pain behind of sternum ;
б) breaking in muscle,trochanter, bones;
в) difuse hyperemia of fauces, dry mucous;
г) headeche in a forehead-temporal area
34
rhinit (rhinorea)
rhinovirus іnfectious
Chart of diagnostics and treatment of acute respiratory viral infectious
Epidemiology anamnesis
- contact with ill man ,which have fever and cataral symptoms ; being in endemic area of ARD,
аnd with health viruscarries for 1-6 days before disease of RS-infection and rhinovirus
іnfection
- start of disease sharp or gradualy ( RS-іnfection);
- hyperemia palatina and posterior wall of pharynx;
- flu: increase a temperature to 39-400С for 2-3 hour, decrease temperature critic,chiefly symptom іntoxication,
cataral signs expres not so .Duration of disease 3-8 days;
- paraflu: chiefly cataral signs , іntoxicationexpres not so, laryngitis, subfebril temperature , duration disease for
2 weeks;
- аdenovirus infection subfebril fever 1-2 weeks, two-wave, limphadenitis, signs of pharyngitis, rhinitis,
conunctivitis, pharyngoconunctival fever : runny nose, edema of face, tearing;
- RS-іnfection: subfebril temperature duration 5-7 days, bronchitis, bronchiolitis with аstmatic component;
- Rhinovirus іnfection:rhinorea, temperature often is normal , nasal breathing is complicate for edema of
mucous, duration disease 1 week
- extract a viruses with wash nasopharynx for a way іnfective chicken еmbriones ( flu, paraflu) and kidneies
of human еmbrione ( of other. ARD), іmmuno lumen method – cutting of spreade - imprintes with mucous
of solution with marked antibodies, serologic diagnostic – reaction undirect hemaglutination, RN,CFT,
immuno enzyme analysis, increase index of 4 time and more, research pair wheys , polimerase chain
reaction for identificate genome
- determination of end diagnosis with score
etiology, syndrom, hard, complicate
-differential diagnosis for meningococcus
infection,meningitis,diphteria,measles,leptospirosis,
аlergic rhinitis, bacterial bronchitis, gaimoritis,
еthmoiditis and other .
- hospitalization of sicks with hard and complicate іnfection, for еpidemic indexes;
- еtiotropic therapy: for flu and paraflu– remantadinum, оxolin, mephenam acid;
- аdenovirus іnfection: 0,05% solution desoxirybonuclease for 1-2 drops in nasal ways , 0,02% - in conunctival
suture ;
- RS-іnfection – іnterferonum in first days of disease – 2-3 drops in nose 4-5 time on a day;
- patogenetic therapy: hot drink,watch out of colding
- flu and paraflu: polivitamins, vitamin С, аntihistamine;
- adenovirus іnfection: іnductors еndogenic interferonum, desensibilizive;
- RS іnfection: remove of spasm breathing muscles (ephedrinum, еuphilinum)
- Rhinovirus іnfection: vessels narrowing drop in nose (2 % еphedrinum, naphtisinum);
- symptomatic therapy;
- аntibacterial therapy for bacterial complicates
- for clinical indexes (for presence of
complications)
- decrease of clinical symptoms ;
normalization laboratory indexes
35
3.3 Literature is made to order
Basic
• Vozianova Z.I. the Infectious and parasitogenic diseases: In 3 т.
- K.: of Health, 2001. - T.1. – 60-339 p.
• Ivakhiv O.L., Gricko R.U., Kiselik I.O. infectious Room of
diseases: Train aid. it is Ternopil', 2006. – 233 p.
• Infectious diseases are in general practice and domestic
medicine / For editor M.A. Andreychina.Ternopil': TDMU, 2007. –
500 p.
• Infectious diseases: Textbook / For an editor Titova M.B. – K.:
Higher school, 1995. – p. 89 - 97
Auxiliary
• Gavrisheva N.A., Antonova T.V. Infectious process.Clinical
and pathophisiologic chages. - Spb.: Special literature, 1999. – 255 p.
• Clinical-laboratory diagnostic infectional disease:Superviser for
doctors. - Spb.: Foliant, 2001. – 384 p.
• Differencial diagnostic infectional disease:Superviser for doctors
/ Т. M.Zubik, K.S.Ivanov: Medicine, 1991. - 168-176 p.
• Differencial diagnostic infectional disease/Devid Shlossberg,
Ionas A.Shulman.: BINOM-Moscov, 1999. – 13-17, 20-23, 101 p.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 Features of exciter of legionelosis, psittacosis, respirator
мікоплазмозу, SARS.
2 Source of infection and factors of transmission.
3 Pathogeny of legionelosis, micoplasmosis, psittacosis, SARS.
4 Classification of legionelosis,micoplasmosis, psittacosis.
5 Basic clinical syndromes of legionelosis,micoplasmosis,
psittacosis, SARS,acute respiratory viral infection.
6 Clinical displays are depending on weight of motion.
7 Specific complications of legionelosis,micoplasmosis,
psittacosis, SARS,acute respiratory viral infection.
8. Differential diagnosis .
9 Plan of inspection patient with a psittacosis,micoplasmosis,
legionelosis, acute respiratory viral infection
36
10 Methods of specific diagnostics of legionelosis,
micoplasmosis, psittacosis, SARS,acute respiratory viral infection.
Interpretation of results of laboratory research.
11
Etiotropic
therapy
of
psittacosis,legionelosis,micoplasmosis,SARS,acute rspiratory viral
infection: doses, way of introduction, duration of treatment.
12 A testimony is to hospitalization.
13 Medicare by a patient on the before hospitalization stage.
14 Governed extracts of reconvalescentes from permanent
establishment.
15 A prophylaxis and measures is in a cell.
3.4.2 Tests are for self-control
To choose right answers
Variant 1
1 Legionelosis:
A) sapronosis
B) zoonosis
C) antroponosis
D) antropozoonosis
2 Clinical forms of legionelosis, except for:
A) pneumonias
B) fevers of Pontiak
C) fevers Fort-Bragg
D) meningitis
3 incubation period of legionelosis:
A) 3-30 days
B) 60-120 days
C) 2-10 days
D) 1-2 hours
4 First symptoms of display of SARS:
A) fever,t 38 0 С and anymore, cough
B) diarea, icterus
C) sharp hypothermia
D) all unright
5 Legionella is cultivated on:
A)chicken embryos
37
B)white mouse
C)environment Kitta-tarocci
D)doesn’t cultivate
E)simple artificial nourishing environments
6 A source of infection of legionelosis:
A)ill man
B)no set
C)bactericarry
D)home birds (chickens, turkey-cocks, ducks)
E)wild birds (parrots, pigeons)
7 Ways of infection legionelosis:
A)аir
B)contact
C)transplacental
D)alimental
E)contact-consumer
8 Legioneli select:
A) еndotoxin
B) еkzotoxin
C) іnterleukin
D) Somatotropinum
9 The infection of legionelosis arises up inhalation:
A) water an aerosol
B) saw
C) soil
D) all is transferred
10 Roentgenologic signs are in lights of legionelosis
A) lobar аbscedic pneumonia
B) one-sided
C) exudative pleurisy
D) all right
Variant 2
1 Exciter of psittacosis:
A) ricketsia
B) chlamidia
C) virus
38
D) micoplasma
2 A psittacosis mainly are ill:
A) workers of poultry factories
B) forest rangers
C) fishings
D) physicians
3 After the carried psittacosis immunity:
A) for all life
B) non-sterile
C) unsteady
D) antitoxic
4 What types of birds are a source at a psittacosis?
A) poultries
B) decorative
C) pigeons
D) all are transferred
5 Ways of transmission are at a psittacosis:
A) air-drops
B) air-dustborne
C) all are transferred
6 A mechanism of transmission is at a psittacosis:
A) transmisive
B) sullage-oral
C) aerogene
D) sexual
7 The latent period of SARS makes:
A) 3 months
B) 2-7 days
C) 30 days
D) 1 year
8 chlamidia in an environment proof to :
A) heating
B) des. solutions
C) freezing
D) drying out
9 chlamidia are:
39
A) intracellular vermin
B)extracellular vermin
C) saprophytes
D) аctinomicetes
10 Birds select an exciter a psittacosis from:
A) by excrements
B) by a nasal secret
C) all right
Variant 3
1 Dangerous patient of micoplasmosis for circumferential?
A) always
B) no
C) at a transmitter
D) at heavy forms
2 The signs of micoplasmosis pneumonia is:
A) temperature
B) myalgias
C) unproductive cough
D) all is transferred
3 Ways of transmission are at SARS:
A) air-drops
B) the pin domestic is possible
C) sullage-oral
D) all right
E) right and,
4 The exciter of micoplasmosis is :
A) chlamidia
B) micoplasma
C) ricketsia
D) spirocheta
5 Mikoplazmosis is:
A) zoonosis
B) аntroponosis
C) аntropozoonosis
D) sapronosis
6 An exciter SARS is:
40
A) viruses
B) bacteria
C) mushrooms
D) the simplest
7 An entrance gate is micoplasmosis:
A) mucus overhead respiratory tracts
B) mucus thin bowels
C) mucus colon
D) wound
8 Specific diagnostics of micoplasmosis, except for:
A) microaglutination
B) Reaction undirect hemaglutination
C) PLR
D) CFT
9 Preparations of choice
for etiotropic treatment of
micoplasmosis:
A)аmpicilinum
B) tetraciclinum
C) Sulfanilamidums
D) tienam
10 An exciter SARS is:
A) togavirus
B) paramyxovirus
C) coronavirus
D) legionella
Variant 4
1 Pain in eyeballs (retroorbital), which appears at motion of eyes,
is characteristic for:
A) flu
B) parainfluenza
C) аdenovirus infections
D) rhinovirus infections
2 How many days more frequent all does a fever last a flu?
A) one day
B) 2-4 days
C) week
41
D) 8 days
3 A latent period of flu:
A) one day
B) two days
C) 3-6 days
D) 12-24 hours
4 A latent period of parainfluenza:
A) 12-24 hours
B) one day
C) two days
D) 3-6 days
5 Laryngitis is a leading symptom at:
A) flu
B) parainfluenza
C) RS- infections
D) rhinovirus infections
6 pharingoconunctival fever is characteristic for:
A) the flu
B) аdenovirus infections
C) to the parainfluenza
D)rhinovirus infections
7 What illness does mainly meet for children to 3th of life?
A)RS infection
B) flu
C)paraflu
D) rhinovirus infection
8 What feature of RS- infection?
A)pharyngoconunctival fever
B) defeat of bronchial tubes and bronchioles
C) lead is a syndrome of intoxication
D) laryngitis
9 Absence or weak expressed of general intoxication is
characteristic for:
A) to the flu
B) to the parainfluenza
C) RS infections
42
D) rhinovirus infections
10 What main sign of rhinovirus infection:
A) Ringo
B) laryngitis
C)pharyngoconunctival fever
D) syndrome of general intoxication
Standards of right answers
Variant 1: 1.A; 2. D; 3. E; 4B.; 5.B; 6. A; 7.A; 8. A; 9.B; 10.C
Variant 2: 1.B; 2.A; 3.C; 4.D; 5.C; 6. C; 7.B; 8.C; 9.A; 10.C
Variant 3: 1.A; 2.D; 3.C; 4.A; 5.A; 6.B ; 7.A; 8. A, 9.D; 10. D
Variant 4: 1.A; 2.B; 3.D; 4.D; 5.B; 6. B; 7. A; 8.B; 9.D; 10.A
3.4.3 Tasks are for self-control
Task 1
For a patient A., 18 years, relapse of focal pneumonia.
Temperature during hospitalization 38,6 °С, head pain, cough with
sputum, pain, moist middle finely vesicule wheezes in the right half
of thorax. A shortness of breath is not. Tones of heart are
hyposthenic. A liver is megascopic on
2 sm.
In a blood test moderate leucocytosis , speed-up ESR. When
compared to primary research the title of antibodies for micoplames
in CFT was increased in 4 times.
1 To diagnose.
2 To work out a plan of inspection and treatment.
Task 2
Sick In., 8 years, appealed on the 2th day of disease. Temperature
of body of 39,0°С. Hyperemia of mucus shell of mouth-pharynx.
Pulse 110/minute. Other changes it is not discovered from the side of
internalss. An enhanceable temperature stuck to during 6 days, a
cough appeared, there is the hard breathing in lights. On a sciagram:
left-side focal pneumonia.CFT with a micoplasm antigen 1:80.
1 What is possible diagnosis?
2 Appoint treatment.
Task 3
Sick D., 50 years, entered hospital on the 2th day of illness with
complaints about head pain, dry cough, general weakness, pain, in
muscles. It is set that simultaneously with it diseased 2 workers of
43
bird’s factory. The general state of sick during a review is
satisfactory, temperature of body of 37,8°С, person, puffy, lymphatic
knots are megascopic,hepatosplenomegalia.
1 About what disease is it possible to think?
2 How to confirm a diagnosis?
Task 4
Sick K., 34, worker of poultry farm, appealed to the doctor with
complaints about the sudden increase of temperature to 38.0-39.0° of
С, chill, dry cough, with the selection of negligible quantity of mucus
sputum. Objectively: a skin is pale, a person is puffy with cyanosys
round a mouth. In urine proteinuria. On the sciagram of thoracal
organs of the focal darkening business is in the lower particle of
lights.
1 The signs of what disease are marked higher?
2 How to confirm a diagnosis?
3 Basic method of treatment?
Task 5
Patient Н., 35 years, appealed to the doctor with complaints about
a fervescence to 39 °С, sharp head pain is with localization in a
frontal area, superciliary arcs, muscles of total-body, oxycinesia
eyes, dry cough. Objectively: diffuse hyperemia of pharynx, dryness
of mucus, there is the hard breathing at аuscultative.
In a blood test: leucopenia, relative lymphocytosis due to
diminishing of neutrophiles.
1 To diagnose.
2 To work out a plan of inspection and treatment.
3 To work out a plan of treatment
Task 6
Sick K., 20 years, complains of blocking a nose, complication of
the nasal breathing and abundant water excretions from a nose. The
temperature of body is normal.
1 About what disease is it possible to think?
2 Give recommendation sick in relation to treatment.
Standards of answers are on a task
Task of I
1 Mikoplasmosis, pneumonic form, heavy motion.
44
2 Sciagraphy of organs of thorax, analysis of sputum, general
analyses of urine, blood, hepatic tests. Antibactrial therapy
(phtorchinolons,macrolides),
coughings
up,
desensitizing,vitaminotherapy but other
Task 2
1 Mikoplasmosis, pneumonic form, heavy degree.
2
Eritromicinum,emollient
inhalations,desintoxication
therapy,polivitamines.
Task 3
1 Psittacosis, middle degree of weight.
2 Selection of exciter from blood, sputum on chicken embryos,
cultures of cages; CFT or RGGA,immunoenzyme analysis; endermic
allergic test of Tersk.
Task 4
1 Psittacosis.
2 CFT.
3 Antibactrial therapy(tetracyclines).
Task 5
1 Flu.Typiform, middle weight.
2
Serum
diagnostics
–
reaction
undirect
hemaglutination,immunoenzyme analyses, increase of title in 4 and
anymore,pair wheys research on 1th and on 7-10th days of illness.
3 Warm drink,remantadinum,аrbidolum, vitamin С,polivitamines,
anticough facilities (codeine).
Task 6
1 Rhinovirus infection.
2 To avoid supercooling, 2 % Naphthyzinum for blocking nose,
steam inhalations through tube, vitaminotherapy.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection patient with a
psittacosis,micoplasmosis,legionelosis,acute
respiratory
viral
infectious.
45
 To conduct curation of patient with a psittacosis,
micoplasmosis, legionelosis, acute respiratory viral infectious.
 To conduct differential diagnostics of psittacosis,
micoplasmosis, legionelosis, acute respiratory viral infectious.
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection of patient with a
psittacosis, micoplasmosis, legionelosis, acute respiratory viral
infectious.
 To recognize complication of psittacosis, micoplasmosis,
legionelosis, acute respiratory viral infectious.
 To work out a plan of treatment patient with a
psittacosis,micoplasmosis,legionelosis,acute
respiratory
viral
infectious.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document in fact of establishment of
diagnosis of psittacosis, micoplasmosis, legionelosis, acute
respiratory viral infectious.
4.2 Professional algorithm in relation to forming of skills and
abilities of diagnostics of legionelosis,psittacosis,respirator
micoplasmosis,acute respiratory viral infectious
№
Task
Sequence of
A remark, warning, is in
implementation
relation to self-control
1
To lay hands 1 Complaints
on the
method of
clinical
inspection of
patient on
legionelosis
,micoplasmos
is, psittacosis,
acute
2 Anamnesis of
46
To separate complaints which
characterize syndromes:
- intoxication;
- catarrhal;
- defeat of respiratory tracts;
- gastrointestinal;
- rash;
- extralungs displays (arthritis,
myocarditis)
To pay a regard to beginning,
respiratory
viral
infectious
2
illness
term, sequence of origin of
symptoms, their dynamics:
- sharp beginning;
- from 2-4 days of the
impression
respiratory tracts;
- in the first days of illness
diarea, stomach-ache, nausea;
- gradual beginning;
- fatigueability is enhanceable;
- pain is in muscles and joints;
- connect catarrhal and intoxic
syndrome.
To find out the carried diseases
3 Anamnesis of Morbidity is during the flash
life
of acute respiratory viral
4 Epidanamnesis infectious;
- group morbidity of children
and young people is in
establishments of the closed
type;
- a disease arises up in warm
time of year;
- dwelling or work is in an
apartment with conditioners;
- dwelling is near the opened
reservoirs;
- contact with the birds of
exotic things, workers
poultry farms
To conduct a To conduct an
curation of
objective
patient
inspection
The expressed, dynamics of
symptoms, is predefined a
term and weight of flow of
illness.
1 General review To pay attention on:
47
- excitation;
- photophobia;
- grave general condition;
- chill;
- absence of respiratory
insufficiency;
- dry unproductive
cough;
-intoxication is poorly
expressed;
- pallor, cyanosys, change of
conduct, pouring out
hemorragic character;
2 Digestive
- intoxication is brightly
system
expressed.
To pay attention on:
- there is a stomach-ache;
- nausea;
- vomit;
- diarea;
3 Nervous system - hepatomegalia;
- hepatosplenomegalia
To pay attention on:
- parahypnosis;
- hallucinations;
- heavy language;
- confusing of consciousness;
- disorders of memory;
- appearance of meningeal
signs at heavy motion;
4 Sercevo- head pain
sudinna system
diffuse character
somnolence, euphoria.
To pay attention on
- muffling of tones of heart;
5 Respiratory
- bradicardia;
48
system
3
To appoint
laboratory
and
additional
researches
- hypotension;
- to possible symptoms of
myocarditis, pericarditis.
To pay attention on
- dry cough;
- there is a stethalgia;
- mucous festering sputum,
with blood;
- increase of breathing
frequency;
- respiratory insufficiency;
- rhinisporidios
tracheobronchitis;
- littleinforming information
from the side of lights;
- shortness of breath, laboured
breathing;
- to wheezing voice;
- stuffiness;
- bronchiolitis, bronchitis;
- Ringo, rhinorea;
- bright diffuse hyperemia of
pharynx;
- tracheitis;
- laryngitis.
1 General
To pay attention on:
analysis of blood - neutrophilic leucocytosis
with the change of leucocytic
formula to the left;
- megascopic ESR;
- lymphocytosis;
- monocytosis;
- normal ESR;
- anaemia
2 General
- Proteinury;
49
analysis of urine
3 Serum
hemanalysis
selection of
exciter from
sputum, pleura
liquids
- hematury;
- moderate аlbuminuria;
- cylinders, tracks of albumen;
- without changes.
- A presence of antibodies is in
RNIF, selection of culture of
exciter;
- specific antibodies, antigens
of exciter
receipt of culture
exciter;
- microscopy of strokes,
painted after
RomanovskimGimze;
- a selection of viruses is from
washings off of nasopharynx
by infecting of chicken
embryos
but pochard of human embryo;
- polimerase chain reaction
Materials of after audition independent work
Subject of UDRS and NDRS
• Features motion of legionelosis,micoplasmosis,psittacosis,
SARS,acute respiratory viral infection in modern terms.
•
Modern
methods
of
specific
diagnostics
of
legionelosis,micoplasmosis, psittacosis, SARS, acute respiratory
viral infection .
• Problems of etiotropic treatment of legionelosis,micoplasmosis,
psittacosis, SARS, acute respiratory viral infection.
• Modern looks to pathogeny of legionelosis,micoplasmosis,
psittacosis, SARS, acute respiratory viral infection.
50
Topic.
HERPESVIRUS
INFECTION.
GENERAL
DESCRIPTION
OF
HERPESVIRUS
INFECTIONS,
ETIOLOGIC
STRUCTURE,
PLACE,
INFECTIOUS
PATHOLOGY. INFECTIONS, CONDITIONED VIRUSES OF
HERPES SIMPLEX OF HSV-1 AND HSV-2. WINDY POX
AND GIRDLE HERPES
Duration - 2 hours.
1 Actuality of theme. Herpesvirus infection belong to the most
widespread virosiss. From data of global review of herpesvirus
researches, the infected and morbidity of humanity from year to year
grows more than on 10 %, and 90 % grown man and child's
population in the entire countries of the world infected one or a few
сserovariantes of herpesviruss. From data WHO, diseases, caused
the viruses of ordinary герпесу, occupy the second place (15,8 %)
after a flu (35,8 %) in the structure of morbidity and death rate at
viral infections. Suffer recurrent герпесвірусними diseases from 2 to
12 % people which need help during all of life.
Gerpesvirus infection - one of most widespread in the world. In
the developed countries of Europe this infection the third of
population is ill.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
 etiology of herpesvirus infections, factors
 pathogenicity of exciter;
 epidemiology of herpesvirus infections;
 pathogeny;
 clinical displays of herpesvirus infections;
 pathogeny, term of origin and clinical
complications of herpesvirus infections;
 laboratory diagnostics of herpesvirus infections;
 principles of treatment;
 principles of prophylaxis;
51
displays
of
 tactic of conduct of patients in the case of origin of the exigent
states;
 prognosis of herpesvirus infections;
 governed extracts of reconvalescentes from permanent
establishment;
 governed the health centre system of reconvalescentes.
2.3. A student must be able:
 to adhere to the basic rules of work near a bed sick on a
herpesvirus infection;
 to collect anamnesis of illness with the estimation of
epidemiology information;
 to inspect a patient and find out basic symptoms and
syndromes of herpesvirus infections, ground a clinical diagnosis for
timely direction of patient in permanent establishment;
 to conduct differential diagnostics of herpesvirus infections;
 on the basis of clinical inspection in good time to recognize
possible complications of herpesvirus infections, exigent states;
 to design a medical document in fact of establishment of
previous diagnosis "herpesvirus infection";
 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 term of illness;
 to work out an individual plan of treatment taking into account
epidemiology information, stage of illness, presence of
complications, weight of the state, allergist anamnesis, concomitant
pathology; to render the first aid on the before hospitalization stage;
 to work out a plan of disease and prophylactic
 measures in the hearth of infection;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescence
3 Materials are to audience independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
52
Disciplina
To know
Able
Previous disciplines
Microbiology
Properties of Nsv-1, Nsv-2,
VZV; methods of specific
diagnostics of herpesvirus
infections
To interpret the
results of specific
methods of
diagnostics
Physiology
Parameters of physiology To estimate
norm of organs and systems information of
of
man;
indexes
of laboratory inspection.
laboratory inspection are in a
norm (general analysis of
blood, urine, biochemistry of
blood, parameters of acidbasic status, electrolytes and
others like that).
Physiopathology A mechanism of violation of
functions of organs and
systems is at the pathosiss of
different genesis.
To interpret
pathological changes
as a result of
laboratory inspection
at parafunctions
organs and systems of
different genesis.
Immunology
Basic concepts of object,
and allergology role of the system of
immunity in an infectious
process, influence on the
term of еlimination exciter
from the organism of man.
Immunological aspects of
chronic viruscarry.
To estimate
information of
immunological
researches.
53
Epidemiology
Epidproces (source,
mechanism of infection,
ways of transmission) of
herpesvirus infections;
prevalence of pathology in
Ukraine and in the world.
To collect
epidemiology
anamnesis.
Prophylactic
measures.
Neurology
Pathogeny, clinical signs of
herpetic encephalitis,
meningitis, myelities
To conduct the
clinical inspection of
patient with the defeat
of the nervous system.
Dermatology
Pathogeny, clinic and stages To recognize a rash
of development of
for a patient with
noncommunicative
герпес.
herpesvirus (herpetic
vesicules)
Ophthalmology Pathogeny, clinical displays To conduct the
of оphtalmoherpes.
clinical inspection of
patient with the defeat
of organ of sight.
Propedevtic of Methods and basic stages of To collect anamnesis,
internal illnesses clinical inspection of patient. conduct the clinical
inspection of patient,
find out pathological
symptoms and
syndromes. To
analyse findings.
Clinical
pharmacology
Pharmacocinetics,
To appoint treatment
pharmacodynamics and side depending on age,
effects of antiviral
individual features of
54
preparations, natural
antioxidants, preparations of
interferon,
іmmunomodulators,inhibitirs
of prostaglandines.
patient, to choose the
optimum mode of
reception and dose of
preparation, write
recipes.
Next disciplines
Family
medicine
Pathogeny, epidemiology,
dynamics of clinical
displays, complications of
herpesvirus infections are
possible. Features of clinical
motion of herpes simplex
and girdle herpes. Principles
of prophylaxis and
treatment.
To conduct
differential
diagnostics of
illnesses of different
genesis with a
herpesvirus infection.
To recognize a
herpesvirus infection,
its complication; to
interpret information
of laboratory
inspection. In good
time to hospitalize a
patient in infectious
permanent
establishment. To
render the first aid in
the case of necessity.
Intradiscipline integration
Infectious
diseases.
Principles of diagnostics,
treatment, prophylaxis of
infectious diseases.
Pathogeny, epidemiology,
dynamics of clinical
displays, laboratory
55
Diagnostics of
herpesvirus infection
with other infectious
diseases. To
recognize herpesvirus
infections, its
diagnostics, complications of
herpesvirus infection are
possible. Features of clinical
motion of simple герпесу
and girdle герпесу.
Principles of prophylaxis
and treatment.
complications; to
interpret information
of laboratory
inspection. To appoint
treatment. To render
the first aid on the
before hospitalization
stage.
3.2 Structurally logical charts of maintenance of theme of employment
plan diagnostics and treatment of herpes girdle (Herpes zoster)
56
Epidemiology anamnesis:
- contact with a sick man and viruscarry; can to infective contact or sexual way, of kiss;
chiefly winter-spring period
- ganglio-cutaneus form: start sharp , with fever , symptoms of general intoxication and sharp baking
pain in area future rash . After 3-4 days (sometime only after 10-12 days) appear characteric
rash.Localization of pain and rash appropriate damage nerves (often intercostal) and have around
character. On area of vesicule rash on the start appear іnfiltration and hyperemia cutaneus,after this
appear vesicules, fulling clear, then dull liquid.Vesicules drying . When ekzantema appearі a pain was
decrease .
- Оphtalmo- form: damage trigeminus node (gaser’s nod) and rash lokalization for course of branch
nerve trigeminus (on mucous of eyes, nose,on skin of face ).
- Ear’s fprm: in process thread through a joint’s nod, a rash appear on auricula and around. May be a
paralise nerve facialis. Watch a general intoxication and fever . Sharp expres neuralgia nerve
trigeminus, which duration about some weeks .
- gangrenose (necrotic) form: watch deep damage of skin with formation scars,very hard run across.
- Мeningoencephatic form: hard run across , a damage begun with ganglio-cutaneus signs,often in
area intercostals nerves. Then appear symptoms meningoencephalitis,meningeal symptoms (аtaxia,
hemiplegia, may be a coma). Term from appear еkzantem for genesis еncephalopathy – from 2 days
for 3 weeks
- reaction іmmunolumen; virusologic:extract virus on culture of cells and tissues (вміст
vesicules, saliva, scrape of ceratum, blood, liquor); serologic diagnostic (immune enzyme
analysis, CFT, RN)
Differention diagnosis from wind pox , еkzema,
еnterovirus herpangina,anthracis,аdenovirus
ceratoconunctivitis, herpes simplex ,erysipelas,
- determination end diagnosis with
calculate forms, hard,lokalization
p
- bed’s regime; local: оxolinum, tebrophen and reapheron ointment; mucus coats urinate of solution
reapheronum,lapheronum,leucocytic іnterferonum, novocainum; for ophtalmoherpes in conunctive
drip of solution іnterferonum, іdosucridine; middle hard and hard run across : reaphernum
(lapheronum) 1000000 ED i/m 1-3 times on a day ; for general form : dexametasonum 1,5 mg/kg on
day; іmmunomodulators;desintoxication therapy
- decrease clinical symptom or durable remision; normalization laboratory indexes
dispanserization:
- for recidive herpes make 3 courses therapy herpvaccine, which input,begin with 0,1-0,2 ml
intracutaneus 2 times on a week ,slowly increase dose for 1,0; course include 5-10 іnjection
plan diagnostics and treatment of herpes simplex (Herpes simplex)
Epidemiology anamnesis:
57
contact with sick man and viruscarry ;can to way of infection contact, sexual, vertical;
chiefly winter-spring period
Typic form herpes of skin: to feel of baking, pricking, itching, hyperemia; appear uniting subspheric
vesicules 1,5-2 mm on background еrytem and edema ,which contents can muddy, begin hemoragic ;to open
vesicules,appear erosions – bottom soft, damp,smooth:. Can to infection and appear in a future ulcers ;
contents vesicules drying, ;moving a peel and on this place appear slowly disappear еrytema with brown
colour.
Primary herpes in 80-90 % run across in unsymptoms form. Іncubation period 2-12 days. A clinical is
expresed watching in children 6 monthes - 5 years and expresed in apperance аftosis stomatitis,accompany
big damage mucous coat mouth cavity, hard general іntoxication syndrome. Often watching formes, that run
across as ARD-type.Recidive herpes run across often with damage of skin .Lokalization is different. Damage
can be fixation and migration. Rash usually is after edema, hyperemia, itching and baking. Typic rash –
group small vesicules on general edema background. Contents of vesicule is clear on the start, then begin to
muddly. Vesicules open , appear еrosion, which cover a peel. Peel tear off, don’t leave scars. All process
durind 5-7 days.Can watching moderate fever , shivering, moderate іntoxication. In men with immunodeficite
– herpes can have general character .
Оphtalmoherpes–dermatitis brows,blepharitis, blepharoconunctivitis, conunctivitis; herpetic ceratitis
(vesicular, ,ulcer of cerate, ceratouveitis .); herpetic uveitis,uveitis (іritis, іridociclitis, chorioretinitis,herpetic
nevritis ); postherpetic ceratopathy (еpilial). Оphtalmoherpes often complicate a background disease and
metabolic damage of tissues of eyes,increaseinternal pressure and second glaucome, damage clearing iris and
genesis cataracta .
Damage mucos coat : fever, baking in the place of damage, onmucous cheeks, palatinas, lounger, appear
vesicules with clear contents, which after 2-3 days genesis in erosion. Can run across as aftosis stomatitis .
Herpetic encephalitis and meningoencephalitis begin sharp with increase temperature for 39-40 °С,
vomiting, strong headeche. With a first days appear meningeal symptoms, pathologic reflexes , darken of
mind . Then appear paresis and paralisesі.In liquor have limphocytic pleocytosis with increasing of protein
RIF, virusologic extract virus on culture of tissue (contents of vesicules,saliva,
scrape of cerate, blood, liquor), serologic diagnostic (CFT, RN)
- determination end diagnosis with
calculate form,hard, localization
Different diagnostic with windy pox ,erysepelas,anthracis,
еnterovirus herpangina , еkzema, damage of eyes and CNS of
other etiology
- bed’s regime; local: оxolinum,tebrophen and reapheron ointment; mucous coats weting of solution
reapheronum, lapheronum,leucocytic іnterferonum, novocainum; for оphtalmoherpes in conunctive drip
solutionof interferonum, іdosucridinum; middle hard and hard run across: reapheronum 1000000 ED
i/m 1-3 times on day ; of general form: dexametazonum 1,5 mg/kg on day ; іmmunomodulator;
desintoxication therapy , herpetic polivaccine : 0,2 ml i/c 2 times on a week , course 5-10 іnjection
- decreaseclinica symptoms or steadfast remission; normalization laboratory indexes
Plan of diagnostics and treatment of windy pox (Varicella
dispanserization:
Epidemiology anamnesis:
Persons which carried herpetic meningitis and encephalitis are looked after by a neurologist,
оphtalmoherpes - oculist.For the patients which suffer on the frequent relapses of herpes the course
polivaccine is repeated through each by 3-6 months during 58
3-5 years.
- a contact is with a man, patient with a windy pox or girdle herpes; children are more frequent ill from 5 to 9 years; - mainly winter-spring
period
-beginning is gradual from the moderato expressed weakness, indisposition, subfebril
temperature; appearance on the skin of veziculese ekzantem: a stomach, shoulders, breasts,
overhead and lower extremities, is struck above all things, then person and hairy part of
chairman; periodicity of pouring out with an interval at 24-48 o'clock; new elements appear
between old their general amount increased; at first the spot of oval form appears diameter
from 5 to 10 mm, then a papula which transforms appears in the center of spotwhich grows into
vezicule, filled a transparent liquid; vezicules have a various form (rounded, oval) and sizes
from 8 to 10 mm, untense; after the second days a crust which from a 6-8th day falls off
appears in place of vezikules, not abandoning after itself scars, sometimes content of vezikules
becomes cloudy, pustula appears; appearance vezikulese enantems on mucus shells; enantema
is localized on a hard palate, on the mucus shells of cheeks, gums, language, on the back wall
of pharynx, and it can for girls can appear on the mucus shells of privy parts; vindy poxe’s
vezicules is quickly damaged and form small superficial erosions
- painting of content of blisters or pustul for Romanovskim and microscopy (exposure of
little bodies of Aragona); immuno enzyme analysis; CFT from 4-multiple by the increase
of title of antibodies
- windy pox, typiform, heavy
motion, meningitis;windy pox,
general form, heavy motion
A differential diagnosis is with vezikuleznim
riketsiozom, herpetic infection, girdle herpes,
bites of insects, pliers, fleas
- bed mode by a term on 1 week; natively 5-10 % potassium permanganat solution or 1 % solution
diamond green; etiotropic therapy (heavy motion and general forms): i/v vidarabin in a dose 15 mg/kg on
days as protracted (about 12 hours) intravenous infusion; leycocyte human interferon, reaferon,
immunoprotein; polivitamines, desensitizing and symptomatic preparates; presence of pustulosis rash antibiotics
disappearance of clinical symptomatic, but not early than a 5th day from the moment
of the last rash; normalization of laboratory indexe
- for clinical requirementes (general forms)
59
3.3 Literature is made to order
Basic
 Vozianova Z.I. the Infectious and parasitogenic diseases: 3 т.
- K.: of Health, 2001. - Т. 2. - P. 540 - 542.
Additional
• The adults (clinic, diagnostics and intensive therapy) /А.О
have a herpetic encephalitis. Rudenko, L.P. Chepkiy, O.O. Yarosh
and co-author.: Method, recommendations for ministry of health
Ukraine.K., 2003. - 40 p.
• Chemich M.D., Ilina N.I, Binda T.P., Trocka I.O. ТОRСНіnfection: clinic, diagnostics, treatment.:Sumi: publish house
SUMDU, 2004. - p. 36-52.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 What group of infectious diseases does a herpesvirus infection
belong to?
2 Ways of passing to the herpesvirus infection?
3 Etiology and epidemiology of herpesvirus infection.
4 Pathogeny of herpesvirus infection.
5 Classification of herpesvirus infection.
6 Stages of development of herpetic vesicules.
7 Basic clinical displays of noncommunicative herpes.
8 Primary herpes.
9 Recurrent herpes.
10 Girdle herpes.
11 Features of motion оphtalmoherpes.
12 Forms of herpetic infection are with the defeat of the nervous
system.
13 Sharp herpetic meningitis.
14 To describe the defeat of spinal cord at a herpetic infection.
15 Born herpetic infection.
16 Consequences of herpetic infection.
17 Principal reasons of lethality herpesvirus infections.
18 There is a plan of inspection patient with a herpesvirus
infection.
19 Methods of specific diagnostics. Interpretation of results.
60
20 Principles of setting of antiviral therapy.
21 Etiotropic therapy of herpetic infection: doses, way of
introduction, duration of treatment.
22 Treatment in a sharp period of disease and during a relapse.
23 Therapy in the stage of remision.
24 Prophylaxis of herpesvirus infection.
3.4.2 Tests are for self-control
To choose right answers
1 The exciter of girdle herpes is:
A - herpesvirus, type 3;
B virus of windmill/zoster
C virus of zoster/herpes 1
D virus of zoster/herpes 2
E- cytomegalovirus
F virus Epshteyn-Barr
2 Girdle herpes mainly are ill:
A persons of declining and senior years
B - put early age
C - put school age
D persons which were not ill a windy pox
E- receptivity is high in all of age-dependent groups
3 Dangerous patients girdle herpes?
A - so, for persons which were not ill a windmill
B - no
C - so, for little children
D - so, for persons old years, hyposthenic
E- so, for persons which were ill on a windy pox
4 At girdle herpes the followings nervous structures are more
frequent all struck, except for:
A - гангліву in the front counterfoils of spinal cord
B - гангліву in the back counterfoils of spinal cord
C - trifacial
D - nervous barrels of spinal cord
E- knee knot
5 A latent period is at the persist form of girdle herpes:
A - a lot of years
61
B - 7-14 days
C - 14-17 days
D - 30 days
E- 1 year
6 There are all of symptoms at the hanglioctaneus form of girdle
herpes, except for:
A hepatosplenomegalia
B fevers
C intoxications
D - vesicules for the step of nervous barrels
E- girdle unbearable pain in the staggered area
7 At an eye form of girdle herpes of vesicules localized:
A - for the step of n.trigeminus
B - for the step of n. trohlearis
C - for the step of n.осиlomotorius
D - for the step of n. hipoglossus
E- for the step of n.abducens
8 At ordinary and girdle herpes taking into account their clinical
form it is necessary to eliminate the followings diseases, except for:
A - to the psittacosis
B – windy pox
C бешихи
D anthracis
E- enterovirus herpangina
9 A herpetic infection is caused:
A - simplex virus/ variocella zoster
B - cytomegalovirus
C - the virus of windmill
D - virus Epshteyna-Barra
E- пеuroryctes rabies
10 The ways of transmission of exciter of herpetic infection are
such, after an exception:
A - аlimental
B - air-drops
C - pin, sexual
D - transplacental
62
E- wound (parenterally)
11 Replication of virus of ordinary herpes takes a place in:
A - epidermis
B - neurons
C - cylinder epithelium of overhead respiratory tracts
D - mucus shell of genitals
E- limphoid tissue
12 Typical localization of herpes simplex
A - round a mouth, on lips, on the wings of nose
B - in the axillar area
C - for the step of intercostal nerves
D - after ears
E- on eyelids
13 Elements of skin from ordinary herpes:
A vesicula, erythema
B papula
C roseola
D pustula
E- urticars
14 Herpetic stomatitis clinically shows up the followings
symptoms, except for:
A general lymphadenopathies
B fevers, intoxications
C feeling of heartburn and pricking of mucus mouth
D - grouped shallow blisters on mucus cheeks, sky, gums
E- abundant salivation, bad smell from a mouth
15 Genital herpes has the followings clinical symptoms, except
for:
A - symptoms of аdnexitis
B - febricula, subfebril temperature
C – pain in down of stomach, diuria phenomena
D - symptoms of vaginitis
E- vesicules on the neck of uterus, vagina, urethra
16 Ophtalmoherpes clinically shows up the followings forms,
except for:
A glaucomas
63
B - herpetic keratitis
C - еpiteliosis
D - parenchimatosis keratitis
E- regional helcoma
17 For visceral herpes all are struck organs are adopted, except
for:
A spleens
B pochard
C - pancreas, liver, lights
18 For etiotropic therapy of herpetic infection utillize:
A - аcyclovirum
B - vaccine
C Sulfanilamidums
D antibiotics
E preparations of Bi
19 With the purpose of specific therapy of herpetic infection
utillize:
A - herpetic vaccine
B herpetic toxoid
C herpetic immunoprotein
D - herpetic plasma
E donor immunoprotein
20 Classification of herpes simplex is conducted after the
followings criteria, except for:
A - complications
B are frequencies
C are localizations
D is forms
E- to prevalence
21 General herpes more frequent all develops in:
A - new-born, patients with HIV-infection
B - patients which got antibiotics long
C - patients with helminthisms
D - patients with a windmill
E- patients from limpholeucosis
64
22 For local treatment of vesicule for ordinary herpes such
remedies are used, except for:
A levomicetinum ointments
B oxolinum ointments
C tebrophenum ointments
D reapheronum ointments
E- phucorcinum
23 Diagnostics of herpetic infection is based on the followings
researches, except for:
A - bioassey
B - virologic research
C - clinical signs of illness
D cytologic research
E- CFT, RN
24 After prevalence herpes simplex is, except for:
A - genital
B - limited
C - widespread
D - general
E- general with the defeat of CNS
25 Atipovi forms of herpes simplex , except for:
A - with the defeat of CNS
B - abortive
C - oedematous
D - zoster form
E - hemorragic
26 Stages of development of herpetic blisters, except for:
A papulae
B erythemas
C vesicules
D formation of crust
E vesicules, erythemas
F ulcers
Standards of right answers
65
1 – B; 2 – A; 3 - A; 4 - A; 5 - A; 6 - A; 7 - A; 8 - A; 9 - A; 10 - A;
11 - A; 12 - A; 13 - A; 14 - A; 15 - A; 16 - A; 17 - A; 18 - A; 19 - A;
20 - A; 21 - A; 22 - A; 23 - A; 24 - A; 25 - A; 26 - A
3.4.. A task is for self-control
Task 1
Patient Н., 16 years, by an ambulance was hospitalized to the
hospital with complaints about a head pharyngalgia, fervescence to
39°С, chill, pain,, cold. It is ill during 3 days, treated oneself
independently, for medical help did not apply. At the review of
patient: on the skin of roseolose rash, phenomena of one-sided
conjunctivitis, pellicle tonsillitis. Clinical blood test: eras. 4,5х1012/l,
general protein 120 g/l, leuk. 5,0х109/l, е 2 %, s 60 %, st 5 %, l 25 %,
m 8 %, ESR 15 mm/hour, tr. 200х109/l.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick Z. Make plan of treatment.
Task 2
Patient A., 42, hospitalized in a hospital on the 10th day of illness
with complaints about the increase of temperature, head pain,
pouring out and great pain, for the step of intercostal nerves. At an
inspection in intercostal intervals the discovered is grouped blisters,
covered crusts, are present also blisters with transparent and turbid
maintenance.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
From to Work out a plan of treatment.
Task 3
Sick P., 19 years, student, appealed to the induction centre of
permanent establishment with complaints about great head pain in a
temporal area, increase of temperature to 38°С, smarts are sharply
expressed during a talk in the left half of person, rash. Anamnesis: ill
sharply. After supercooling the temperature of body rose to 38°С,
pains appeared in the left half of person.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
From to Work out a plan of treatment.
Standards of faithful answers
66
Task 1
1 Primary girdle herpes, spiral form, typical motion, middle
weight.
2 Serum research: immunoenzyme analysis, CFT (method of pair
wheys),cytologic research of maintenance of blisters for the exposure
of including of virus.
3 Natively - оxollinum,tebrophenum ointments, ointment of
"Zoviraks", аcyclovirum 4 gr on days during 7 days, levamisole 0,15
gr 1 time per 4 days or cyclopheronum after a chart.
Task 2
1 Primary girdle herpes, craniocerebral form, typical motion,
middle degree.
2 Serum researches: IFA (Ig M, Ig G), Reaction undirect
hemaglutination, RN, CFT (with pair wheys).general clinical blood,
urine tests.
3 Natively – fucorcinum,unguentum"Aciklovir","Gerpevir".
Zoviraks for 800 mg 5 times per days 5-7 days. Desensitizing
preparations;desintoxication
therapy,
іmmunomodulator
(cyclopheronum, levamisole).
Task № 3
1 Primary simple noncommunicative herpes is with the defeat of
skin, middle degree.
2 Serum researches: method of fluorescent antibodies (strokes imprints research for vesicules), CFT,reaction solid hemaglutination
with pair wheys, immuno enzyme analysis - Ig M to the virus of
herpes simplex .
3 Gerpevir for 0,2 5 times per days during 5 days, natively is
ointment
of
"Gerpevir",fucorcin,desensitizing
preparations,
cyclopheron after a chart.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection patient with a
herpetic infection.
 To conduct a curation of patient with a herpetic infection.
67
 To conduct differential diagnostics of disease.
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection of patient with a
herpetic infection.
 To recognize complication of herpetic infection.
 To work out a plan of treatment patient with a herpetic
infection.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document.
4.2 A professional algorithm is in relation to forming of skills
and abilities of diagnostics
№ Task
Sequence
A remark, warning, is in
п/п
implementation relation to self-control
1
2
To
lay
hands on
the method
of clinical
inspection
of patient
on
a
herpesvirus
infection
To conduct
a curation
of patient
I to Find out the To separate complaints which
complaints
of characterize syndromes:
patient
- general intoxication
- organ defeats to Pay a regard to
gradual beginning, term, sequence
of origin
ІІ to Find out dynamics:
anamnesis
- fevers;
1 Anamnesis of - head pain;
illness
- parahypnosiss;
- vomiting;
- cramps;
-appearance of the grouped
semispherical blisters on a
background erythema and edema;
- appearance of erosion;
- other symptoms. To find out the
carried illnesses.
Find out information in relation to
realization of contact or air- tiny
68
2 Anamnesis of
life
3
Epidanamnesis
ІІ to Conduct an
objective
inspection:
1
General
review:
- general state of
patient
2 Skin
3 Mucus shells:
- review of oral
cavity;
- review of eyes;
- review of
overhead
respiratory
tracts;
- review of
privy parts.
mechanism
of transmission, to
pay a regard to stay of patient in a
contact from herpesviruses by
patients or presence of this disease
for a patient in the pas.
To remember: a presence,
expressed, dynamics of symptoms,
is predefined a term and weight of
flow of illness, depend on age
sick, concomitant pathology.
To pay attention on:
- presence, localization, character
of rash.
To pay attention on:
- presence of vesicule - erosive
gingivostomatitis;
presence
of
keratitis,ceratoconunctivitis;
- presence of display of ARD;
presence of urethritis, cervicitis, to
the vulvovaginitis.
To pay attention on:
presence of signs
of herpetic
encephalitis;
- presence of signs of meningitis;
- presence of signs of myelities;
- syndrome of Giyen-barre;
- syndrome of paralysis of Landri;
- syndrome of parkinsonism;
- a syndrome is BASS.
69
4
Nervous
system
of
patient
3
To appoint
laboratory
and
additional
researches,
interpret
results
1
General To pay a regard to typical
analysis
of changes:leucopenia,mononucleosis
blood
with a lymphocytosis, anaemia.
Absence of considerable changes
is at typical motion.
2
General Appointed regardless of term of
analysis of urine illness.
3
Serum Determination of specific анти –
methods
Nsv Ig M; determination of
specific antibodies of class Ig M;
PLR for determination of DNK
Nsv in blood, neurolymph, saliva,
to the tear and others like that.
Materials of outside independent work
Subject of UDRS and NDRS:
• Features of motion of herpetic infections are in modern terms.
• Modern methods of specific diagnostics of herpetic infections.
• Problems of etiotropic treatment of herpetic infections.
70
Topic. HERPES VIRUS INFECTION.
EBV-ІNFECTION AND СМV-ІNFECTION. INFECTIOUS
MONONUKLEOSIS
Duration – 2 hours.
1 Actuality of theme. After the level of prevalence VPG occupies
one of first place-almost 90 % the population of earth is infected this
virus. Herpes simplex makes the special danger for new-born
children - perishes about 30 % babies which was infected during
births or in the first days after birth. Set also, that virus herpes
simplex can become reason of оncogenic transformation, more
frequent all the display of which is carcinoma for neck of uterus. In
Ukraine a fight against this infection is bothered by absence of order
about its obligatory registration.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
 etiology
of
ЕВV-іnfection,CMV–infection,infectious
mononucleosis;
 epidemiology of herpesvirus infections;
 pathogeny;
 clinical displays of EBV-, СМV-іnfection, infectious
mononucleosis;
 classification of СМV-іnfection ;
 laboratory diagnostics;
 principles of treatment;
 principles of prophylaxis;
 tactic in the case of origin of the exigent states;
 prognosis of herpesvirus infections;
 governed excerption of reconvalescetes from permanent
establishment;
 governed the health centre system of reconvalescentes.
2.2 A student must be able:
а-3
 to adhere to the basic rules of work near a bed sick;
71
 to collect anamnesis of illness with the estimation of
epidemiology information;
 • to inspect a patient and find out basic symptoms and
syndromes of ЕВV-іnfection and CMV–infection, infectious
mononucleosis, ground a clinical diagnosis for timely direction of
patient in permanent establishment;
 to conduct differential diagnostics;
 on the basis of clinical inspection in good time to recognize
possible complications;
 to design a medical document in fact of establishment of
previous diagnosis (an urgent report 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 information, weight of the state, presence of
complications, allergist anamnesis, concomitant pathology; to render
the first aid on the before hospitalization stage;
 to work out a plan of disease and prophylactic measures in the
hearth of infection;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescentes
 3 Materials are to audience independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties of CMV, EBV To interpret the results
of specific methods of
diagnostics of ЕВVіnfection,CMV–
infection,infectious
72
mononucleosis
Physiology
Parameters of physiology To estimate information
norm of organs and
of laboratory inspection
systems of man; indexes
of laboratory inspection
are in a norm (global
analysis of blood, urine,
biochemistry of blood,
parameters of KOS,
electrolytes and others
like that)
Physiopathology A mechanism of violation
of functions of organs and
systems is at the pathosiss
of different genesis
To interpret pathological
changes as a result of
clinical and laboratory
inspection
Immunology
Basic concepts of object, To estimate information
and allergology role of the system of
of immunological
immunity in an infectious researches
process, influence on the
term of елімінації of
exciter from the organism
of man
Epidemiology
Epidemic process (source,
mechanism of infection,
ways of transmission) at
CMV, EBV - infections;
prevalence of pathology
in Ukraine and in the
world
To collect epidemiology
anamnesis,
conduct
disease and prophylactic
measures in the hearth of
infection
Neurology
Pathogeny, clinical
To conduct the clinical
73
syndromes of disease
inspection of patient
with the defeat of the
nervous system
Propedevtic of Basic stages and methods To collect anamnesis,
internal illnesses of clinical inspection of conduct the clinical
patient
inspection of patient,
find out pathological
symptoms and
syndromes. To analyse
findings
Clinical
pharmacology
Pharmakokinetics and
pharmacodynamics, side
effects of facilities of
specific nosotropic
therapy
To appoint treatment
depending on the degree
of weight of motion,
individual features of
patient.
To write recipes
Next disciplines
family medicine Pathogeny, epidemiology,
dynamics
of
clinical
displays, complications of
infectious diseases are
possible. Principles of
prophylaxis
and
treatment.
74
To conduct differential
diagnostics of illnesses
of different genesis. To
recognize an infectious
disease, his
complication; to
interpret information of
laboratory inspection. In
good time to hospitalize
a patient in infectious
permanent
establishment. To render
the first aid in the case
of necessity.
Intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics,
treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics
of
clinical
displays,
laboratory
diagnostics,
complications
of
infectious diseases are
possible.
75
To conduct differential
diagnostics of illnesses
of different genesis. To
recognize an infectious
disease, his
complication; to
interpret information of
laboratory inspection. To
appoint treatment. To
render the first aid on the
before hospitalization
stage.
3.2 Structurally logical chart of maintenance of theme of employment
Chart of diagnostics and treatment of infectious mononucleosis (Mononucleosis infection)
Epidemiology anamnesis:
- socializing with persons, which were ill ARD, by a flu or quinsy;
- more frequent young people and to put
- sharp beginning of illness – from a chill, high temperature, pharyngalgia, head
pain, general weakness;
- long duration fever;
- tonsillitis;
-a lymphadenopathy;
-gepatosplenomegalia
- general analysis of blood (leucocytosis with predominance of uninuclear cells,
limfomonocytosis, atypic mononukleares (more than 10%); it is a reaction of
Paul-Bunnelya, Lavrika-Devidsona, Goffa-Bauera
- determination of the final unfolded
diagnosis (weight, form of illness and
complications
Differential diagnosis with quinsies,
diphtheria, adenovirusnoy infection, sharp
leucosis, rabbit-fever, viral hepatitis, by a tifoparatyphoid by diseases, by a
megacaryoblastoma and other
- rinse of oropharynx;
- nosotropic – dezintoksication, antihistaminics (vitamins groups B, C);
-symptomatic therapy;
-cardiac glycosides and other.;
-preparations which stimulate leucopoesis;
-in heavy cases are antibiotics (benzilpenicilin, cefalosporini), corticosteroides
- disappearance of clinical simptomatc;
- normalization of gemogrami
- during 6-12 months for presence of remaining changes of peripheral blood
76
Plan of diagnostics and treatment of cytomegalovirus infection (Cytomegalia)
Epidemiology anamnesis:
contact with patients or rekvalescentes; infection of fetus from a sick mother;
it is a leadthrough of parenterally manipulations, blood or its preparations
transfusion
- local form: sialoadenit.
-Mononucleosis-like form: general intoxication, splenomegalia, fever, tonsillitis.
-Visceral form: hepatitis, pneumonia, encephalitis, gastroenteritis.
-Generalisation form: lymphadenopathy, gepatosplenomegalia, fever, presence of other
defeats, heavy motion.
Congenital form : icterus, gepatosplenomegalia, trombogemoragic syndrome, making
progress anaemia, defects of development.
-For HIV-infection: fever, weakness, sweating, mialgia, artralgia, trombocytopenia,
leucopenia, larg number of mononucleares
- cytoscopy (urine, bioptate, organs);
- virusologic research;
- serologic research: CFT, reaction undirect hemaglutination (increase index in
4 times);
- RIFA ( аntybody, tieing with ІgМ)
formulation of final diagnosis is
with pointing of form, motion,
weight and complications
Differential diagnosis with gemolitic icteruses,
toksoplazmosis, listeriosis, lues, sepsis
etiotropic therapy (laferon, neovir, foskornet);
-imunostimulate therapy;
-vitaminotherapy;
a human immunoprotein (to pregnant in the first three months of pregnancy)
- disappearance of clinical symptomatic;
- normalization of laboratory indexes
- for clinical requirementes
77
3.3 Literature is made to order
Basic
• Vozianova zh.I. the Infectious and parasitogenic diseases: 3 т. –
K.: of Health, 2001. – Т 1 - p. 433 – 457.
• Infectious diseases: Textbook / For an editor Titova M.B. – K.:
Higher school, 1995. – P. 89 – 97.
• Superviser for infectious diseases / for editor U.V. Lobzina Spb: Foliant, 2003. – 1040 P.
• Shuvalova E.P. Infection diseases. Rostov of l/D.: Feniks, 2001.
– 959 P.
Additional:
• Gavrisheva N.A., Antonova T.V. Infection process.Clinical and
pathophisiologic problems.- Spb.: Special literature, 1999. – 255 p.
• Clinical-laboratory diagnostic infectious diseases:Superviser for
doctors. - Spb.: Foliant, 2001. – 384 p.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 Feature of exciters of ЕВV-іfectious,CMV–infection, infectious
mononucleosis.
2 Source of infection and ways of transmission of exciters of these
illnesses.
3 Pathogeny of ЕВV-іnfection,CMV–infection,infectious
mononucleosis.
4 Classification of ЕВV-іnfection,CMV–infection,infectious
mononucleosis.
5 Clinical displays of ЕВV-іnfection.
6 Clinic of purchased CMV–infection.
7 Clinic of infectious mononucleosis.
8 Specific complications.
9 A differential diagnosis of illnesses is with the overwhelming
defeat of skin.
10 Plan of inspection sick.
11 Methods of specific diagnostics. Interpretation of results of
laboratory research.
78
12 Specific therapy: doses, way of introduction, duration of
treatment.
13 Principles of the first aid.
14 Governed extracts of reconvalescentes from permanent
establishment.
15 A prophylaxis and measures is in a cell.
3.4.2 Tests are for self-control
To choose right answers
Variant 1
1 herpesvirus іnfection belongs to :
A - food toxicoinfection
B - bloody infections
C - enteroideas
D – infections of skin covers
E- food intoxications
2 Exciter of infectious mononucleosis:
A treponema pallidum
B virus Epshteyn-barra
C - Vibrio cholera
D - Clostridium perfringens
E- Clostridium botulinum
3 A source of infection CMV:
A food products
B man
C water
D weed-eaters
E canned products
4 Factors of transmission are at infectious mononucleosis:
A direct contact
B poor quality green-stuffs
C unwashed fruit
D all is transferred
E chhanas
5 Duration of latent period is at a herpetic infection:
A - 2 weeks
79
B - 1 month
C - all right
D - 2-3 hours
E – 4-12 days
6 What seasonality is characteristic for infectious mononucleosis?
A winter-spring period;
B spring summer period;
C summer-autumn period;
D a fall-winter period.
7 Clinical forms of girdle herpes, except for:
A eye form
B ear form
C - phlegmonous
D - gangrenous
8 For verification diagnosis of herpetic infection all is used,
except for:
A reactions of immunofluorescence
B - virologic selection a virus on the cultures of tissues
C - clinical blood test
D - serum diagnostics
9 For treatment of herpetic infection Dexamethazonum is utillized
in a dose:
A 1,5 mg/ kg on days
B 0,5 mg/ kg on days
C 0,1 mg/ kg on days
D 0,2 mg/ kg on days.
10 An immunomodulation is conducted a levamisole in a dose:
A - 0,15 on night
B - 0,25 on night
C - 0,1 on night
D - 0,2 on night.
Standards of right answers
1 - D; 2 -; 3 -; 4 - A; 5 - E; 6 - A; 7 - C; 8 - C; 9 - A; 10 - A.
3.4.3 A task is for self-control
80
Task 1
Sick P.,19 years, student, appealed to the induction centre of
permanent establishment with complaints about great head pain in a
temporal area, increase of temperature to 38ОС, smarts are sharply
expressed during a talk in the left half of person, rash. Anamnesis:
illed sharply. After supercooling the temperature of body rose to
380С, heartburn and dermahemia the left cheek appeared. In 4 days
on the skin of person the grouped blisters appeared as a chain.
Objectively: for the step of facial nerve blisters are placed 1-2 mm
in a diameter, with transparent maintenance, sickly by touch.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 2
Patient A., 42, hospitalized in a hospital on the 10th day of illness
with complaints about the increase of temperature, head pain,
pouring out and great pain, for the step of intercostal nerves. At an
inspection in intercostal intervals the discovered is grouped blisters,
covered crusts, are present also blisters with transparent and turbid
maintenance.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 3
Patient Н., 16 years, by an ambulance was hospitalized to the
hospital with complaints about head pain, fervescence to 390 С, chill,
pain, in a throat, cold. It is ill during 3 days, treated oneself
independently, for medical help did not apply. At the review of
patient: on the skin of розеольозний rash, phenomena of one-sided
conjunctivitis, pellicle tonsillitis. Clinical blood test: eras. 4,5х1012/l,
Nv 120 g/l, leuc. 5,0х109/l, е 2 %, s 60 %, st 5 %, l 25 %, m 8 %,
ESR 15 mm/hour, tr. 200х109/l.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
81
Standards of answers
Task 1
1 Primary simple noncommunicative herpes is with the defeat of
skin, middle degree.
2 Serum researches: method of lumen antibodies (strokes –
imprints research for vesicules),CFT,reaction solid hemaglutination
with pair wheys,immuno enzyme analysis – Ig M to the virus of
herpes simplex .
3 Gerpevir for 0,2 gr 5 times per days during 5 days, natively is
ointment
of
“Gerpevir”,fucorin,desensibilization
preparations,cyclopheronum after a chart.
Task 2
1 Primary girdle herpes, craniocerebral form, typical motion,
middle degree.
2 Serum researches:immuno enzyme analysis (Ig M and Ig G),
reaction undirect hemaglutination, RN, CFT (with pair wheys).
General clinical blood, urine tests.
3 Natively is ointment of “Aciklovir”, “Gerpevir”, fucorcin.
Zoviraks for 800 mg 5 times per days 5-7 days. Desensitizing
preparations;desintoxication
therapy,
іmmunomodulator
(cyclopheronum, levamisole).
Task 3
1 Primary girdle herpes, spinal pectoral form, typical motion of
middle weight.
2 Serum research:immuno enzyme analysis, CFT (method of pair
wheys),cytologic research of maintenance of blisters for the exposure
of including of virus.
3 Natively – оxolinum,tebrophenum ointments, ointment of
“Zoviraks”, аcyclovir 4 gr on days during 7 days, levamisole 0,15
grammes 1 time per 4 days or cyclopheronum after a chart.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection patient with a
herpetic infection.
82
 To conduct a curation of patient with a herpetic infection.
 To conduct differential diagnostics of herpetic infection
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection of patient with a
herpetic infection.
 To recognize complication of herpetic infection.
 To work out a plan of treatment patient with a herpetic
infection.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document in fact of establishment of
diagnosis “herpetic infection”.
4.2 A professional algorithm is in relation to forming of skills
and abilities of diagnostics of herpetic infection
№ Task
Sequence
A remark, warning, is in
п/п
implementation relation to self-control
1
2
To lay hands
the method
clinical
inspection
patient on
herpesvirus
infection
To conduct
curation
patient
on And to Find out
of the complaints
of patient
of
a
To separate complaints
which
characterize
syndromes:
- general intoxication;
- organ defeats to Pay a
regard to gradual beginning
ІІ to Find out term, sequence of origin
a anamnesis
dynamics:
of 1 Anamnesis of - fevers;
illness
- head pain;
- to tonsillitis;
- lymphadenopathies;
- to hepatitis;
appearance of erosion;
- to the encephalitis;
- other symptoms. To find
out the carried illnesses.
83
2 Anamnesis of
life
3 Epidanamnesis
ІІ to Conduct an
objective
inspection:
1
General
review:
- general state of
patient
2 Skin
3 Mucus shells:
- review of oral
cavity;
- review of eyes;
review
of
overhead
respiratory
tracts;
- review of privy
parts.
4
Nervous
84
Find out information in
relation to realization of
contact
or air-tiny
mechanism
of
transmission, to pay a
regard to stay of patient in a
contact with patients or
presence of this disease for
a patient in the pas.
To remember: a presence,
expressed, dynamics of
symptoms, is predefined a
term and weight of flow of
illness, depend on age
sick,
concomitant
pathology.
To pay attention on:
it is a color
presence and localization,
to the rash.
To pay attention on:
- presence of tonsillitis;
- presence of display of
GRZ;
presence of urethritis.
To pay attention on:
presence of signs
of
encephalitis;
- presence of signs of
meningitis;
system of patient - presence of signs of
myelities;
- syndrome of Giyenabarre;
- syndrome of paralysis of
Landri;
syndrome
of
parkinsonism;
- a syndrome is BASS.
3
To
appoint 1
General
laboratory and analysis of blood
additional
researches,
interpret results
2
General
analysis of urine
3
Serum
methods
To pay a regard to typical
changes:
leucopenia,mononucleosis
with a lymphocytosis,
anaemia,
аtypic
mononuclears.
Absence of considerable
changes is at typical
motion.
Appointed regardless of
term of illness.
determination of specific
анти –CMV,EBV IgM;
determination of specific
antibodies of class IgM; PLR for determination of
DNK of viruses in blood,
neurolymph, saliva, to the
tear and others like that.
Materials of after audition independent work
Subject of UDRS and NDRS:
• Problems of etiotropic treatment of herpetic infection.
• Modern looks are to pathogeny of herpetic infectio
85
Topic. CHILDREN’S RESPIRATORY INFECTIONS IN
ADULTS. MEASLES. GERMAN MEASLES. PAROTIT
VIRUSES
Duration - 2 hours.
1.Actuality of theme. Children’s respiratory infections remain
one of issues of the day of health protection not only in countries
which develop but also in a number of the developed countries. In
the world the over 30 million and about 1 million mortal cases cases
of disease are annually registered from measles, german measles,
parotit infection and their complications, not only among children
but also among a grown man population.
A lot of factors are instrumental in spreading a disease: air-drop’s
mechanism of transmission, high receptivity of organism of man to
these infections, propensity of illness to epidemic distribution,
especially in regions with a low social and sanitary-hygenic level.
Actuality of children’s drop’s infections is predefined absence of
watchfulness from the side of doctors to this pathology, especially
among adults, by weight of motion, risk of origin of heavy
complications which can threaten life of patients.
To distribution of children’s drop’s infections among adults in
Ukraine promote low social and sanitary-hygenic level of population,
large congestion of people in cities, absence of the proper
watchfulness, and often and the proper knowledges among doctors.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1A student must know:
 etiology of children’s drop’s infections (measles, german
measles, epidemic parotitis), factors of pathogenicity of exciters;
 epidemiology of children’s drop’s infections;
 pathogeny;
 adults have clinical displays of children’s drop’s infections;
 adults have clinical-еpidemіologic features of children’s drop’s
infections;
86
 pathogeny, term of origin and clinical displays of
complications of children’s drop’s infections;
 laboratory diagnostics of children’s drop’s infections;
 principles of treatment;
 principles of prophylaxis;
 adults have a prognosis of children’s drop’s infections;
 governed excerption of reconvalescentes from permanent
establishment;
 governed the health centre system of reconvalescentes.
2.2 A student must be able:
 to adhere to the basic rules of work near a bed patient with
measles, german measles, parotit illness;
 to collect anamnesis of illness with the estimation of
epidemiology information;
 to inspect a patient and find out basic symptoms and
syndromes, which meet at to measles, german measles,parotit illness,
ground a clinical diagnosis for timely direction of patient in
permanent establishment;
 to conduct differential diagnostics of “child's” drop’s infections
for adults;
 on the basis of clinical inspection in good time to recognize
possible complications of “child's” drop’s infections for adults;
 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 term of illness;
 to work out an individual plan of treatment taking into account
epidemiology information, stage of illness, presence of
complications, weight of the state, allergist anamnesis, concomitant
pathology ; to give a help on the before hospitalization stage;
 to work out a plan of disease and prophylactic measures in the
hearth of infection;
87
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period reconvalescence.
3 Materials of before audition independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties of viruses,
which are the exciters of
кору, german measles,
паротитної
illness;
methods
of
their
diagnostics.
Physiology
Parameters
of To
estimate
physiology norm of information
of
organs and systems of laboratory inspection.
man;
indexes
of
laboratory inspection are
in a norm (заг. blood,
urine test, biochemistry
of blood, parameters of
KOS, electrolytes and
others like that).
Physiopatholog A
mechanism
of
y
violation of functions of
organs and systems is at
the pathosiss of different
genesis.
88
To interpret the results
of
methods
of
diagnostics of measles,
german measles, parotit
illness.
To
interpret
pathological changes as
a result of laboratory
inspection
at
parafunctions
organs
and
systems
of
different genesis.
Immunology
Basic concepts of object,
and allergology role of the system of
immunity
in
an
infectious
process,
influence on the term of
елімінації of exciter
from the organism of
man.
To
estimate
information
of
immunological
researches.
Epidemiology
Epid. process (source,
mechanism of infection,
ways of transmission) at
to
measles,
german
measles,
паротитній
illness; prevalence of
pathology in Ukraine and
in the world.
To
collect
epidemiology
anamnesis,
conduct
disease
and
prophylactic measures
in the hearth of
infection.
Neurology
Pathogeny, clinical signs
of the isolated defeat of
CNS at parotit illness,
encephalopathy at bark
To conduct the clinical
inspection of patient
with the defeat of the
nervous system.
Dermatology
Pathogeny,
clinical To recognize a rash for
description of еczantems. a patient with кір,
german measles.
Surgery
clinical-laboratory signs
of defeat of pancreas and
оrchitis are epidemic
parotitis.
Propedevtic
internal
illnesses
In good time to
diagnose
these
complications, appoint
the proper inspection.
of Methods and basic stages To collect anamnesis,
of clinical inspection of conduct the clinical
patient.
inspection of patient,
89
find out pathological
symptoms
and
syndromes. To analyse
findings.
Next disciplines
Family
medicine
Pathogeny,
epidemiology, dynamics
of clinical displays,
complications
of
measles,
german
measles,
epidemic
parotitis are possible.
Adults have features of
clinical motion of these
infections. Principles of
prophylaxis
and
treatment.
To conduct differential
diagnostics of illnesses.
To recognize measles,
german
measles,
epidemic parotitis; to
interpret information of
laboratory inspection.
In good time to
hospitalize a patient in
infectious permanent
establishment.
intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics, treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics
of clinical displays,
laboratory diagnostics,
complications
of
measles,
german
measles,
epidemic
parotitis are possible.
Adults have features of
90
To conduct differential
diagnostics of child's
крапельних infections
with other infectious
diseases. To recognize
measles,
german
measles,
epidemic
parotitis,
their
complication;
to
interpret information of
laboratory inspection.
To appoint treatment.
To render the first aid
clinical
motion
of on
the
before
measles,german measles, hospitalization stage.
epidemic
parotitis
.
Principles of prophylaxis
and treatment.
91
3.2 Structurally logical chart of maintenance of theme of employment
Chart of diagnostics and treatment of measles (Morbillis)
Epidemiology anamnesis:
- contact with a sick man – from closing 2 dates of latent period to the 5th day of
appearance of rash; absence of vaccination of measles for children after 12 months
- sharp beginning, fervescence to 380C, rhinorea, cough, photophobia, puffiness of person, edema never,
turning of conjunctiv, spot of Belskogo-Filatov-Koplika (pink spots with the dots of gum-blush in a
center on the internal surface of cheeks opposite lower molyares) red, stain enantema on the mucus
shell of soft palate; on the 3-4th day of illness the state gets worse, a temperature rises to 40 0 C, the
catarrhal phenomena, symptoms of intoxication, grow; -ekzantema: as a pinky spots appears out of ears,
for a day long spreads on a person, neck and overhead part of breasts and back, on a 2th day – on a trunk
and overhead extremities, on a 3th day – lower extremities; the elements of rash are increased in sizes,
rise above the level of skin, transform in stain papular, become crimson, arise up on a background the
unchanged skin, with unequal edges, have a tendency to confluence kept 3-4 days, go out during 2-3
days, disappear in the same sequence, as well as poured leave pigmentation, bran-like shelling;
expressed conjunctivitis; increase a back of neck , cervical, lymphatic knots of arm-pits
virologic research (selection in the first days of virus from the epipharyngeal washing off, to the
secret of conjunctiva on the culture of tissue or by the method of immunofluorescence); serum
methods (RN, CFT,reaction braking hemaglutination, reaction undirect hemaglutination, immuno
enzyme analysis with a morbillous antigen in the dynamics of illness) are an increase title of
antimorbillous antibodies in 4 times and anymore; a blood test is leykopenia, limfocytes, decline
of amount of eozinofiles, monocytes, ESR is moderato accelerated
- determination of final diagnosis of
illness, weight, complications
Differential diagnosis with a flu, other acute respiratory
viral desease , german measles, еnterovirus (boston’s)
еkzantem,infectious mononucleosis, meningococcemia,
allergic еkzantems, a scarlatin
- mainly in home terms, except for patients with complications and after epidemic requirementes;
isolation in a separate, well ventilated, room; bed mode 7-10 days, valuable feed, plenty of liquid; a care
is of skin and mucus shells; symptomatic therapy (at a festering conjunctivitis is solution natrii
sulfacilum , for a rhinorea – in a nose Protargolum, galazolin; for a cough – bromgeksin, libeksin);
antihistaminic preparations of heavy forms; antibioticoterapy for complications
-not early than a 4th day from the beginning rashing, of complications – not early than a 10th day
- for clinical requiremenes
92
Plan of diagnostics and treatment of german measles (Rubeola)
Epidemiology anamnesis:
contact with a sick man at the end of latent period and during 2-5 days from the beginning of
rash; a disease of mother is on a german measles during pregnancy; a contact is with
patients with congenital german measles (contagiose for 2 years)
- beginning the gradual, general state is broken insignificantly; for 1-2 days of appearance of rash there
is a cough; during a rash the temperature of body increase to 380C (it can be normal); increase of
posterior neck, back of head,back of ears and other lymphatic knots; a rash appears in the first day of
illness, thick, as pinky, round or oval spots, shallow or large, during a few hours appears on face of
neck and spreads on all body with overwhelming localization on extensor surfaces of extremities,
back, stomach, buttocks, on the unchanged background of skin, does not have a tendency to
confluence, sticks to 1-3 days, does not abandon pigmentation and shelling; enantema is possible:
separate pink spots are on soft palatine; adults carry a german measles heavier, with the expressed
fever, head pains, intoxication, a rash is more thick, sometimes with propensity to confluence,
anymore expressed limfadenit; for the patients of expectant mothers a fetus is struck; in a clinic
analysis of blood is leykopenia, neutropenia, relative limfocytes ,monocytes ( for 20% and higher) and
presence of plazmatic cells and cells of Turk (to 10 – 25%)
...
- virologic method-selection of exciter from
blood, epipharyngeal washings off, urine, in
the first 5-7 days of illness; are serum
methods – reaction braking hemaglutination,
CFT,RN (increase a title of antibodies in 4
times at research pair wheys of blood with
an interval in 10-14 days); it is an exposure
in blood of antibodies of class IGM
Differential diagnosis with
infectious mononukleosis,
scarlatin, toksikoalergic
dermatosiss, enterovirus
ekzantem, measles
- determination final diagnosis of illness, weight, complications
- for the uncomplication form of german measles treatment in home terms; it is the bed mode in
all period of rash, large volume of liquid, care for a skin and mucus shells; - medications in most
cases are not used;
- during considerable intoxication and thick rash – desintoxication and symptomatic therapy
- for the clinical requirementes of months
- not early than a 5th day from the moment of
pouring out
93
plan of diagnostics and treatment of parotit illness (Morbus parotitis)
Epidemiology anamnesis:
-seasonality is end of the winter and spring;
-it is a presence of direct contact with a patient for 1-3 weeks;
it is absence in anamnesis ranishe the carried parotitis illness
beginning of illness is sharp; general signs: fever to 38-390C, indisposition, sickliness, head pain, pain,
in neck muscles.
Glandular form: defeat of parotid salivary glands ( Filatov’s syndrome, signs of Mursu), more
frequent in 6-8 days defeat of pancreas, orkhitis.
Nervous form: meningitis, meningoencefalit (general cerebral, hypertensive, meningeal, likvor
syndromes, syndrome of focal changes).
Combined forms (defeat of glandular organs and CNS)
-reaction braking hemaglutination, diagnostic title 1:80 (pair wheys); - CFT (pair
wheys, increase of title in 4 times);immuno enzyme analysis, PCR; it is a blood test:
leykopenia, relative lymphocytosis, for the complicated motion leykocytosis with the
change of formula to the left, acceleration of ESR
- formulation of clinical diagnosis is with
determinations of form, distribution and
localization of process, weight, complications
Differential diagnosis with a citomegalovirus
infection, festering and toxic parotitis, saliva-stone
illness, tumours, limfadenitis, meningitises, and
meningoencefalitis of other etiology
- hospitalization heavy and complicated motion, and also for epidrequirements;
- the bed mode for normalization of temperature;
-diet 5, 5a;
- for a boys-carrieing suspenzory;
-care cavity of mouth (rinse natrii hydrocarbonate a 2% solution, furacilinum 1:5000);
-nosotropic therapy: dezintocsication, desensibilisation, vitamins;
-inhibitors of enzymes (trasilol, kontrikal, gordoks);
- symptomatic therapy (febrifuge, antiinflamation, analgetic preparates);
- inductors- to the interferon ( mefenamova acid
- disappearance of clinical symptoms not before, than on a 9th day from the beginning of disease
- patients are subject with complications of parotitis illness: with carried orkhitis (through a
month review of urologist); persons which carried meningitis are subject a supervision for a
neurologist
94
3.3. Literature is made to order
Basic
 Vozianova zh.I. the Infectious and parasitogenic diseases: 3 Т.
Kyiv: Health, 2001. - T.1. - p. 234-241.
 Superviser for infection diseases / for editor U.V. Lobzina.– 3
publish., supplement. and change .SPB: Foliant, 2003. - p. 99-102.
 Shuvalova E.P. Infection diseases.Rostov l/d.: Feniks. - p. 111114.
Additional
•
Gavrisheva N.A., Antonova T.V. Infection process.Clinical and
pathophisiologic problems. - Spb.: Special literatures, 1999. - p. 54-57, 6064.
• Immunology of infection process:Superviser for doctors /for editor
V.I. Pokrovskogo, S.P. Gordienko, V.I. Litvinova - M.: RAMN, 2000. - p.
113-120.
• clinical-laboratory diagnostic infection diseases: Superviser for
doctors. - Spb.: Foliant, - p. 98-103.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 What group of infectious diseases does measles, german
measles,parotit illness belong to after the source of infection?
2 Ways of passing measles, german measles,parotit illness?
3 Factors of pathogenicity of exciters measles, german measles,
epidemic parotitis.
4 Stages of pathogeny of measles, german measles, epidemic
parotitis.
5 Morphological changes on a skin of measles and german
measles.
6 Stages of cyclic clinical motion of measles, german measles,
epidemic parotitis.
7 Basic symptoms of measles, german measles, epidemic parotitis,
are in an initial period of illness.
8 Supporting symptoms of measles, german measles, epidemic
parotitis, are in full play of illness.
95
9 Description, term of origin and loud speaker of rash for a patient
with measles and german measles.
10 Clinical displays of оrchitis of epidemic parotitis.
11 Adults have features of motion measles, german measles,
epidemic parotitis.
12 Features of motion measles, german measles, epidemic
parotitis, are in modern terms.
13 Adults have consequences of measles, german measles,
epidemic parotitis.
14 Specific complications of epidemic parotitis.
15 There is a plan of inspection of patients with child's drop’s
infections.
16 Methods of diagnostics of typhoid. Interpretation of results is
depending on the term of illness and material for research.
17 Adults have principles of nosotropic and symptomatic therapy
of “child's” drop’s infections.
18 Governed excerption of reconvalescentes from permanent
establishment.
3.4.2 Tests are for self-control
To choose right answers
1 What term does a patient with measles become contagious
from?
A - from the first day of illness;
B - from the first 2th days of latent period;
C - from the last 2th days of latent period;
D - from the 3th day of illness;
E - from the 5th day of illness.
2 A basic link in pathogeny of disease on measles is:
A viremia;
B toxemia;
C defeat of central and peripheral departments of the nervous
system;
D bacterimia;
E - all of answers are faithful.
3 In the clinic of measles it is possible to select such periods :
96
A latent period;
B - prodromal;
C period of pouring out;
D period of pigmentation;
E - all of answers are faithful.
4 Duration of latent period of measles:
A - 6-7 days;
B - 9-17 days;
C - 17-21 day;
D - 3-9 days;
E - 17 days.
5 For measles not characteristically:
A sharp beginning;
B considerable catarrhal signs;
C fever;
D hepatolienal syndrome;
E- еkzantema and еnantema.
6 The pathognomic symptom of german measles is:
A increase of peripheral lymphonoduss;
B increase of liver;
C increase of spleen;
D psilosis;
E - all right.
A latent period lasts at a german measles:
A - 5-6 days;
B - 15-24 days;
C - 6-10 days;
D - 10-15 days;
E - 4-10 days.
8 A latent period lasts at a parotit infection:
A - 11-21 days;
B - 12-15 days;
C - 6-8 days;
D - 20-28 days;
E- 10-24 days.
97
9 The source of infection of parotit infection is:
A animal;
B bacillicarrier;
C sick man;
D finfishess;
E - all right.
10 The exciter of parotit illness is:
A virus;
B bacteria;
C spirochets;
D ricketsias;
E mushrooms.
11 All belong before complications of measles, except for:
A pneumonias;
B - encephalitis;
C - otitis;
D - pancreatitis;
E - laryngitis.
12 The virus of measles belongs to to:
A - аrbovirus;
B - eogavirus;
C - calcivirus;
D - paramyxoviruss;
E - picornaviruss.
13 Most credible gate of infection been measles :
A skin is damaged;
B intestinal;
C lights;
D glandulars;
E conjunctiva of eye.
14 Ways of transmission of parotit infection:
A - air-drop;
B - sullage-oral;
C - sexual;
D pin;
98
E- all right.
15 Treatment of measles can be:
A - etiotropic;
B - with application of antibiotics;
C - nosotropic;
D - symptomatic;
E - all right.
16 On what term does set a quarantine of parotit infection?
A - 21 day;
B - 22 days;
C - 18 days;
D - 15 days;
E - 23 days.
17 Duration of postvaccinal immunity makes of parotit infection:
A - 2-4 years;
B - 3-6 years;
C - 2-4 months;
D - 3-6 months;
E - 2-4 weeks.
18 The virus of german measles belongs to family:
A - picornaviruss;
B - herpesvirus;
C - mixovirus;
D - аrbovirus;
E - enteroviruss.
19 What day of illness does a rash appear on at a german measles?
A - 1-2th day;
B - 2-3th day;
C - 3-4th day;
D - 5-6th day;
E- 6-7th day.
20 The virus of epidemic parotitis has tropic for:
A - glandular tissue;
B - intestinal;
C - lights;
99
D is a pochard;
E - all right.
Standards of faithful answers
1 - C; 2 - A; 3 - E; 4 -; 5D; 6 - A; 7 -; 8 - A; 9 - C; 10 – A; 11 D;
12 D; 13 - E; 14 - A; 15 - E; 16 - A; 17 -; 18 - C; 19 - A; 20 - A.
3.4.3 Tasks are for self-control
Task 1
Sick K., 27 years, works as a nursery governess in preschool,
hospitalized in an infectious separation on the 4th day of illness. A
disease was begun sharply with a fervescence to 38,5 0С, febricula,
cough. On the 3th day of disease a temperature was normalized. The
sick did not apply to the doctor, but on the 4th day of illness again
the temperature of body rose to 39 0С, the catarrhal phenomena,
symptoms of intoxication, increased. Pinky spots after ears, which
for a day long spread on a person, appeared on a 4th day, sew
overhead part of breasts and back.heart rate 108/minute, ABP 120/70
mm h.с. Tones of heart are clean. Breathing of везикулярне. In a
clinical blood test:leucopenia, lymphocytosis, decline of amount of
eosinophiles,monocytes,ESR 20 mm/hour.
1 To formulate a diagnosis
2 To work out a plan of inspection sick
3 To work out a plan of treatment
Task 2
Patient G., 35 years, nursery governess of preschool, hospitalized
in an infectious separation with complaints about a weakness, head
pain, chill, insomnia and pouring out. A disease began gradually,
there was a cough to appearance of pouring out. After appearance of
pouring out the temperature of body rose to 38 0С. General state of
sick middle weight. Pouring out as shallow pinky round spots during
a few hours appeared on face, neck, spread on all of body with
overwhelming localization on the розгинальних surfaces of
extremities, placed on the unchanged background of skin, meet
placed, does not abandon pigmentation and shelling. At sick : behind
the ears and cervical posterior lymphatic knots is megascopic. In a
100
clinical blood test:leucopenia, neutropenia,monocytosis, presence
plasmatic cages and cages Tyurka, to 20 %.
1 To formulate a diagnosis
2 To work out a plan of inspection sick
3 To work out a plan of treatment
Task 3
For the nursery governess of preschool a disease was begun with a
fervescence to 39 0С, appearances of cough, нежитю, to the
conjunctivitis. A temperature remained enhanceable three days, the
catarrhal phenomena grew. On the 4th day of illness during a review
marked conjunctivitis,blepharospasm, on mucus company еnantema, spots of Belskogo-filatova-koplika. On the skin of person,
after ears there is a stain-papular rash.
1 To formulate a diagnosis
2 To work out a plan of inspection sick
3 To work out a plan of treatment
Standards of answers are to the tasks
Task 1
1 German measles, typiform, middle hard degree of weight.
2 General clinical analyses of blood, urine, coprogram.
Exposure in blood of antibodies class IgM by the method
immuno enzyme analysis, RGGA, CFT, RN by the method of
research of pair wheys.
3 bed’s routine, desensitizing preparations, vitamins.
Task 2
1 measles, typiform,middle hard ran across.
2 general clinical blood, urine, excrement tests. Serum methods:
RN, CFT, RGGA with pair wheys.
3 There is an isolation of patient in got a lot of fresh air; bed
mode; a care is of skin and cavity of mouth; symptomatic therapy
(anticough, drops in a nose), antihistaminic preparations.
Task 3
1 measles, typiform,middle hard ran across.
2 general clinical blood, urine, excrement tests. Serum methods:
RN, CFT, RGGA with pair wheys.
101
3 There is an isolation of patient in got a lot of fresh air; bed
mode; a care is of skin and cavity of mouth; symptomatic therapy
(anticough, drops in a nose), antihistaminic preparations.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of clinical inspection of patient
with measles, german measles, parotitis.
 To conduct a curation of patient
 To appoint laboratory and additional researches, interpret
results.
 To work out a plan of laboratory inspection
 To recognize complication
 To work out a plan of treatment sick
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document
4.2 A professional algorithm is in relation to forming of skills and
abilities of diagnostics of child's drop’s infections
№ Task
Sequence
of A remark, warning, is
implementation
in relation to selfcontrol
1.
To lay hands
on the method
of
clinical
inspection of
patient
with
measles,
german
measles,
parotitis.
I to Find out the To separate complaints
complaints
of which
characterize
patient.
syndromes:
- general intoxication
- organ defeats
To pay a regard to
II to Find out gradual beginning; term,
anamnesis:
sequence
of
origin,
1 Anamnesis of dynamics:
illness
- fevers;
- head pain;
- to the rash;
- other symptoms
To find out the carried
102
illnesses.
To find out information
in relation to realization
3
Epidemiology of air-drop’s mechanism
anamnesis
of transmission.
2 Anamnesis of life
2.
To conduct a III to Conduct an To
remember:
a
curation of
objective inspection. presence,
expressed,
patient
dynamics of symptoms,
is predefined a term and
weight of flow of illness,
depend on age sick,
concomitant pathology.
1 General review:
To pay attention on:
- general state of - languor, adynami,
patient;
dormancy of patient;
- temperature of body;
- color of skin;
skin,
mucus - presence, localization,
ротоглотки;
character of rash.
To pay attention on:
- tachicardia;
2 Cordially is the
vascular system:
- oscillation of A/t;
- pulse;
- arteriotony;
- moderate deafness of
- cardiophony.
tones of heart.
3
Respiratory To pay attention on:
system:
- dry wheezes often
- аuscultation of dissipated;
lights;
- hyperemia of зіва,
- review of зіва.
енантему.
103
3.
To
appoint 1 General analysis To pay a regard to
laboratory and of blood.
typical
additional
changes:leucopenia,
researches. to
limphomonocytosis,
interpret
аneosinophilia
results.
(leucocytosis, anaemia,
acceleration of ESR,
arise up in the case of
development
of
2 General analysis complications).
of urine.
Absence of considerable
changes is at typical
3 Serum methods:
motion.
- RNGA, CFT
Appointed in the pair
wheys of blood with an
- Immuno enzyme interval 10 days; growth
analysis (IGM).
of title in 4 times.
4 Virologic research. A selection a virus is on
the culture of fabrics.
Materials of after audition independent work
Subject of UDRS and NDRS:
• Features of motion of child's drop’s infections are in modern
terms.
• Modern methods of diagnostics.
• Problems of etiotropic treatment of child's drop’s infections
today.
• Modern looks are to pathogeny of child's drop’s infections.
104
Topic. DIPHTHERIA. DIFFERENTIAL DIAGNOSTICS OF
SYNDROME IS «QUINSY»
Duration - 2 hours.
1 Actuality of theme. At the end of 70th it was succeeded
practically to liquidate diphtheria. It was registered as single cases (in
Ukraine an index of morbidity on diphtheria in 1981 was 0,06 on a
100 000 population). However much illness periodically reminded
about itself in different, even developed, countries. Yes, for example,
in 1984-1985 y. there was a small flash of diphtheria in Geteborzi
(Sweden), with which succeeded comparatively quickly to manage
due to the active measures conducted in good time. Regularly enough
registered in the countries of Africa different, mainly dermic, forms
of diphtheria, however much an infection belonged to fully guided
did not cause a large alarm. And even then, when from the beginning
of 80th gradual growth of morbidity began to be registered, mainly in
the East-European region, it did not cause an alarm at our health
protection. And from the end of 80th - the epidemic of diphtheria
which overcame almost all of republics of former Soviet Union (over
95 % all of diseases, incorporated in Europe) began beginning of
90th, максимум was morbidity on Russia and Ukraine. Yes, already
in 1991 morbidity in Ukraine was 2,2 on a 100 000 population,
continuing to grow. Yet and presently, almost in 10 years, to
overcome fully an epidemic not succeeded.
The feature of this epidemic is considerable advantage among
diseased grown man population above a child (correlation 7:1-5:1).
The greatest morbidity is registered in cities (Moscow, saint
Petersburg, Kyiv).
An exposure, treatment of patients, prophylactic measures, need
large financial charges. In addition, the real danger of distribution of
infection is created in other countries.
A situation which arose up with diphtheria testifies that the guided
infections remain on control only until about them remember,
engaged in them. Failure to observe of the graph of inoculations, a
waiver is groundless of them, plenty of contra-indications
immediately result in activating of еpidprocess. In fact, from data of
105
WHO, scope the prophylactic planned inoculations of children by age
12-23 months in the different regions of the world are 11-70 %. Even
in the USA in 1980 only 37,5 % children were valuably instiled.
Presently there was such situation, that the forgotten infection
reminded about itself, taking away hundreds of human lives already.
The level of the real morbidity on diphtheria yet and is presently
unknown, as even in the developed countries only 11-63 % cases of
disease get to official statistics.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
 etiology of diphtheria, factors of pathogenicity of exciter;
 epidemiology of diphtheria;
 pathogeny;
 clinical displays of diphtheria are at typical motion;
 clinical displays of syndrome ?ангіна?
 clinical-еpіdemiologic features of diphtheria;
 pathogeny, term of origin and clinical displays of
complications of diphtheria;
 laboratory diagnostics of diphtheria;
 principles of treatment;
 principles of prophylaxis;
 tactic in the case of origin of the exigent states;
 prognosis of diphtheria;
 governed excerption of reconvalescentes from permanent
establishment
 governed the health centre system of reconvalescenres;
 differential diagnostics of syndrome «quinsy».
2.2 A student must be able:
 to adhere to the basic rules of work near a bed sick;
 to collect anamnesis of illness with the estimation of
epidemiology information;
106
 to inspect a patient and find out basic symptoms and
syndromes of diphtheria, ground a clinical diagnosis for timely
direction of patient in permanent establishment;
 to conduct differential diagnostics of diphtheria and syndrome
«quinsy»;
 on the basis of clinical inspection in good time to recognize
possible complications of diphtheria, exigent states;
 to design a medical document in fact of establishment of
previous diagnosis "diphtheria" (an urgent report 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 information, weight of the state, presence of
complications, allergist anamnesis, concomitant pathology; to render
the first aid on the before hospitalization stage;
 to work out a plan of disease and prophylactic measures in the
hearth of infection;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescence.
3 Materials are to audience independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties
Corynebacterium
diphtheriae, methods
specific diagnostics
diphtheria
Physiology
Parameters of physiology To
107
of
of
of
of
To interpret the results
of specific methods of
diagnostics
of
diphtheria
estimate
norm of organs and information
of
systems of man; indexes of laboratory inspection
laboratory inspection are in
a norm (general аnalysis of
blood, urine, biochemistry
of blood, parameters of
KOS, electrolytes and
others like that)
Physiopathology A mechanism of violation
of functions of organs and
systemsof the pathosiss of
different genesis
To
interpret
pathological changes
as a result of clinical
and
laboratory
inspection
Immunology and Basic concepts of object,
allergology
role of the system of
immunity in an infectious
process, influence on the
term of еlimination of
exciter from the organism
of man
To
estimate
information
of
immunological
researches
Epidemiology
An
epidemic
process
(source, mechanism of
infection,
ways
of
transmission)
is
at
diphtheria; prevalence of
pathology in Ukraine and
in the world
To
collect
epidemiology
anamnesis,
conduct
disease
and
prophylactic measures
in the hearth of
infection
Neurology
Pathogeny,
clinical To conduct the clinical
syndromes of disease
inspection of patient
with the defeat of the
nervous system
108
Propedevtic of Basic stages and methods To collect anamnesis,
internal illnesses of clinical inspection of conduct the clinical
patient
inspection of patient,
find out pathological
symptoms
and
syndromes. To analyse
findings.
Clinical
pharmacology
Pharmakokinetics and
pharmacodynamics,
side
effects of facilities of
specific and nosotropic
therapy
To appoint treatment
depending on the
degree of weight,
individual features of
patient.
To write recipes
Next disciplines
family medicine
Pathogeny, epidemiology,
dynamics
of
clinical
displays, complications of
infectious diseases are
possible. Principles of
prophylaxis and treatment.
109
To conduct differential
diagnostics of illnesses
of different genesis.
To
recognize
an
infectious disease, his
complication;
to
interpret information
of
laboratory
inspection. In good
time to hospitalize a
patient in infectious
permanent
establishment.
To
render the first aid in
the case of necessity.
Intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics,
treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics of
clinical displays, laboratory
diagnostics, complications
of infectious diseases are
possible.
110
To conduct differential
diagnostics of illnesses
of different genesis.
To
recognize
an
infectious disease, his
complication;
to
interpret information
of
laboratory
inspection. To appoint
treatment. To render
the first aid on the
before hospitalization
stage.
3.2 Structurally logical chart of maintenance of theme of employment
Chart of diagnostics and treatment of diphtheria (Diphtheria)
Epidemiology anamnesis:
- contact with a patient with diphtheria in the nearest 14 days, contact
with a rekonvalescence-transmitter or with a healthy transmitter;
-absence of inoculations against diphtheria
- beginning of illness is sharp, moderate phenomena of intoxication, a pharyngalgia is insignificant; at
the review of fauces: stagnant dim hyperemia is with the cyanochroic tint of mucus; glandulars fillings
out, on their surface continuous gum-blush with a mother-of-pearl tint fibrinose raids which go out
outside glandulars spread on handles, tongue, soft palate; badly taken off a spatula, here inferior a by
spatulas; through 15-20 minutes. after greasing 2 % solution of tellurite potassium tape turns black;
regional lymphonoduss are megascopic, moderato sickly mucus shell bleeds (“symptom of bloody
dew”); diphtherial tape sinks in water, not ground between
- microscopy of stroke from fauces and nose;
- bacteriologic examination of stroke from fauces and nose; - reaction undirect
hemaglutination with antigen of Corinebacterium diphtheriae, Immuno enzyme analysis
Differential diagnosis with quinsies,
infectious
mononukleosis,
scarlatin,
pseudotuberculosis, anginal-bubonic by the
form rabbit-fever, mycotic defeat of
glandulars, adenovirus infection, sharp
leucosis and agranulocytosis
- determination of weight,
distribution of process, character of
raid, as an exciter, complications
- antitoxic antidifteria whey (10000-150000 OD);
-antibiotics (benzilpenicilin cefalosporini, makrolides);
-desintoxication therapy;
- glucocorticosteroides;
- symptomatic therapy
- disappearance of clinical symptoms; negative results of two
bacteriologic examinations of mucus from fauces and nose on the
exciter of diphtheria with a two-day interval
- reconvalescentes are under surveillance doctor of clinic infectious department;
they rid of going in for sports of hard physical work during a 3-6 months.; for
presence complications of supervision for a cardiologist and neurologist for a year
111
Chart of diagnostics and treatment of quinsy (Angina)
Epidemiology anamnesis:
- contact with a patient or rekonvalescent on a quinsy or other streptococcus infection;
- contact with a healthy transmitter gemolitic streptococcus;
-stay in the recently formed collectives (child, soldiery, student)
sharp beginning, fever, tonsillitis, regional limfadenitis
-Clinical analysis of blood , urine;
-Bacteriologicexamination of mucus from the surface of glandulars
a final diagnosis is with
determination clinical form, degree
of weight, exciter, complications
Differential diagnosis with chronic tonsillitis, with the
noncommunicative form of diphtheria oropharynx, with a
scarlatin, infectious mononucleosis, anginal form of rabbitfever, acute respiratory viral infection, a leucosis
- etiotropic therapy (antibiotics, Sulfanilamidums);
-nosotropic (rinse fauces of antiseptics solutions);
- antihistaminic preparations, vitamins;
- physiotherapy (Ultra high frequency, tubus-quartz)
- disappearance of clinical simptomatic;
-normalization indexes of blood, urine
- during a month (a review of doctor is 1 time on 10 days,
obligatory non-permanent research of urine, blood)
112
3.3 Literature is made to order
Basic
• Vozianova Z.I. the Infectious and parasitogenic diseases:3т.
Kyiv: Health, 2001. - Т 1.– p. 190-216
• Superviser for infection diseases /for editor U.V. Lobzina.
3publish.,supplement and change. - Spb.: Foliant, 2003. –1020 p.
• Shuvalova E.P. Infection diseases.Rostov L/Д.: Feniks, 2001.959 p.
Additional
• Clinical-laboratory diagnostic infection diseases:Superviser
for doctors. - Spb.: Foliant, 2001. – p.406-412.
• Infectious diseases: Situatioonal tasks: Train aid/M.D. Chemich,
N.I. Ilina, Sumy: publish house SUMDU, 2000. – 175 p.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 Features of exciter of diphtheria.
2 Description of еczotoxin.
3 Source of infection and factors of transmission.
4 Pathogeny of diphtheria.
5 Classification of diphtheria.
6 Basic clinical syndromes of diphtheria.
7 Clinical displays are depending on weight of motion.
8 Specific complications of diphtheria.
9 Differential diagnosis of diphtheria and syndrome of mангінаm.
10 Differential diagnostics of syndrome is a «quinsy».
11 There is a plan of inspection patient with diphtheria.
12 Methods of specific diagnostics of diphtheria. Interpretation of
results of laboratory research.
13 Specific therapy of diphtheria: doses, way of introduction,
duration of treatment.
14 First aid to the patient with diphtheria.
15 Governed excerption of reconvalescentes from permanent
establishment.
16 A prophylaxis and measures is in a cell.
3.4.2 Tests are for self-control
113
To choose right answers
Variant 1
1. Diphtheria belongs to to:
A - food toxicoinfection
B - bloody infections
C - enteroideas
D - air-drop’s infections
E - food intoxications
2 Exciter of diphteria:
A treponema pallidum
B - C.diphtheriae
C - Vibrio cholerae
D - Clostridium of perfringens
E- Clostridium of botulinum
3 What toxins are selected by the exciter of diphtheria?
A еndotoxin
B - neyraminidase, gialuronidase, hemolizinum
C a toxoid
D - does not select
E еkzotoxin
4 A source of infection is at diphtheria:
A are food products
B is a man
C is water
D is weed-eaters
E are the canned products
5 Factors of transmission are at diphtheria:
A is a direct contact with the respiratory secret of patients or from
by the exsudate of the staggered areas of skin
B are of poor quality green-stuffs
C are unwashed fruit
D - all is transferred
E are chhanas
6 What is a starting mechanism in pathogeny of diphtheria?
114
A - a toxin is able to stipulate the infection of skin and mucus
shells
B is a defeat of cholinergic departments of the nervous system a
toxin
C is a defeat of the digestive system a toxin
D is penetration of vegetative forms of exciter from bowels in
organs and tissues
E is a defeat of аdrenergic departments of the nervous system a
toxin
7 Duration of latent period is at diphtheria:
A - 2 – 10 days
B -1 month
C - all right
D - 2-3 hours
E- 6-24 hours, possibly continuation to 10 days
8 What research is basic in confirmation of diagnosis of
diphtheria?
A is research of strokes of mucus from fauces, nose, excretions
from wounds, ulcers, conjunctiva of eye (of external pharyngeal
form), to find out еkzotoxin of C.diphtheriae
B is research of urine for the exposure of еkzotoxin
C is a hemanalysis,vomiting, scourages of stomach, emptying,
tailings of meal, with the purpose of exposure of diphtherin
D is research of products for the exposure of C.diphtheriae
E is a bacteriologicexamination of blood,vomiting, scourages of
stomach, emptying, tailings of meal, by sowing on clear soup of
Khotingera
9 Is there what multipleness of introduction of PDS at the middle
hard form of diphtheria?
A- 12 hours
B-24 hours
C - 6 hours
D - 2 hours
E- 4 hours
115
10 Is there what multipleness of introduction of PDS at the heavy
form of diphtheria?
A- 12 hours
B-24 hours
C - 6 hours
D - 2 hours
E - 4 hours
Variant 2
1 Does meet nystagmus at diphtheria?
A - no
B - only for children
C - so
D - only at heavy motion
E- only for people old years
2 What types are groats meet at diphtheria after character of motion?
A-stormy making progress
B - slowly making progress
C - noncommunicative
D– widespread
3 How can a pulse change at the asphyxial stage of diphtheria?
A is a fall of pulse wave on height of breath
B fall of pulse wave on height of breath out
C tachicardia
D bradicardia
E arrhythmia
4 What term of vaccination of children a diphtherial toxoid, in default of
contra-indications?
A - 5 - months
B - 3-5 months
C - 6-7 months
D - 2 -3 months
E - there is not a faithful answer
5 What term of revaccination by the diphtherial toxoid of children in
default of contra-indications?
A - 18 months, 11, 14, 18 years
116
B - 12 months, 4, 8, 12 years
C - 18 months, 4, 8, 12 years
D - 12 months, 11, 14, 18 years
E- there is not a faithful answer
6 Most effective antibiotic at treatment of transmitters of toxigenic
corynebacteria:
A еrytromicinum 98 %
B - gentamicinum
C ampicillin
D- riphampicinum
E- there is not a faithful answer
7 Therapy of transmitters of toxigenic corynebacterii includes:
A antibiotic during 7 days
B nistatinum
C local sanation of ротоглотки and nose
D- antihistaminic preparations
E - all is transferred
8 How is the cardio-vessels system struck at diphtheria?
A is paretic expansion of shallow vessels
B is sharp myocarditis
C are deep degenerative changes in myocardium
D is a diffuse sclerosis of myocardium as a result of sharp myocarditis
E- all is transferred
9 Name the supporting symptoms of diphtheria in full play disease:
Ais the sharp beginning
B is heavy toxicosis
C is a diphtherial croup
D is the combined forms as combination of a few heavy variants of
illness
E - all is transferred
10 Term of brief bacteriacarry:
A - to 2 weeks
B - from 2 weeks to 1 month
C - from 1 to 6 months
D - more than 6 months
117
E - there is not a faithful answer
Variant 3
1 Name the clinical displays of beginning of toxic form of diphtheria:
A is head pain, dizziness
B is a "net", "fog" before eyes
C is a head stomach-ache, temperature of 39° of S,slabkist', anorexia,
vomit, pain
D is a nystagmus, dizziness, rapid fatigue
E is a diplopia, nystagmus and dryness, in a company
iF is is dryness in a company, paresis of soft palate, violation of act of
swallowing
2 0to -particular raid at diphtheria:
A - dense, grey fibrinotic
B is a surface brilliant,comb-like appearances
C - formed after 2 -3 days, at first web-like
D - often go beyond anatomic limits
E is «dew», without therapy appears again
F is - all is transferred
3 Basic nourishing environments are for cultivation of exciter of
diphtheria:
A environment of Klauberga - 2
B gelose on clear soup of Khottingera
C - 10 -15 % blood hemolyzes
D - 0.03 - 0.04 % telurit potassium
E is an environment of Tinsdeyla
F is - all is transferred
4 The main criterion of weight of diphtheria glandulars and pharynx is:
A degree of toxicosis
B - feet of dehydration
C degree of intoxication
D right answer “c”
E - there is not a right answer
5 What preparation is utillized for etiotropic therapy at diphtheria?
A - Laevomycetіmi succіmatis solubil. 1,0 intramuscular 3 times per
days
118
B - Visllipi-5 intramuscular for 1500000 OD 1 time per days
C - Sol. gentamycini sulfatis 4 % intramuscular for 1 ml 3 times per
days
D еrytromicynum,ryphampicynum
E - tab. Rovamicini for 3000 MО 3 times per days
6 What is a starting mechanism in pathogeny of diphtheria?
A - a toxin is able to stipulate the infection of skin and mucus shells
B is a defeat of cholinergic departments of the nervous system a toxin
C is a defeat of the digestive system a toxin
D is penetration of vegetative forms of exciter from bowels in organs and
fabrics
E is a defeat of аdrenergic departments of the nervous system a toxin
7 How is it possible to neutralize diphtherial еkzotoxin?
A - to enter a medical antidiphteria whey
B - hemosorbcia
C - to do a cleansing siphon enteroclysis
D - to enter sorbentes in a stomach
E is the зондове washing of stomach 5 % by soluble-sodium
hydrocarbonat
8 How is a antidiphteria whey entered?
A - the dose of whey is dissolved in 5% solution glucose
B - the dose of whey is dissolved in isotonic solution NaCl 1:2
C- prednisolonum in the dose of 2 mg /kg
D - warm up and enter with speed of 40- 60 drops/1 minute.
E- all is transferred faithful
9 What the combined form of diphtheria?
A - discover for the uninstiled children different age
B - more frequent all in age 1 – 5
C is combination of diphtheria glandulars and diphtherial croup
D rapid formation of fibrinotic tapes not only in a larynx but also in a
trachea, bronchial tubes
E combination of «syndrome of quinsy» from the defeat of larynx
F -all the faithful is transferred
I0 What clinical forms does diphtheria have?
A diphtheria of glandulars
119
B nasopharyngeal diphtheria
C hypertoxic form
D diphtherial croup
E combined forms of diphtheria
F - all of answers are faithful
Standards of faithful answers
Variant 1: 1 D; 2 -B; 3 -B, E; 4 -B; 5 - A; 6 - A; 7 - A; 8 - A; 9 ; 10 C.
Variant 2: 1 - A; 2 - A,; 3 - A; 4 -; 5 - A; 6 - A, D; 7 - E; 8 - E; 9
- E; 10 - A.
Variant 3: 1 - C; 2 - G; 3 - G; 4 - A; 5 D; 6 - A; 7 - A; 8 - E; 9 G; 10 - G.
3.4.3 Tasks are for self-control
Task 1
A patient is 40 years accepted in an infectious separation on the
4th day of illness. A disease was begun with a fervescence to 39 0С,
febricula, head pain. The next day a pharyngalgia appeared at
swallowing. A temperature did not go down the last 2 days, arrived
at 39-40 0С, there was repeated vomit. Objectively: patient of
аdynamic, the pallor of skin, hyperemia of mucus shell and
considerable edema of glandulars, is expressed, palatal handles,
tongue, soft palate.
Aglandulars is megascopic, on their surface there is dense tape of
rather yellow grey color, which is not taken off a tampon and goes
out outside glandulars. Regionarni lymphatic knots are megascopic
to 1,5 sm, dense, sickly of palpation. The edema of hypoderm is
expressed to the middle of neck, a sweetish smell is felt from a
mouth.heart rate 120/minute., ABP 90/60 mm h.с. At a hemanalysis
found out leucocytosis,trombocytopenia,ESR 20 mm/hour.
1 To formulate a diagnosis
2 To work out a plan of inspection sick
3 To work out a plan of treatment
Task 2
Patient 20 years in the 1th day of illness grumbles about a
pharyngalgia, temperature of 39°С, weakness, head pain, nasality of
120
voice. Objectively: адинамічне pale person. Bilateral painless edema
of neck. Mucus shell of mouth-pharynx, pharynx, moderato
hyperemia, considerable edema and increase of glandulars with tape
of dirty-grey color, which is not taken off.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 3
Youth 20 years complains on, heartburn in a right eye, mucous
festerings excretions from an eye. Objectively: it was swollen never,
point hemorrages on the conjunctiva of sclerotica of right eye, on
mucus eyelids are present grey for a gum-blush tapes which was
hardness taken off a wadding tampon. A conjunctiva bled here.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 4
A child is 5 years ill 2 days. Temperature of body 38,0 °С,
languor, pain at swallowing. Migdaliki fillings out, with dirty-grey
raids which are not taken off a spatula, submandibular lymphatic
knots are megascopic.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Standards of answers
Task 1
1 Pellicle diphtheria of glandulars is noncommunicative middling
heavy motion.
2 General analyses of blood, urine. A backterioscopy of stroke is
from glandulars; a bacteriologicexamination of mucus is from a
pharynx and nose; serum researches (RNGA with pair wheys),
immuno enzyme analysis, ECG.
3 Antitoxic antidiphteria whey 60 000 OD i/v;benzylpenicillini
200 000 OD/kg i/c 4 hours during 5-6 days, desintoxic and
symptomatic therapy.
121
Task 2
1 Pellicle diphtheria of glandulars, a form is noncommunicative,
middle hard ran across.
2 General analyses of blood, urine. A backterioscopy of stroke is
from glandulars; a bacteriologicexamination of mucus is from a
pharynx and nose; serum researches (RNGA with pair wheys),
immuno enzyme analysis, ECG.
3 Antitoxic antidiphteria whey 60 000 OD i/v;
- benzylpenicillini 200 000 OD/kg i/c 4 hours during 5-6 days
- desintoxication and symptomatic therapy.
Task 3
1 Pellicle diphtheria of right eye, a form, easy motion, is
noncommunicative.
2 General analyses of blood, urine. A backterioscopy of stroke is
from a right eye; a bacteriologicexamination of excretions is from an
eye; serum researches (RNGA with pair wheys), immuno enzyme
analysis, ECG.
3 Antitoxic antidipheria whey 40 000 OD i/v;
- benzylpenicillini 200 000 OD/kg i/c 4 hours during 5-6 days
- desintoxication and symptomatic therapy.
Task 4
1
Diphtheria
of
mouth-pharynx,
a
form
is
noncommunicative,middle hard ran across.
2 General analyses of blood, urine. A backterioscopy of stroke
from gandulars; a bacteriologicexamination of mucus is from a
pharynx and nose; serum researches (RNGA with pair wheys),
immuno enzyme analysis, ECG.
3 Antitoxic antidiphteria whey 60 000 OD i/v;
- cefazolin of 1,0 2 р в/м. during 5-6 days;
- desintoxic and symptomatic therapy.
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection patient with
diphtheria.
122
 To conduct a curation of patient with diphtheria.
 To conduct differential diagnostics of diphtheria and
syndrome «quinsy».
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection of patient with
diphtheria.
 To recognize complication of diphtheria.
 To work out a plan of treatment patient with diphtheria.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document in fact of establishment of
diagnosis «diphtheria».
4.2 Professional algorithm in relation to forming of skills and
abilities of diagnostics of diphtheria and syndrome «quinsy».
№ Task
Sequence
of A remark, warning, is in
п/п
implementatio relation to self-control
n
1
To lay hands 1 Complaints
on
the
method
of
clinical
inspection of 2 Anamnesis
patient with illnesses
diphtheria
3 Anamnesis
life
To separate complaints which
characterize syndromes:
- general intoxication;
- organ defeats.
To pay a regard to beginning,
term, sequence of origin of
symptoms, their dynamics:
- sharp beginning;
- moderate pains are in mouthpharynx at swallowing;
- shortness of breath.
- nasality of voice (palatoplegia
).
To find out the carried illnesses
To find out information in
123
4 Epidanamnez relation to realization
повітряно-краплинного
mechanism of transmission.
2
of
To conduct To conduct an To remember: the expressed,
курацію of objective
dynamics of symptoms, is
patient
inspection:
predefined a term and weight of
flow of illness.
1 General
To pay attention on:
review:
- languor, аdynami, dormancy
- general state of patient;
of patient;
- temperature of body;
- skin, mucus - pallor of skin, small cyanosys;
mouth-pharynx. presence,
localization,
character of raid;
- increase of submandibular
lymphatic knots;
oedematousness
of
submandibular area.
2
Digestive To pay attention on:
system:
- a language is assessed, lips are
- review of dry, chappy;
language;
- stomach-ache, more frequent
- percusion of sharp, sudden;
stomach
- закреп, vomit.
- palpation of
stomach
- character of
emptying.
To pay attention on:
3 Nervous
- dystrophic and necrotizing
system
changes;
- paresis of soft palate;
- cacesthesias;
- defeat of CNS, was swollen,
hemorrages;
124
- comma.
To pay attention on:
4 cardio-vessels - decline of AT;
system
- tachicardia (does not answer a
temperature);
- myocarditis is with an
asequence cardiac rhythm;
- DVZ- syndrome.
5
Respiratory To pay attention on:
system
- shortness of breath in a state of
rest;
- paradoxical type of breathing
(defeat of diaphragm).
3
To appoint 1
General
laboratory
analysis
of
and
blood
additional
researches
To pay attention on:
- neutrophilic leucocytosis with
the change of leucocytic
formula to the left;
- megascopic ESR.
- maintenance of albumen is
2
General enhanceable
(to
a
10
analysis of urine gramme/л);
- cylinders (gialin and grainy);
- single changed red corpuscles;
- high specific closeness.
Necessary in the case of
determination of degree of
3 Biochemical violation of activity of different
hemanalysis
organs and systems.
(ASAT, LDG,
acid-basic
status,
electrolytes,
coagulogram,
kidney tests, to Presence of exciter
125
рН-blood)
4 Bakterioskopiya of secret of
mouth-pharynx Growth of title of antibodies
and
nasal
motions.
5
Serum Presence in 24 hours of
research
of коринебактерій diphtheria.
RPGA
6 Bakteriologichna diagnostics
Materials of after audition independent work
Subject of UDRS and NDRS:
• Features of motion of diphtheria are in modern terms.
• Modern methods of specific diagnostics of diphtheria.
• Problems of etiotropic treatment of diphtheria today.
• Modern looks are to pathogeny of diphtheria.
126
Topic. A MENINGEAL SYNDROME IN THE CLINIC OF
INFECTIOUS DISEASES. DIFFERENTIAL DIAGNOSTICS
OF
SEROSAL
AND
FESTERINGS
MENINGITIS.
MENINGOCOCCUS INFECTION
Duration – 2 hours.
1 Actuality of theme. Presently a meningococcus infection as
sporadic cases or small epidemic flashes is registered in entire
countries. In 80% cases primary bacterial meningitis has
meningococcus etiology.
As a result of high sensitiveness to to children and young people
are ill mainly meningococ. High step of contagiose instrumental in
the origin of epidemics, and investigation of it are enormous
economic expenses.
A disease can run across hardness with high lethality.
A meningococcus infection so far remains incomplete guided, as
there is not a vaccine created against all of groups meningococcus.
Questions of pathogeny are not enough studied, in particular,
reasons of forming of fulminante and chronic forms.
Taking into account lightness of distribution of infection,
unforeseeableness of its motion, registration, all are subject it clinical
forms – from a transmitter to fulminante.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
 etiology of meningococcus infection, factors of pathogenicity
of exciter;
 epidemiology of meningococcus infection;
 pathogeny;
 clinical displays of meningococcus infection are at typical
motion;
 clinical-еpіdemiologic features of meningococcus infection;
 pathogeny and clinical displays of complications of
meningococcus infection;
 pathogeny and clinic of edema and swelling of cerebrum;
127
 laboratory diagnostics of meningococcus infection;
 principles of treatment;
 principles of prophylaxis;
 tactic in the case of origin of the exigent states;
 prognosis of meningococcus infection;
 governed extracts of reconvalescentes from permanent
establishment;
 governed the health centre system of reconvalescentes
 2.3 A student must be able:
 to adhere to the basic rules of work near a bed sick;
 to collect anamnesis of illness with the estimation of
epidemiology information;
 to inspect a patient and find out basic symptoms and
syndromes of meningococcus infection, ground a clinical diagnosis
for timely direction of patient in permanent establishment;
 to conduct differential diagnostics of meningococcus infection;
 on the basis of clinical inspection in good time to recognize
possible complications of meningococcus infection, exigent states;
 to design a medical document in fact of establishment of
previous diagnosis "meningococcus infection" (an urgent report 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 information, weight of the state, presence of
complications, allergist anamnesis, concomitant pathology; to render
the first aid on the before hospitalization stage;
 to work out a plan of disease and prophylactic measures in the
hearth of infection;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescentes.
3 Materials are to audience independent work
128
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties
of
meningococces, methods
of specific diagnostics of
meningococcus infection
Physiology
Parameters of physiology To estimate information
norm of organs and of laboratory inspection
systems of man; indexes
of laboratory inspection
are in a norm (заг. ан. to
blood, urine, biochemistry
of blood, parameters of
KOS, electrolytes and
others like that)
Physiopathology A mechanism of violation
of functions of organs and
systems is at the pathosiss
of different genesis
Immunology
and
allergology
To interpret the results
of specific methods of
diagnostics
of
meningococcus infection
To interpret pathological
changes as a result of
clinical and laboratory
inspection
Basic concepts of object, To estimate information
role of the system of of
immunological
immunity in an infectious researches
process, influence on the
term of еlimination of
exciter from the organism
of man
129
Epidemiology
An epidemic process
(source, mechanism of
infection,
ways
of
transmission)
of
meningococcus infection;
prevalence of pathology in
Ukraine and in the world
To collect epidemiology
anamnesis, to conduct
disease and
prophylactic measures
are in the hearth of
infection
Neurology
Pathogeny,
clinical To conduct the clinical
syndromes of disease
inspection of patient
with the defeat of the
nervous system
Propedevtika of Basic stages and methods To collect anamnesis,
internal illnesses of clinical inspection of conduct the clinical
patient
inspection of patient,
find out pathological
symptoms
and
syndromes. To analyse
findings.
Clinical
pharmacology
Pharmakokinetics and
pharmacodynamics, side
effects of facilities of
specific and nosotropic
therapy
Next disciplines
130
To appoint treatment
depending on the degree
of weight, individual
features of patient.
To write recipes
family medicine Pathogeny,
epidemiology, dynamics
of clinical displays,
complications
of
infectious diseases are
possible. Principles of
prophylaxis
and
treatment.
To conduct differential
diagnostics of illnesses of
different genesis. To
recognize an infectious
disease, his complication;
to interpret information of
laboratory inspection. In
good time to hospitalize a
patient
in
infectious
permanent establishment.
To render the first aid in
the case of necessity.
intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics, treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics
of clinical displays,
laboratory diagnostics,
complications
of
infectious diseases are
possible.
131
To conduct differential
diagnostics of illnesses of
different genesis. To
recognize an infectious
disease, his complication;
to interpret information of
laboratory inspection. To
appoint treatment. To
render the first aid on the
before
hospitalization
stage.
3.2. Structurally logical chart of maintenance of theme of employment
Chart of diagnostics and treatment of meningococcus infection (Morbus meningococceus)
Epidemiology anamnesis:
socializing with patients nasopharingitis or other patients with an enhanceable
temperature; it is intercourse from rekonvalescentami or by the healthy
transmitters of meningococcus
sharp or quick as lightning beginning with a high temperature, moderate head pain, by pain in
muscles and joints;
- tachicardia, low blood pressure;
a presence of hemorrhages, more frequent hemorragic rash of wrong form as a stars through 5-15
hour from the beginning of disease on extremities, back, buttocks;
-total cyanosys with the so-called of a corpse spots (ITSH);
presence of herpes;
-meningeal signs, hyperaestezia, violations of consciousness;
-development of sharp insufficiency of bark adrenal glands
- -study of gemogram and neurolymph; backterioscopy of neurolymph; a bacteriologic
examination of neurolymph, mucus, from nasopharynx, blood; luminescent microscopy;
research of eyeground; serum researches; lateks-agglutination; immune enzyme analysis,
PCR
- determination of the final unfolded
diagnosis is taking into account a form,
weight of motion, complications
Differential
diagnosis
with
tubercular,
pnevmokokovim, staphylococcus but other by
meningitises, and also with a subarachnoidite
hemorrhage, sepsis, medicinal illness, spotted fever,
flu, leptospirosis, hemorragic fevers, thrombocytopenic
purpuroy, rheumatoceils, illness of Verlgofa
- etiotropic (antibiotics, Sulfanilamidums);
-nosotropic therapy:desintocsication, degidrataction, corticosteroides, anticoagulants;
-anticonvulsant preparations, oxigenotherapy;
- reanimation measures of heavy motion and development of complications
clinical and laboratory convalescence
- for clinical requirementes for a year researching a neurologist
132
Plan diagnostics and treatment of hemophilic infection (Haemophilus of infectio)
Epidemiology anamnesis:
a presence of contact with a patient (more frequent all – by a child) with the sharp inflammatory
process of organs breathing or CNS; stay in the places of large accumulation people; to put in age
6-8 months; winter-spring seasonality; presence of immunodeficit, sickle-like cellular anaemia,
megacaryoblastoma, after a splenectomy and chemotherapy
- stering meningitis: sharp beginning from catarrhal symptoms, then symptomatic of bacterial
meningitises, heavy motion; sometimes joining of festering arthritis, inflammation of epiglotitidis;
to celulit.
-Hemophilic pneumonia: focal or croupous, very often with joining of festering pleurisy; possible
complications are festering pericarditis, inflammation of middle ear; can have the protracted
motion.
-Hemophilic sepsis: symptoms of heavy septicemy with stormy motion and septic shock;
septicopyemias not observed.
-Celyulit: more frequent localized on face, begun with the picture of ARD: characterized the limited
slight swelling, hyperemia with a cyanochroic tint; localization-a cheek or eye socket; a
temperature subfebril, intoxication is not expressed.
-Inflammation of epiglottiditis: sharp beginning, rapid fervescence, considerable intoxication,
quickly making progress; often bakteriemia.
-Festering arthritis: often with osteomielitom, other displays rarer
- selection of exciter (from a pus, sputum, neurolymph, material, from a mucus shell);
- determination of capsule AG hemophilic stick in a neurolymph (sometimes in urine) in the
reaction of counter immunoelectrophoresis or immune enzyme analysis
determination of the eventual
unfolded diagnosis (form, degree of
weight, complications
Differential diagnosis with meningitises and sepsis of other
etiology, arthritis and osteomielites of other etiology, with
a flu and other acute respiratory viral infection,
pneumonias
obligatory hospitalization;
-etiotropic therapy: antibacterial preparations – cefalosporini (at obligatory determination of
sensitiveness of exciter to the antibiotics) mainly intravenously, for easy forms - makrolides,
phtorchinolones,
- desintocsication therapy;
- desensitive preparations;
- vitamins;
-symptomatic therapy
- disappearance of clinical symptomatic;
- normalization of laboratory indexes
-for a clinical requirementes
133
3.3 Literature is made to order
Basic
• Vozianova zh.I. the Infectious and parasitogenic diseases: 3 Т. –
K.: of Health, 2001. Т 1. - p. 433 – 457
• Infectious diseases. Textbook / For editor M.B. Titova – K.:
Higher school, 1995. – p. 89 - 97
• Superviser for infection diseases / for editor
U.V.
Lobzina - Spb: Foliant, 2003. – 1040 p.
• Shuvalova e.P. Infection diseases. Rostov l/d.: Feniks, 2001. –
959 p.
Additional
• Gavrisheva N.A., Antonova T.V. Infection process.Clinical and
pathophisiologic problems.-Spb.: Special literature, 1999. – 255p.
• Clinical-laboratory of diagnostic infection diseases: Suoerviser
for doctors. - Spb.: Foliant, 2001. – 384 p.
3.4 Materials are for self-control
3.4.1 A question is for self-control
Control questions are for the preparatory stage of employment
1 Features of exciter of meningococcus infection.
2 Description of еndotoxine.
3 Source of infection and factors of transmision.
4 Pathogeny of meningococcus infection.
5 Classification of meningococcus infection.
6 Basic clinical syndromes of meningococcus infection.
7 Clinical displays are depending on weight of motion.
8 Specific complications of meningococcus infection.
9 Differential diagnosis of meningococcus infection.
10 Plan of inspection sick on meningococcus infection.
11 Methods of specific diagnostics of meningococcus infection.
Interpretation of results of laboratory research.
12 Pathogeny and clinical displays of NNGM.
13 Modern classification of NNGM.
14 Specific therapy of meningococcus infection: doses, way of
introduction, duration of treatment.
15 First aid to the patient with a meningococcus infection.
134
16 A plan of conduct sick is from NNGM.
17 Governed extracts of reconvalescenes from permanent
establishment.
18 A prophylaxis and measures is in a cell.
3.4.2 Tests of 2th level
To choose right answers
Variant 1
1 A menigococcus infection belongs to to:
A – infections of respiratory tracts
B - bloody infections
C - enteroideas
D – infections of external covers
E– slow an infection
2 A mechanism of infection is at a meningococcus infection:
A – vertical
B – transmisive
C – pin
D is sullage-oral
E – aerogene
3 A latent period of meningococcus infection:
A – 2 – 15 days
B – 1 – 10 days
C – 2 -3 weeks
D – 45 – 90 days
E – 20 – 25 days.
4 There is characteristic nasopharyngitis for a meningococcus
infection?
A – so
B – no
C – only for children
D – only for a patient with chronic Ringo
E – only for patients with the heavy flow of illness.
5 What temperature is needed for cultivation of meningococcus?
A – 10-15 0С
B – 0 0С
135
C – 40-45 0С
D – 36-37 0С
E – 38-39 0С
6 What materials from a patient do undertake for bacteriological
confirmation of meningococcus infection?
A a pleura liquid, excrement
B sputum
C – washing water of stomach
D urine, sputum
E strokes from the back wall of nasopharynx, blood, neurolymph
7 What illnesses is it needed to differentiate meningococcus
meningitis with?
A – with a psittacosis
B – with infectious mononucleosis
C – with tubercular meningitis
D – with illness of Lime
E– with a topsail fever.
8 There is characteristic neutrophilic pleocytosis for
meningococcus meningitis?
A – so, all of period of illness
B – no
C – so, at the beginning of illness
D – so, at the end of illness
E – so, for some patients
9 Day's dose penicillinum to the patient with meningococcus
meningitis:
A – 1000000 – 2000000 Od/ of kg of mass / days
B - 10000 – 50000 Od/ of kg of mass / days
C - 1000000 – 500000 Od/ of kg of mass / days
D - 200000 – 500000 Od/ of kg of mass / days
E - 50000 – 100000 Od/ of kg of mass / days
10 Term of looking after the epidemic hearth of meningococcus
infection:
A – 10 days after the isolation of patient
B – 10 days after the beginning of the first disease
136
C – 10 days after the isolation of the last patient
D – 24 days after the isolation of the last patient
E – 24 days after the beginning of the first disease
11 Clinical displays of NNGM:
A sharp head pain
B a motive anxiety
C disorders of breathing
D is cramps
E – all right
12 NNGM arises up as a result of:
A – toxication
B – the fixed diuresis
C – to the hyperproduction neurolymph
D - cramps
Standards of right answers
1 - A; 2 - E; 3 -; 4 - A; 5 - C; 6 - E; 7 - C; 8 - A; 9 D; 10 - A, 11 E, 12 - A.
3.4.3 Situatioonal tasks of the second level of mastering
Task 1
In an infectious hospital delivered a patient in a grave condition.
Sick suddenly, when a temperature rose to 39,30 С, head pain
appeared, artralgias, bloking nose, with mucous festerings excretions.
Objectively: a skin is pale, on-the-spot buttocks, shins, feet the
abundant rash of wrong star’s form takes a place, by sizes from
петехій to large еcchimoses diameter 4 – 7 sm. Elements are dense,
a bit come forward above the surface of skin. On the mucus shell of
oral cavity, scleroticas and conjunctiva, hemorrhages. ABP 90/50
mm.h.с., deafness of cardiac tones, arrhythmia,heart rate 110
/minuteхв.
1 Formulate a diagnosis.
2 Classification of this disease.
3 Specific prophylaxis.
137
Task 2
An ambulance to the induction centre is deliver a patient in a
grave condition. According to native, захворів sharply 2 days ago,
head pain appeared, the temperature of body rose to 38,90 С; vomit
which did not bring a facilitation appeared the next day. Patient of
аdynamic, consciousness, stored, meningeal signs appear: symptoms
of Brudzinsk, Kernig, rygid of cervical muscles; reflexes are lowspirited, asymmetric. On the skin of shins, buttocks, forearm of
petechial, rash wrong star form. ABP 110/60 mm. h .c,heart rate
95/minute ., breath rate 24/minute.
1 Formulate a diagnosis.
2 Specific diagnostics.
3 Complication of disease
4 Differential diagnostics of disease.
5 Etiotropic and nosotropic treatment.
Task 3
In permanent establishment hospitalized a patient is with
complaints about a fervescence to 38,00 С, weakness, head pain,
non-permanent vomit, pharyngalgia at swallowing and to wheezing
voice. Objectively: the state of patient is relatively satisfactory, pays
attention on itself herpetic pouring out on lips, закладеність nose
with mucous festerings excretions. Mucus nose the bloodshot, mucus
shell of back wall of pharynx is bloodshot with the hypertrophy of
follicles and «festering path». In a clinical blood test moderate
neutrophilic leucocytosis.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Standards of answers
Task 1
1 Meningococcemia, heavy motion. Complication: ITSH, sharp
myocarditis.
2 A. Lokalisation forms: meningoccarry, nasopharyngitis.
138
3 B. Generalisation forms:A) typical meningococcemia; B) аtypic
meningococcemia (without metastases in internalss, with metastases
in internalss); C) meningoccus meningitis.
V. Combination forms.
After the degree of weight: easy, middle, heavy, as heavy as lead.
3 A specific prophylaxis is provided a vaccine. Lead nonpermanent в/м, dose accordingly age. Vaccines which contain
capsule polisacharide of meningococcus of type A, С are made, V,
W135, there are monovaccines (A and С); bivalent (A+s); quart of
vaccine (A+s+v+w135). A-vakcina provides securing for 2 years, Son 2-4 years.
Task 2
1 Sharp meningococcus meningoencephalit, middle weight.
2 Bakterioskopichne of hemanalysis, neurolymph, urine,synovial,
pericardiac, pleura liquid, strokes, from a nose and mouth-pharynx.
Serum methods: CFT, RPGA, RA, immuno enzyme analysis, PLR.
3 It was swollen a brain, wedging of prolate brain in the large
cervical opening, syndrome of cerebral hypotension,ependimatitis,
subdural sweat, deafness, epilepsy, hydrocranium, death.
4 Tubercular meningitis, subarachnoidal hemorrhage, comatose
states.
5 Penicillin 24 000 000 OD/day, ampicillinum 400 mg/kg/day,
solution of levomicetin succinate to 4 gr/days, Oxacillinum 300
mg/kg/day,ceftriaxonum,cefotaximum,
Tetracyclinum.
GKK:
Dexamethazonum 2-3 mg (8-10mg) i/v 4-6 days. Diuretic: 15 %
solution manitol, 30 % solution of urea is combined from 20 %
solution of аlbumin. Parentetal detoxication, correction of acid-basic
status, oxigenitherapy salt solutions.
Task 3
1 Sharp meningoccus nasopharyngitis, middle weight.
2
Clinically
blood
test,
clinical
uranalysis,
bacteriologicexamination of strokes, from a nose and mouthpharynx, CFT, RA, immune enzyme analysis, PLR.
3 Respirator viruses (flu, parainfluenza, аdenovirus, rhinovirus),
antritis, diphtheria of mouth-pharynx.
139
4 Levomicetin is 0,75 g 4 times per days, ampicillin 0,5 gr 4 times
per days 5 days. Rinse of throat by solutions furacillinum, of natrii
hydrocarbonatum.
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection patient with a
meningococcus infection to Conduct a curation of patient with a
meningococcus infection.
 To conduct differential diagnostics of meningococcus
infection.
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection of patient with a
meningococcus infection.
 To recognize complication of meningococcus infection.
 To work out a plan of treatment patient with ameningococcus
infection.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document in fact of establishment of
diagnosis «meningococcus infection».
4.2 A professional algorithm is in relation to forming of skills
and abilities of diagnostics meningococcus infection
№ Task
Sequence
of A remark, warning, is in
п/п
implementatio relation to self-control
n
1
To lay hands 1 Complaints
on the method
of
clinical
inspection of
patient with a
meningococcus
infection
2 Anamnesis of
illness
140
To separate complaints which
characterize syndromes:
fervescence;
general cerebral ;
- meningeal signs.
To pay a regard to beginning,
term, sequence of origin of
symptoms, their dynamics:
- violation of cardiac activity;
- general cerebral;
- violation of breathing.
To find out the carried
illnesses
3 Anamnesis of
life
4
Epidanamnesis
2
To find out information in
relation to realization of airdrop’s
mechanism
of
transmission.
To
conduct 1 To conduct The expressed, dynamics of
курацію
of an
objective symptoms, is predefined a
patient
inspection
term and weight of flow of
illness.
2 General
To pay attention on:
review
consciousness;
a rash is on a skin, his
character, form, size.
3 Digestive
To pay attention on:
system
mucus shell, hemorrhages
are possible;
vomit which does not
bring a facilitation.
4 Nervous
To pay attention on:
system
- meningeal signs (symptom of
Brudzinskogo, Kernig, rygid
of cervical muscles);
- decline of reflexes, their
asymmetry;
- violation of breathing.
To pay attention on:
5cardio-vessels - muffling of tones of heart;
141
system
- tachicardia;
- decline ABP.
6 Respiratory To pay attention on:
system
- violation of breathing rhythm
(аpnoae);
- increase of breathing
frequency.
3
To
appoint 1
General
laboratory and analysis
of
additional
blood
researches
To pay attention on:
- neutrophilic leucocytosis
with the change of leucocytic
formula to the left;
- megascopic ESR.
Presence of meningococcus
2
Serum endotoxine
hemanalysis,
neurolymph,
pleura,sinovial,
pericardiac
liquid.
3 acid- basicstate
Materials of after audition of independent work
Subject of UDRS and NDRS:
• Features of motion of meningococcus infection are in modern
terms.
• Modern methods of specific diagnostics of meningococcus
infection.
• Problems of etiotropic treatment of meningococcus infection
today.
• Modern looks are to pathogeny of meningococcus infection.
142
Topic. EXIGENT STATES FOR PATIENTS WITH
INFECTIOUS
DISEASES
WITH THE
AIR-DROP’S
MECHANISM OF TRANSMISSION. ITSH. REAL CROUP.
UNREAL CROUP. ACUTE RESPIRATORY INSUFFICIENCY
Duration - 2 hours.
1 Actuality of theme. The exigent states for infectious patients
develop often, especially at the heavy flow of illness. Wrong
diagnostic decisions result not only in ineffective and uneffective
medical measures, but make a threat for life sick. Than it is before
diagnosed presence or threat of development for the patient of
critical condition and the leadthrough of reanimation measures is
before begun, the greater probability of success is in treatment.
Knowledge of the exigent states for infectious patients needs the
doctors of all of specialities, especially that, who works in many
prophiles and rural medical establishments. They often remain in
private with problems which arise up for a patient suddenly. Life of
man depends on speed of decision-making, rightness of actions of
doctor.
2 Whole lessons (with pointing of level of mastering which is
planned)
2.1 A student must know:
а-2
 infectiously toxic shock, sharp respiratory insufficiency, real
and unreal croup: determination, etiology;
 pathogeny of the exigent states;
 clinical and laboratory diagnostics of water-electrolyte
violations;
 differential diagnostics of the exigent states with the shock
states of other genesis;
 principles of treatment, first aid by a patient on the before
hospitalization stage.
2.3 A student must be able:
а-3
 to adhere to the basic rules of work near a bed sick with the
exigent states;
143
 to collect anamnesis of illness;
 to inspect a patient, ground a diagnosis;
 to conduct differential diagnostics of the exigent states;
 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 information, stage of illness, to render the first aid on
the before hospitalization stage;
 to give recommendations in relation to the mode, diet,
inspection, supervision, in the period of reconvalescence.
3 Materials are to audience independent work
3.1 Base knowledges, abilities, skills, necessary for a study
themes (interdiscipline integration)
Discipline
To know
Able
Previous disciplines
Microbiology
Properties
of
C. To interpret the results of
diphteriae, S. aureus, H. specific methods of
influenzae. Methods of diagnostics
specific diagnostics
Physiology
Parameters of physiology To estimate information
norm of organs and of laboratory inspection
systems of man;indexes
laboratory inspection in a
norm (general аnanalysis
of
blood,
urine,
parameters of acid-basic
state, electrolytes and
others like that)
144
Physiopatholog A mechanism of violation
y
of functions of organs and
systems is at the pathosiss
of different genesis
To interpret pathological
changes as a result of
clinical and laboratory
inspection
Immunology
Basic concepts of object, To estimate information
and allergology role of the system of of
immunological
immunity in an infectious researches
process, influence on the
term of елімінації of
exciter from the organism
of man
Epidemiology
Epidemic process (source,
mechanism of infection,
ways of transmission) at
the
exigent
states,
prevalence of pathology in
Ukraine and in the world
To collect epidemiology
anamnesis,
conduct
disease and prophylactic
measures in the hearth of
infection
Propedevtika of Basic stages and methods To collect anamnesis,
internal
of clinical inspection of conduct the clinical
illnesses
patient
inspection of patient,
find out pathological
symptoms
and
syndromes. To analyse
findings
Clinical
pharmacology
Pharmakokinetics
and
pharmacodynamics, side
effects of facilities of
specific and nosotropic
therapy
Next disciplines
145
To appoint treatment
depending on the degree
of weight of motion,
individual features of
patient. To write recipes
family
medicine
Pathogeny, epidemiology,
dynamics
of
clinical
displays, complications of
infectious diseases are
possible. Principles of
prophylaxis and treatment.
To conduct differential
diagnostics of illnesses
of different genesis. To
recognize an infectious
disease,
his
complication; to interpret
information of laboratory
inspection. In good time
to hospitalize a patient in
infectious
permanent
establishment. To render
the first aid in the case of
necessity.
intradiscipline integration
Infectious
diseases
Features of infectious
diseases. Principles of
diagnostics,
treatment,
prophylaxis of infectious
diseases.
Pathogeny,
epidemiology, dynamics
of
clinical
displays,
laboratory
diagnostics,
complications
of
infectious diseases are
possible.
146
To conduct differential
diagnostics of illnesses
of different genesis. To
recognize an infectious
disease,
his
complication; to interpret
information of laboratory
inspection. To appoint
treatment. To render the
first
aid
on
the
догоспітальному stage.
3.2. Structurally logical chart of maintenance of theme of employment
plan of diagnostics and treatment of infectiously toxic shock
Epidemiology anamnesis:
-a patient has a presence of focal infection; patients with the high degree authenticity of shock
reactions (generale form of meningococus infection, sepsis and other );
-introduction of large doses of antibiotics bactericidal action patients from bakterimia
Early phase (I stage):
Massive operating on the organism of microbal toxins, intoxication, fever, chill, head pain, pain, in an
abdominal region; skin usually color, dry, heat; The arterial pressure sistolic - 90-140 mm h. c of
diminishing of pulse pressure; slowing down diuresis; shock index 0,7-1,0.
Expressed shock (II stage):
decline of temperature, violation of consciousness; a skin is pale, moist, cold, cyanosys increases;
Arterial pressure sistolic < 90 mm h. c, pulse 120-140 / minute; shock index 1,0-1,4; shortbreathing,
intersticial pulmonary edema; oligoanuria (a selection urine less than 25 ml/gramme); metabolic
acidosis.
Late phase of shock (III stage): a skin is cold, earthy tint, gemoragies round joints; temperature below
36,00 S; a pulses- threadlike, arterial pressure sistolic of critical level; shock index 1,5 and higher,
disorders of breathing, anury; loss of consciousness
...
- bacteriologic examination of blood, neurolymph, urine, bile and other biological substances;
general analysis of blood (leucocytosis, erytrocytosis, trombocytopenia, acceleration of ESR); a
presence of changes in urine (red corpuscles, leucocytes, albumen, cylinders); biochemical blood
test (enhanceable indexes of bilirubin, kreatinine, indikan, urine); coagulogram (violation of rolling
function of blood); determination of the acid-base state (acidosis)
-to formulate a diagnosis with pointing
of basic disease, which became
complicated infectiously toxic by shock,
degree of weight
A differential diagnosis is with shocks of other
etiology, DVZ-syndrome, bacillosiss which are
accompanied a fever
- forbidden to transport patients; desintocsication therapy; etiotropic therapy (antibiotics of
bakteriostatic action); glyucocorticoides (II-III stage of shock); correction of micromicrocirculation
(heparin, trental); diuretic (manitol, Mannitum); inhibitors of proteases; vitaminotherapy
- disappearance of clinical symtomatic of basic disease; normalization of
laboratory indexes
- in obedience for a basic disease
147
Sharp respiratory insufficiency
Еtiopathogenesis
Lungs causesі
sharp сstenosis larynx,
laryngotracheobronchitis
Оbstruction high
Respiratory ways
extralungs causes
decrease functional
volume
of lungs
restruction high
Respiratory ways
Аctive lighting process
damage breathing
of nose,and
і sick breathing
mouth cavity
edema of lungs
poliomelitis,
правець
difuse type respiratory insufficiency
paralise
action on musc
le
neuroparalitic type res
piratory insufficiency
damage winking
еpitelium of bronch , trachea,
larynx
damage drenage
function of lungs
sharp lungs insufficiency
edema mucous and submucous
coats laryngs annd high
delay in high r
Respiratory way dense saliva
drying saliva
Appear closely peel
Оbstruction high respiratory ways
Sharp respiratory insufficiency
148
Edema of lungs
Еtiopathogenesis
hyperhydratation
hypertoxic shock
hyperproteinemia
Intensive replication
,storing up viruses
in respiratory
ways
decrease оncodenic
pressure of
blood
increase
hydrostatic
pressure
diphteria,leptospirosis
meningococcus
іnfection and other.
infection
miocarditis
damage of microcirculation
increase
penetreting
capilares in lungs
circulation-
deficte
surfactant
insufficiency leftventricule
increse hydrostatic
pressure
in a small blood
transudacia
decrease,
colaculation
аlveoles
Еkzotoxin, еndotoxine
difuse lung vasculite
edema
іntersticiallungs
storing up
ня liquor
in аlveoles
hypoxia
Аcydosis
freeing vasoactive peptides
metabolicі damage
in tissue
poliorgans
insufficiency
Sharp respiratory insufficiency
149
DVSsyndrom
3.3 Literature is made to order
Basic
 Vozianova Z. I. Infectious and parasitogenic illnesses : In 3 т.
– K.: Healthy I, 2001- Т. 3- p. 296-466.
 Ivakhiv O.L., Grishko R.U., Kiselik I.O. infectious Room of
diseases: Train aid.- Ternopil, 2006.- 350 p.
 Infectious diseases are in general practice and family
medicine / For editor M.A. Andreychina. –Ternopil: TDMU, 2007.470 p.
3.4 Materials are for self-control
3.4.1 A question is for self-control
1 What characteristically for the initial phase of shock?
2 What illnesses does it follow to differentiate ITSH with?
3 Governed setting of antibiotics.
4 Principles of therapy are in the conditions of permanent
establishment.
5 Gemograma of patient is from ITSH.
6 Pathogeny of acute respiratory insufficiency.
7 What complications do arise up acute respiratory insufficiency
?
8 A complex of medical measures is acute respiratory
insufficiency .
9 What vaccines do utillize for the prophylaxis of flu?
10 What additional methods of inspection do utillize for
diagnostics of acute respiratory insufficiency ?
11 Differential diagnostics of the real and unreal croup.
12 The first aid is in the case of acute respiratory insufficiency .
3.4.2 Tests are for self-control
To choose right answers:
Variant 1
150
1 What preparations do appoint at laryngospasm?
A - Natrii oxibutiratis
B - to sodium chloride
C vitamin of С
D a heparin
E is a phentanyl.
2 How many degrees of stenosis of larynx?
A-2
B-4
C-3
D-6
E-1
3 Can the syndrome of croup arise up at?
A - sharp enteroideas
B - the meningococcus infection
C - diphtheria
D - acute respiratory disease
E - all right.
4 What additional methods of diagnostics of croup?
A is an echoencephalography
B is medullispinal punction
C - еlectroencephalography
D - all correctly
E is sciagraphy
5 What characteristic information does have an important value
for diagnostics of acute respiratory insufficiency ?
A is a level of glucose of blood
B is a level of haemoglobin
C is determination of рСО2 р O2 of blood
D - all right
6 The syndrome of croup develops in :
A - women
B - children to 3
C - men
D - adults
151
E – old people
7 Reason of development of croup is:
A is a flu
B is a parainfluenza
C аdenovirus
D is a bacillosis
E - all right
8 A near-term measure is in treatment of croup:
A - аtroventum
B - Natrii oxibutiratum
C tracheotomy
D аerosol-paroxigen mixture
E - salbotamolum
Variant 2
1 The basic clinical signs of croup is;
A is a rough barking cough
B - wheezing voice
C is the loud breathing with the laboured inhalation
D is an indrawing of intercostal intervals
E - all right
2 I the degree of stenosis of larynx is characterized :
A - blowing wings of nose
B - by cyanosys of naso-lip’s triangle
C - by a “barking cough”
D - a shortness of breath is not
E - all right
3 What degree of stenosis of larynx is the inciter shortness of
breath expressed at in a spacehold?
A-1
B-2
C-3
D -4
4 Sodium hydrocarbonatis is appointed with a purpose:
A - desintoxication
B are prophylaxises
152
C decline of ABP
D corrections of аcidosis
E - against cramps
5 What diseases is it needed to differentiate acute respiratory
insufficiency with?
A - by a quinsy, psittacosis,measles
B - by a sepsis,meningoencephalitis
C - measles, german measles
D - psittacosis, sepsis, by a german measles
6 In the phase of the expressed shock:
A is diminishing of amount of thrombocytes
B is diminishing of time of hemopexis
C hyperkaliemia
D is an increase of urea, kreatin well
E is a hyperglycaemia
7 For the initial phase of ITSH characteristically:
A is an increase of urea, kreatinine
B is diminishing of time of hemopexis
C is a hyperglycaemia
D is lactatacidemia
E - hyperenzynemia
8 Kontrikal appoint for :
A is diminishing of blood volume
B are normalizations of hemodynamics
C are corrections of acid-basic equilibrium
D is oppression of enzyme’s activity
E is a leadingout of liquid
Standards of right answers
Variant 1: 1 – A; 2 –B; 3D; 4D; 5 D; 6 –B; 7 – E; 8 D.
Variant 2: 1 - E; 2 - E; 3 - C; 4 D; 5 - A; 6 - A; 7 -; 8 - C .
3.4.3 Situatioonal tasks
Task 1
Patient A, 40 years, delivered in an infectious hospital. Third day
illnesses, temperature 39,9 0С. Sharp the signs of respiratory
insufficiency are expressed: frequency of breathing/40 minute,
153
diffuse cyanosys. A cough attack is permanent, periodically, with
passing to the stuffiness.Sputum is festering-mucus, departs
hardness. In lights hard breathing, differentdiameter moist and dry
wheezes. On a sciagram: signs of bronchitis. Blood test: eryth -4,0
10/l, l – 6,0 10/l, general protein - 120 g/l,ESR - 14 mm/hour.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 2
In the separation of intensive therapy a patient is delivered In., 35
years, with complaints about feeling of insufficiency of air, shortness
of breath of inciter character. great pain behind sternum, dry cough,
increase of temperature, is to 37,6 0С. Objectively: a patient is
uneasy, a skin is pale, covered a death-damp, neck veins
swell,breathing rate 30/minute., in lights hearkened to the dry
whistling wheezes. ABP 100/60 mm hidrargium column ,heart rate
100/minute..A cardiac shove is increased. Granici of heart is declined
on the right. Anamnesis of disease: ill sharp that is why, when pain
after a breastbone and shortness of breath appeared suddenly, lost
consciousness then.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 3
Sick к., 38 years, illnes suddenly. A disease began a трясучим
chill and sharp fervescence to 390 С. Great head pain, nausea, vomit,
attacks of tonic and clonic cramps, appeared. The symptoms of
Kerniga and Brudzinskogo are sharply expressed. A patient lies with
the neglected head, feet are arcuated in knee-joints. Found out a
paropsis, cross-eye, diplopia, paresis of muscles of person, shortness
of breath, arrhythmia. A person is bloodshot, covered sweat with the
herpetic pouring out on the mucus shell of lips, nose. Blood
test:leucocytosis 4,0 10/l,ESR 40 mm/hour. A neurolymph is turbid,
festering, flows out with enhanceable pressure (600 mm waters
154
column), cellular-albuminous dissociation, albumen 2,5 grammes/л,
the amount of sugar and chlorides is mionectic.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 4
Boy Н., 1 year 4 misses, delivered in permanent establishment
with complaints about the increase of temperature, hoarse of voice,
frequent barking cough, shortness of breath. Zakhvoriv sharply at
night, when in sleep there was an attack of strong cough, hoarse of
voice, in two hours the temperature of body rose to 380С, the
shortness of breath and child was increased was delivered in
permanent establishment.
At a review: the state is heavy. Temperature of body of 38,8 0С.
Skin is pale, clean, expressed perorbital and peroral cyanosys. In a
pharynx hyperemia, voice is hoarse, a cough is rough, «barking»,
breathing whistling, to hear in the distance, an auxiliary musculature
takes part in the act of breathing. Breathing rate 60/minute.
Perkutorno: above lights pulmonary sound. Auskul'tativno: leading
dry wheezes on either side, tones of heart are hyposthenic,heart rate
140/minute.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Task 5
Patient A. hospitalized in an infectious separation with a diagnosis
meningococcus infection. On a 3th day the state of patient was
worsened. Pains appeared in muscles, joints, stomach, cyanosys of
lips, nail phalanxes. A patient is excited, a hemorragic rash appeared
on a skin. Enhanceable AP,tachicardia.
1 To formulate a diagnosis.
2 To work out a plan of inspection sick.
3 To work out a plan of treatment.
Answers are to the tasks
Task 1
155
1 A flu is hypertoxic. Sharp laryngotracheobronchitis, acute
respiratory insufficiency 2 power .
2. Luminescent microscopy, virologic methods of research, serum
reactions (CFT, RGGA).
3. Remalloy 0,1 3 times per days,leucocytic interferon.
Task 2
1 Tromboemboly pulmonary artery, sharp motion,acute
respiratory insufficiency 2 power,middle hard form.
2 General analyses of blood and urine, biochemical blood (general
protein,protein factions, seromucoid, haptoglobin,coagulogram,
ALAT, ASAT), ECG test, sciagraphy of lights.
3
NaCl,
phentanyl,droperidolum,heparin,еuphilinum,streptokinasa,oxygen
inhalation therapy.
Zadcha 3
1 Meningococcus infection, meningitis, heavy motion,
complicated an edema and swelling of cerebrum, stage of
subcompensation.
2Craniografy,electro-encephalography,
echoencephalography,bacterioscopic and bacteriologicexamination
of neurolymph, thick drop of blood, bacteriologicexamination of
mucus, from nasopharynx, RNGA.
3 Desintoxication,dehidratation,endocrinotherapy, anticonvulsant
facilities, facilities, for excitation of respiratory center.
Task 4
1 acute respiratory viral infectious.Stenosis laryngotracheitis 2th
power (subcompensated).
2 Luminescent microscopy, virologic methods of research, serum
reactions (RZK, RGGA).
3 Remalloy 0,1 3 times per days,leucocytic interferon.
Task 5
1 Meningococcus infection,meningococcemia, ITSH of 1th degree
2 General analysis of blood and urine, biochemical blood test,
blood test, on sugar, serum diagnostics (RGGA, RNGA, IFA ).
156
3 Etiotropic therapy (ceftriaxonum), antihistaminic preparations,
desintoxication therapy, diuretic .
4 Materials are for audience independent work
4.1 List of educational practical tasks which must be executed
on practical employment
 To lay hands on the method of inspection of patients with the
exigent states.
 To conduct differential diagnostics of the exigent states
 To work out a plan of laboratory inspection.
 To interpret the results of specific inspection.
 To define medical tactic in the case of origin of the exigent
states.
 To design a medical document.
4.2 A professional algorithm is in relation to forming of skills
and abilities of diagnostics
№ Task
Sequence of A remark, warning, is in
п/п
implementation relation to self-control
1
To lay hands on
the method of
clinical
inspection
of
patients with the
повітрянокраплинним
mechanism of
transmission
with
the
невідкладними
states
(ITSH,
real
croup,
unreal
croup, GDN)
I to Find out To separate complaints which
the complaints characterize ITSH, real croup,
of patient.
unreal croup, GDN.
To pay attention on: sequence
II to Find out of origin, dynamics of
anamnesis:
symptoms, peculiar for ITSH,
1 Anamnesis of real croup, unreal croup, GDN
illness
157
2
To conduct a 2 Anamnesis of To find out the carried
curation
of life
illnesses.
patient
3Epidanamnesis Find out information in
relation to realization airdrops
mechanism
of
transmission, to pay a regard
to stay of patient in regions
with the enhanceable risk of
infection
on
infectious
diseases with the aid-drops
mechanism of transmission
II to Conduct To remember: a presence,
an
objective expressed,
dynamics
of
inspection
symptoms, is predefined a
term and weight of flow of
illness, depends on age sick,
concomitant pathology.
To pay attention on:
1
General - languor, аdinamy, dormancy
review:
of patient;
- general state - temperature of body;
of patient;
- cyanosys of skin, a turgor is
- skin, mucus sharply mionectic;
shell of oral - symptoms of ITSH.
cavity.
2
Digestive
system:
To pay attention on:
- review of - a language is covered a
language;
white raid;
- dryness of language;
-percution and - dysperistalsis intestine;
palpation
of
stomach;
- an amount, character,
-characteristic inclination,to
diarea
158
emptying.
(appearance
of
melena
testifies to the enterorrhagia).
3
Sercevosudinna
system:
- pulse;
- arteriotony;
- cardiophony.
3
To pay attention on:
- tachicardia;
- moderato mionectic AP (a
considerable decline testifies
to complication);
- moderate deafness of tones
of heart.
To
appoint 1
General
laboratory and analysis
of
additional
blood.
researches,
interpret results
To pay a regard to typical
changes:
-leucopenia or leucocytosis,
lymphocytosis,
аneosinophilia,
trombocytopenia
(leucocytosis, anaemia,ESR,
arise up in the case of
development
of
enterorrhagia).
2
General Symptom of toxic bud.
analysis
of
urine.
Materials of after audition independent work
Subject of UDRS and NDRS:
 Pathogeny of infectiously toxic shock, sharp respiratory
insufficiency, real and unreal croup.
159
Topic. CONCLUDING SESSION OF THE SEMANTIC
MODULE 2: infectious diseases with the air-drops mechanism of
transmission
Reference list of questions to the concluding session of the
semantic module 2:
1 General description of infectious diseases of respiratory tracts.
2 Flu: etiology, epidemiology, pathogeny, clinical motion,
laboratory diagnostics, differential diagnosis, complication,
treatment, prophylaxis. A testimony is to hospitalization.
3 Parainfluenza: etiology, epidemiology, pathogeny, clinical
motion, laboratory diagnostics, differential diagnosis, complication,
treatment, prophylaxis. A testimony is to hospitalization.
4 Adenovirus illness: etiology, epidemiology, pathogeny, clinical
motion, laboratory diagnostics, differential diagnosis, complication,
treatment, prophylaxis. A testimony is to hospitalization.
5 RS-іnfectious: etiology, epidemiology, pathogeny, clinical
motion, laboratory diagnostics, differential diagnosis, complication,
treatment, prophylaxis. A testimony is to hospitalization.
6 Rhinovirus infection: etiology, epidemiology, pathogeny,
clinical motion, laboratory diagnostics, differential diagnosis,
complication, treatment, prophylaxis. A testimony is to
hospitalization.
7 Classification of herpesviruss man. General characteristic of
herpesvirus illnesses.
8 Herpetic infection: etiology, epidemiology, pathogeny,
classification, clinical motion, laboratory diagnostics, differential
diagnosis, complication, treatment, prophylaxis. A testimony is to
hospitalization.
9 Windy pox. Girdle herpes. Etiology, epidemiology, pathogeny,
clinical motion, laboratory diagnostics, differential diagnosis,
complication, treatment, prophylaxis. Testimony to hospitalization,
governed extracts of patients from permanent establishment.
10 Infectious mononucleosis: etiology, epidemiology, pathogeny,
classification, clinical motion, laboratory diagnostics, differential
160
diagnosis, complication, treatment, prophylaxis. A testimony is to
hospitalization.
11 Features motion of herpesvirus infections for patients on
HIV/AIDS.
12 Measels: etiology, epidemiology, pathogeny, classification,
clinic, features of motion, for adults, laboratory diagnostics,
differential diagnosis, complication, treatment, prophylaxis.
Testimony to hospitalization, governed extracts of patients from
infectious permanent establishment.
13 German measles: etiology, epidemiology, pathogeny,
classification, clinic, features of motion, for adults, laboratory
diagnostics, differential diagnosis, complication, treatment,
prophylaxis. Testimony to hospitalization, governed extracts of
patients from infectious permanent establishment.
14 Parotitis virus: etiology, epidemiology, pathogeny,
classification, clinic, features of motion, for adults, laboratory
diagnostics, differential diagnosis, complication, treatment,
prophylaxis. Testimony to hospitalization, governed extracts of
patients from infectious permanent establishment.
15 Diphtheria: etiology, epidemiology, pathogeny, classification,
clinical motion, laboratory diagnostics, differential diagnosis,
complication, treatment, prophylaxis. Order of hospitalization,
governed extracts from infectious permanent establishment.
16 Meningococcus infection: etiology, epidemiology, pathogeny,
classification, clinical motion, laboratory diagnostics, differential
diagnosis, complication, principles of treatment of different clinical
forms, first aid, is on the before hospitalization stage, prophylaxis.
Order of hospitalization, governed extracts of patients from
infectious permanent establishment.
17 ITSH: determination of concept, pathogeny, classification,
clinical and laboratory diagnostics, principles of treatment, first aid,
is on the before hospitalization stage.
18 NNGM: determination of concept, pathogeny, classification,
clinical and laboratory diagnostics, principles of treatment, first aid,
is on the before hospitalization stage.
161
19 Respirator micoplasmosis: etiology, epidemiology, pathogeny,
classification, clinical motion, laboratory diagnostics, differential
diagnosis, complication, principles of treatment of different clinical
forms, prophylaxis. A testimony to hospitalization.
20 Psittacosis: etiology, epidemiology, pathogeny, classification,
clinical motion, laboratory diagnostics, differential diagnosis,
complication, principles of treatment of different clinical forms,
prophylaxis. A testimony to hospitalization.
21
Legionelosis:
etiology,
epidemiology,
pathogeny,
classification, clinical motion, laboratory diagnostics, differential
diagnosis, complication, principles of treatment of different clinical
forms, prophylaxis. A testimony to hospitalization.
22 Sharp respiratory insufficiency: determination of concept,
classification, pathogeny, clinical and laboratory diagnostics,
principles of treatment, first aid, on the before hospitalization stage.
162
LIST OF PRACTICAL SKILLS
1. A skin allergic test with ornitinum.
2. A skin allergic test is with a tuberculin (at tuberculosis).
3. Method of introduction of medical wheys.
4. A fence of blood is for serum researches.
5. A fence of material is for research on viruses.
6. Spinal punction.
7. Cannulation of urinary bladder.
8. A testimony to hospitalization of patients in permanent
establishment.
9. Nondirect massage of heart.
10. Intubation of trachea.
11. Artificial ventilation of lights.
12. Punction of pleural cavity.
163
Educational edition
M
MEETTH
HO
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DIIC
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ALL R
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CO
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REPARATION TO PRACTICAL CLASSES OF
IIN
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((M
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2
)
MODULE 2)
for the students of senior courses of higher medical establishments of formation of
III-IV of levels of accreditation
Accountable for the issue M.D. Chemych
Editor
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