Download Aim - Запорізький державний медичний університет

МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ’Я УКРАЇНИ
ЗАПОРІЗЬКИЙ ДЕРЖАВНИЙ МЕДИЧНИЙ УНІВЕРСИТЕТ
КАФЕДРА ДИТЯЧИХ ІНФЕКЦІЙНИХ ХВОРОБ
Manual for education for the 6th year students having higher medical
education in English
Методичні вказівки для практичних занять зі студентами 6 курсу
медичних вищих навчальних закладів з англійською мовою навчання
Запоріжжя 2013
2
Lesson 1
Lesson 2
Lesson 3
Lesson 4
Lesson 5
THE THEMATIC PLAN OF PRACTICAL LESSONS
for the 6-TH year students of the international medical faculty
Differential diagnosis of the infectious diseases with the syndrome of
the exanthem (scarlet fever, varicella, measles, rubella,
meningococcemia, allergic exanthem).
Differential diagnosis of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) in children of the early age.
Neuroinfectious in children of the early age. Meningococcal Infection.
Viral Hepatitis in children of the 1st year of life. Differential diagnosis
of the icteric in children of the 1st year of life.
Differential diagnosis of the acute respiratory viral infectious and
influenza in children. Test control.
THE THEMATIC PLAN OF INDEPENDENCE LESSONS
FOR THE 6-TH YEAR STUDENTS OF THE INTERNATIONAL MEDICAL
FACULTY
1. Diphtheria in children.
2. Acute epidemic poliomyelitis in children.
3. Working of a doctor in an epidemic focus of the infectious diseases.
3
DIFFERENTIAL DIAGNOSIS OF THE INFECTIOUS DISEASES WITH THE
SYNDROME OF THE EXANTHEM (SCARLET FEVER, VARICELLA,
MEASLES, RUBELLA, PSEUDOTUBERCULOSIS, MENINGOCOCCEMIA,
UNINFECTIOUS ALLERGIC EXANTHEM)
Duration: – 7 hour.
Actualizes of this problem: the rate of the diseases with the syndrome of the exanthem
is still high and of course is especially severe in children at the early age. The district
doctor must not only know how to determine the disease timely, but also learn how to use
the methods of therapy, master the complex of anti-epidemic methods in the district to
prevent the spreading of infectious diseases, leading to an epidemic outbreak.
Aim
To study the information about etiology, epidemiology, pathogenesis, pathophysiology,
clinical manifestations, diagnosis, differential diagnosis, complications, prognosis,
treatment, prevention of scarlet fever, varicella, measles, rubella, pseudotuberculosis,
meningococcemia. In description of these nosologic forms special attention is paid to
questions of clinical picture in new-borns, in children of the 1 st year of life and also of
differential diagnosis.
Tasks
Students must to know:
1. To study information about epidemiology, pathogenesis of scarlet fever, varicella,
measles, rubella, pseudotuberculosis, meningococcemia.
2. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
scarlet fever, varicella, measles, rubella, pseudotuberculosis, meningococcemia.
3. To teach students clinical peculiarities of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in newborns and children of the 1 st year of life.
4. To discuss questions of complications, prognosis of scarlet fever, varicella, measles,
rubella, pseudotuberculosis, meningococcemia in children.
5. To study information about modern diagnostics of scarlet fever, varicella, measles,
rubella, pseudotuberculosis, meningococcemia in children.
6. To teach students to prescribe etiotropic and pathogenetic of scarlet fever, varicella,
measles, rubella, pseudotuberculosis, meningococcemia in children.
7. . To discuss questions of prevention and vaccine prophylaxis of scarlet fever,
varicella, measles, rubella, pseudotuberculosis, meningococcemia in children.
Students must to make (skills):
1. To ask the parents or the child about the complaints.
2. To ask the patients about the family history, the past history, the history of the
present illness.
3. To prescribe to patients of the laboratory and instrumental investigations.
4. To value of the patient’s result of the laboratory and instrumental investigations.
5. To make an initial diagnosis.
6. To make a differential diagnosis.
7. To make a complete diagnosis.
8. To apply a new method of treatment.
9. To elaborate of the prophylactic measures for prevention of children infection
4
Place of lesson carrying out:
Classroom, hospital departments (department of neuroinfections, resuscitation
department), biochemical, clinical laboratories.
Starting level of knowledge:
Programme of microbiology, normal and pathologic physiology departments of Medical
University.
Didactic equipment:
Tables, codograms, case histories and other medical documents.
Contents.
The determination of meaning of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia. Etiology, epidemiology, pathogenesis of scarlet
fever, varicella, measles, rubella, pseudotuberculosis, meningococcemia. Clinical
manifestations of scarlet fever, varicella, measles, rubella, pseudotuberculosis,
meningococcemia. Clinical peculiarities of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in newborns and children of the 1 st year of life.
Modern diagnostics of scarlet fever, varicella, measles, rubella, pseudotuberculosis,
meningococcemia. Diagnosis, differential diagnosis of scarlet fever, varicella, measles,
rubella, pseudotuberculosis, meningococcemia. Complications, prognosis of scarlet fever,
varicella, measles, rubella, pseudotuberculosis, meningococcemia in children. Etiotropic
and pathogenetic treatment of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in children. Prevetion and vaccine prophylaxis of
scarlet fever, varicella, measles, rubella, pseudotuberculosis, meningococcemia in
children.
General plan of lesson.
The theme is studied during 1 lesson.
Student’s self-education includes the study of textbook and lecture materials according to
the tasks of the lesson.
The lesson consists of four parts: introduction, main part of the lesson, independent
curation of in- patients in hospital departments, final part of the lesson.
1. During introductory part of the lesson the control of initial knowledge and
effectiveness of out-class training must be done by the teacher in written form with use of
test control or verbal form with the mark according to five mark system. This part of the
lesson is conducted in the class.
2. The main part of the lesson includes the demonstration of the patients with various
forms of infectious diseases by the teacher. The teacher demonstrates the work of
different departments: department of neuroinfections, resuscitation department,
biochemical, clinical laboratories. During the demonstration of out-patient the teacher
acquaints students with clinical picture of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in children, with clinical and laboratoryinstrumental methods of investigation for diagnostics, with prescription of an adequate
therapy, conducting of prophylactic measures for prevention of children infection. The
teacher demonstrates some types of medical documents: case histories, results of clinical
examination, laboratory-instrumental investigations and others.
3. During the third part of the lesson students examine in-patients in hospital
departments without assistance. They describe clinical picture of different infectious
5
diseases, study medical documents: case histories, results of clinical examination,
laboratory-instrumental investigations and others.
4. The final part of the lesson must be conducted in the class. Final control may be done
using situation tests. Final mark includes the mark of initial knowledge and of situation
tests.
Control questions.
1. Ground the actuality of the problem in children, especially in children of the 1st year
of life.
2. What do you know about epidemiology of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia?
3. Describe the clinical picture of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in children.
4. Describe the clinical picture of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia in children of the 1 st years of life.
5. What do you know about clinical and laboratory methods of investigation in
diagnostics of scarlet fever, varicella, measles, rubella, pseudotuberculosis,
meningococcemia?
6. To make differential diagnosis of the infectious diseases with the syndrome of the
exanthem (scarlet fever, varicella, measles, rubella, pseudotuberculosis,
meningococcemia, uninfectious allergic exanthem).
7. What do you know about complications and prognosis of scarlet fever, varicella,
measles, rubella, pseudotuberculosis, meningococcemia?
8. Prescribe an adequate therapy of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia to children.
9. What do you know about prophylaxis of scarlet fever, varicella, measles, rubella,
pseudotuberculosis, meningococcemia?
Tests of the 1-st level
1. What methods of diagnostics of measles is most informative:
А. PCR
В. Serologic
С. Immunofluorencence
D. HAIT, CFT
Е. Hematology
2. A doctor diagnose the measles at the 4 th years child. What are his tactics? :
А. Hospitalization of the patient with measles
В. Isolation at home of the patient with measles
С. Laboratory investigation for all contact
D. Enters of normal gamma-globulin to all members of family
Е. Isolation for all members of family
3. In plan of treatment of the patient with measles enters all, except for:
А. Fresh and clean air
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В. Vitamins of group B,C
С. Plentyful fluid (1-2 liter per day)
D. Antibiotics
Е. Antihistamine medications
4. What preparation is necessary administered for treatment of the several forms of
varicella?
А. Penicillin
В. Prednisolon
С. Acyclovir
D. Intron
Е. Trexil
5. What preparation is contra-indicated treatment of the typical forms of varicella:
А. Penicillin
В. Prednisolon
С. Acyclovir
D. Intron
Tests of the 2-nd level
1. The child of the age 3 years was admitted to a hospital in 2-nd day of a rash with a
diagnosis: Measles, typical moderately form,.
What treatment is it necessary to the patient?
A. Anntibiotics
B. Detoxication therapy
C. Desensibilication therapy and vitamins
D. Steroid therapy
E. Oxygen therapy
2. The child with measles will be infectious thoroughly:
A. 5-th day after the latter elements of rash.
B. 5-th day from a beginning of disease.
C. 5-th day after ending disease.
D. 5-th day from a beginning of the rash.
E. 5-th day after appearance pigmentation.
3. Main means of preventive maintenance of the measles among children is:
A. Introduction of the antimissiles immunoglobulin.
B. Duly dissociation contact.
C. Vaccination.
D. Application of the interpheron.
E. Vitamin therapy.
4. At the child of the 4 years was diagnosed scarlet fever, several form. For the third day
of illness: high fever, necrotic tonsillitis, purulent lymphadenitis. What form of the scarlet
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fever has got this patient?
A. Toxic form of the scarlet fever.
B. Extrabuccal form of the scarlet fever.
C. Hypertoxic form of the scarlet fever.
D. Septic form of the scarlet fever.
E. Subclinical form of the scarlet fever.
5. At the child of the 5 years was diagnosed the typical form of scarlet fever.
What from listed antibiotics is more effective for treatment this patient?
A. Levomicetin.
B. Gentamicin.
C. Biseptol.
D. Polymicsin.
E. Penicillin.
6. At the child of the 4 years with varicella for 5 day from a beginning of the rush
высыпания have been appeared dizziness, uncertainly when walking. Objectively:
instability in a Romberg’s pose, non-execution of the coordination tests, nistagm.
What complication of the varicella is most probably?
A. Poliradiculonevritis.
C. Encephalitis.
D. Neuvrotoxicosis.
E.Encephalopatia.
7. The pregnant woman on the 8-th week of pregnancy had contact to the patient with
rubella. She was not immunized against rubella, the point data about transferred rubella
in last are not present.
What investigation is necessary for determine of the right diagnosis?
A. Serological test.
B. Direct immunofluorecent.
C. Virologist test of blood
D. Virologist test of feces.
E. RNA of rubella.
8. At the girl of the 5 years in 2 weeks after transferred scarlet fever have been appeared
pains in heart, extension of boundaries of heart to the left, the deaf tones, systolic noise
on a top.
What complication of the scarlet fever has this child got?
A. Miocarditis.
B. Pericarditis.
C. Miocardiodistrophia.
D. Pancarditis.
E. «Scalatinal heart».
9. The child of the 6 years was contacted with patient with measles. Term of the
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revaccination against measles has approached.
Taking into account epidemiology anamnesis, this measure is necessary to conduct:
A. Immediately.
B. Through 1 month.
C. Through 2 months.
D. After expiry of the term of quarantine on measles
E. To not conduct in general.
10. Young woman gave birth to the child with inherent ugliness: defect of heart, cataract,
microcephalic hydrocephalus, deafness. From anamnesis we are known, that on the 12-th
week of pregnancy the mother had been ill with any virus disease.
What congenital infection is possible in the child?
A. Toxoplasmosis.
B. Cytomegalovirus infection.
C. Chlamydeous.
D. Rubella.
E. Measles.
Tests of the 3-rd level
1. The child of the 5 years old was treated in out-patient with diagnosis ARVI during 3
days. For the 4-th day on a face and neck have appeared pink maculopapular rush,
whitish spots surrounded by a narrow band of hyperemia on the buccal mucosa on the
line of opposition of the molar teeth.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
2. Young woman gave birth to the child with inherent ugliness: defect of heart, cataract,
microcephalic hydrocephalus, deafness. From anamnesis we are known, that on the 12-th
week of pregnancy the mother had been ill with any virus disease.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
3. The child of the 5 years was ill acutely with rise of temperature, appearance of a rash
as maculopapuls, vesicles and brown crusts on a face, scalp, trunk and limbs.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
4. The child of the 3 years was ill acutely with increasing of the temperature up to 37.3 оС,
weakness, selections from a nose, appearing on all body of the papules rash in time.
Objectively: catarrh of the upper respiratory tract, in the hard sky – enanthema, swelling
of the suboccipital lymph nodes.
A. The most probably diagnosis.
9
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
5. At the child of the 3 years after overcooling on lips and around of a mouth have been
appeared a small vesicles in groups. Subjective sensations are itch, pain and burning pain.
The general common state is not infringed.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
6. At the girl of the 3years in 14 days after transferred of the scarlet fever has ben
appeared macrohematuria, arterial pressure is180/120, edema on lower limbs. Daily
diuresis is 200ml.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
7. At the child of the 9 years has been appeared red, round elements of the rast on the
extensor surface of the limb, back, buttocks, abdomen and chest within a few hours. The
rust lasts 2 days and disappears rapidly without leaving any pigmentation. Suboccipital
lymph nodes are increased.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
8. At the child of the 5 years: the temperature is 39 оС, pain in a throat, the rash. Elements
of rash are roseolas, cheeks are red, and the area around the mouth is pale, rash more
intense in skin folds. Lacunars tonsillitis, “raspberry tongue”.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient.
DIFFERENTIAL DIAGNOSIS OF THE ACUTE INTESTINAL INFECTIONS
(DYSENTERY. SALMONELLOSIS. INTESTINAL COLI INFECTION) IN
CHILDREN OF THE EARLY AGE.
Duration: – 7 hour.
Actualizes of this problem: the rate of the acute intestinal infections is still high and of
course is especially severe in children at the early age. The district doctor must not only
know how to determine the disease timely, but also learn how to use the methods of
therapy, master the complex of anti-epidemic methods in the district to prevent the
spreading of infectious diseases, leading to an epidemic outbreak.
10
Aim
To study the information about etiology, epidemiology, pathogenesis, pathophysiology,
clinical manifestations, diagnosis, differential diagnosis, complications, prognosis,
treatment, prevention of the acute intestinal infections (dysentery. salmonellosis.
intestinal coli infection). In description of these nosologic forms special attention is paid
to questions of clinical picture in new-borns, in children of the 1 st year of life and also of
differential diagnosis.
Tasks
Students must to know:
1. To study information about epidemiology of the acute intestinal infections
(dysentery. salmonellosis. intestinal coli infection).
2. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
the acute intestinal infections (dysentery. salmonellosis. intestinal coli infection).
3. To teach students clinical peculiarities of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) in newborns and children of the 1 st year of life.
4. To discuss questions of complications, prognosis of the acute intestinal infections
(dysentery. salmonellosis. intestinal coli infection)in children.
5. To study information about modern of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection).
6. To teach students to prescribe etiotropic and pathogenetic of the acute intestinal
infections (dysentery. salmonellosis. intestinal coli infection) in children.
7. . To discuss questions of prevention and vaccine prophylaxis of the acute intestinal
infections (dysentery. salmonellosis. intestinal coli infection) in children.
Students must to make (skills):
1. To ask the parents or the child about the complaints.
2. To ask the patients about the family history, the past history, the history of the
present illness.
3. To prescribe to patients of the laboratory and instrumental investigations.
4. To value of the patient’s result of the laboratory and instrumental investigations.
5. To make an initial diagnosis.
6. To make a differential diagnosis.
7. To make a complete diagnosis.
8. To apply a new method of treatment.
9. To elaborate of the prophylactic measures for prevention of children infection
Place of lesson carrying out:
Classroom, hospital departments (department of the acute intestinal infections,
resuscitation department), biochemical, clinical laboratories.
Starting level of knowledge:
Programme of microbiology, normal and pathologic physiology departments of Medical
University.
Didactic equipment:
Tables, codograms, case histories and other medical documents.
Contents.
The determination of meaning of the acute intestinal infections. Etiology, epidemiology,
pathogenesis of the acute intestinal infections (dysentery. salmonellosis. intestinal coli
11
infection). Clinical manifestations of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection). Clinical peculiarities of the acute intestinal
infections (dysentery. salmonellosis. intestinal coli infection)in newborns and children of
the 1 st year of life. Modern diagnostics of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection). Diagnosis, differential diagnosis of the acute
intestinal infections (dysentery. salmonellosis. intestinal coli infection). Complications,
prognosis of the acute intestinal infections (dysentery. salmonellosis. intestinal coli
infection) in children. Etiotropic and pathogenetic treatment of scarlet fever, varicella,
measles, rubella, pseudotuberculosis, meningococcemia in children. Prevetion of the
acute intestinal infections (dysentery. salmonellosis. intestinal coli infection) in children.
General plan of lesson.
The theme is studied during 1 lesson.
Student’s self-education includes the study of textbook and lecture materials according to
the tasks of the lesson.
The lesson consists of four parts: introduction, main part of the lesson, independent
curation of in- patients in hospital departments, final part of the lesson.
1. During introductory part of the lesson the control of initial knowledge and
effectiveness of out-class training must be done by the teacher in written form with use of
test control or verbal form with the mark according to five mark system. This part of the
lesson is conducted in the class.
2. The main part of the lesson includes the demonstration of the patients with various
forms of infectious diseases by the teacher. The teacher demonstrates the work of
different departments: department of the acute intestinal infections, resuscitation
department, biochemical, clinical laboratories. During the demonstration of out-patient
the teacher acquaints students with clinical picture of the acute intestinal infections
(dysentery. salmonellosis. intestinal coli infection) in children, with clinical and
laboratory-instrumental methods of investigation for diagnostics, with prescription of an
adequate therapy, conducting of prophylactic measures for prevention of children
infection. The teacher demonstrates some types of medical documents: case histories,
results of clinical examination, laboratory-instrumental investigations and others.
3. During the third part of the lesson students examine in-patients in hospital
departments without assistance. They describe clinical picture of different infectious
diseases, study medical documents: case histories, results of clinical examination,
laboratory-instrumental investigations and others.
4. The final part of the lesson must be conducted in the class. Final control may be done
using situation tests. Final mark includes the mark of initial knowledge and of situation
tests.
Control questions.
1. Ground the actuality of the problem of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) in children, especially in children of the 1st year of
life.
2. What do you know about epidemiology of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection)?
12
3. Describe the clinical picture of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) in children.
4. Describe the clinical picture of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) in children of the 1 st years of life.
5. Describe the clinical picture of the toxic syndrome in acute intestinal infections in
children.
6. What do you know about clinical and laboratory methods of investigation in
diagnostics of the acute intestinal infections (dysentery. salmonellosis. intestinal coli
infection)?
7. To make differential diagnosis of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection).
8. What do you know about complications and prognosis of the acute intestinal
infections (dysentery. salmonellosis. intestinal coli infection)?
9. Prescribe an adequate therapy of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection) to children.
10. Prescribe an adequate therapy of the toxic syndrome in acute intestinal infections in
children.
11. What do you know about prophylaxis of the acute intestinal infections (dysentery.
salmonellosis. intestinal coli infection)?
Tests of the 1-st level
1. Who more often ills for enteropathogen form of the escherichiosis?
A. Children from 6 month till 2 years
B. Children from 3 up to 12 month.
C. 2-4 years old children
D. 5-7 years old children
E. 8-14 years old children
2. Term of dispancery observation of children who had been ill of escherichiosis
A. 1 month
B. 3 month
C. 6 month
D. 9 month
E. 12 month
3. What symptoms are characteristic for colitis form of salmonellosis?
A. Abdominal cramps
B. Tenesmus
C. Hardening of sigmoid colon
D. Feces contain mucus, blood
E. All answer are correct
4. For gastroenteritis form of salmonellosis are characteristic all symptoms, except for:
A. Greenish stool
B. Vomiting
13
C.
D.
E.
Diarrhea
Pain in a stomach
Feces contain of mucus and blood
5.
A.
B.
C.
D.
E.
What does clinical form of salmonellosis most frequently meets at children?
Gastrointestinal
Typhus-like
Septic
Asymptomatic
Subclinical
Tests of the 2-nd level
1. At the child of the 8 month is staying in the in-patient department with an acute
intestinal infection. Physical examination: skin is pale, dry, turgor of tissue is decreased,
severe thirst, tachycardia, oliguria. Laboratory investigation: hematocrit- 0,62, K+ of
blood - 4,8 mkmole/L, Na+ of blood - 166 mkmole/L.
What kind of dehydration was developed at the child?
A. Solt-deficiency.
B. Isotonic .
C. Water- deficiency.
D. Dehydration is not present.
E. On offered data it is impossible to tell about kind of dehydration.
2. 10 children from a kindergarten were sick in 3 hours after breakfast. They have ate a
cake, except for main meal. The diseases began with fever up to 39-40оС, weakness,
headache, abdominal pain, vomiting. In hospital after undertaking of the detoxic therapy
the state of the patients was improved.
What diagnosis is most probably?
A. Staphylococcal enterocolitis.
B. Salmonellosis.
C. Escherichiosis.
D. Rotaviral infection.
E. Food poisoning
3. In decoding of an etiology acute intestinal infections were caused conditionally pathogenically microorganisms, the main is:
A. Clinical data.
B. Epidemiological data.
C. Serological methods of a research.
D. Bacteriological methods of a research.
E. All listed methods.
4. At the child of the 5 years with salmonelosis, which have received complex treatment
was generated carriage of salmonellas.
What is therapy the most effective?
14
A.
B.
C.
D.
E.
Immunotherapy.
Antibacterial therapy.
Antitoxic therapy.
Enterosorbents.
Passive immunization.
5. The child of the 9 years was ill acutely with increase of temperature up to 40ОС in five
days. Objectively: sleepiness, the headache, exanthema on skin of a face, trunk,
especially on the hands and feet (“gloves” and “socks” signs. Liver +2sm, lien +1sm.
What is disease at this child?
A. Enteroviral infection.
B. Infectious mononucleosis.
C. Yersiniosis.
D. Scarlet fever.
E. Typhoid fever.
6. At the department of the pathology of newborn at 8 children was appeared
simultaneously clinical of an acute intestinal infection. From feces of all children is
selected salmonella infantis.
To liquidate intrahospital flare of the salmonellosis it is necessary first of all:
A. To transfer all patients with an acute intestinal infection in infectious department or
hospital.
B. To discharge all patients with an acute intestinal infection on out-patient treatment.
C. To prescribe to all patients with an acute intestinal infection antibiotics in conditions
this department.
D. To transfer all children, without clinic of the acute intestinal infection in other
departments of hospital.
E. To prescribe to all patients with an acute intestinal infection bifidumbacterin in
conditions this department.
7. The child of the 10 years, was ill acutely from rise of temperature up to 37,8 ОС,
weakness, loses of appetite. Objectively: general state of an average degree. A skin is not
dry, turgor of tissue is normal. Tenderness and hardened sigmoid colon is found on
abdominal palpation. Stools occur 6 times daily, retain stercoral character having addition
of mucus. The symptoms of dehydratation are not present..
What antibiotics is it necessary to administer to the patient?
A. Ampicillin.
B. Levomicetin.
C. Erytromicin
D. Cephasolin.
E. To administer of the antibiotics is not necessary
8. At the fortnight child with pyodermia has been amplified of the toxicosis, temperature
was increased, has been appeared vomiting, stools occur 6 times daily, watery with
mucus and blood. Bacteriological tests on dysentery, salmonellosis, eschirichiosis are
15
negative.
What diagnosis is most probable?
A. Dysentery.
B. Salmonellosis.
C. Intestinal infection of staphylococcal etiology
D. Eschirichiosis.
E. Rotaviral infection.
9. At the girl of the 3 years the doctor diagnosed of the acute intestinal infection.
Objectively: stools occur up to 15 times daily, vomiting – 8 times, the skin and the
mucous membranes are dry, turgor of tissue is decreased, oligouria. What from listed
syndromes is leading in this case?
A. Acute liver insufficiency.
B. Acute renal insufficiency.
C. Toxicosis with dehydration.
D. Infective-toxic shock.
E. Neuvrotoxicosis.
10. At the three-years child with osteomielitis: temperature was raised up to 39ОС,
repeated vomiting, stools occur up to8 times daily with impurity of slime and blood, from
feces is selected staphylococci.
What investigation is necessary to conduct for confirmation of the diagnosis
"Staphylococcal enterocolitis "?
A. Agglutination test with titer of specific antibodies 1:100 and higher.
B. Bacteriological test of urine.
C. Agglutination test with titer of specific antibodies 1:10.
D. Blood on the sterility.
E. Blood on hemoculture.
Tests of the 3-rd level
1. The child of the 6 years old was admitted to a hospital on the 8-th day of illness.
During 10 days the temperature was in limits 38-39,4оС. Physical examination: a general
state severe, pale, on a skin of a trunk – the single roseola elements. The tongue coated of
dirty-brown film with prints of teeth. Bradicardia , moderate meteorism, enlargement of
the liver and spleen, decrease of percussion sound in the right iliac fossa.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
2. The child of the 5 month is sick for the 5 days. Complaint: the temperature 38-39оС,
vomiting 2-3 times per day, diarrhea, anorexia. Physical examination: the baby became
restless, weakened, turgor of tissue is decreased. Stool 10 times per day, watery, orange
color, contain mucus.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
16
C. To prescribe of the treatment to this patient
3. The boy of the 7 years, in 3 days after bathing in the dirty pond was ill. The disease has
an abrupt onset with frequently passed stools without abdominal pain and tenesmus. The
feces are clear and without odor, contain flecks of mucus that impart a “rice-water”
appearance, the temperature is 35,8оС, skin dry, elasticity is reduced, turgor is lost.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
4. At the girl of 13 years in 5 days are marked increase of temperature up to 39ОС,
weakness, slackness, dormancy. For 5 days of illness objectively it is marked:
hyperthermia 39,8ОС, slackness, sleepless, prostration, appearing of roseola on the skin
of abdomen, the tongue is dry with coat and prints from teeth, increase of a liver,
bradicardia.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
5. The child was ill acutely with vomiting, frequently stools without abdominal pain and
tenesmus. The feces are clear, like “rise-water”. Objectively: state of the patient is
several, skin is pale, dry, turgor is reduced. Temperature of a body is 35,8 оС. Meningeal
signs are negative.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
6. At the child of the 7 years in infectious hospital was diagnosed acute dysentery
clinical. Bacteriological test of the feces: is selected EIEC O124.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
7. In the child’s house in the winter within a week were ill 10 children: temperature 37,538оС, vomiting, weakness, loss of the appetite. Objectively: catarrh of the upper
respiratory tract, stools occur 6 to 10 times daily are watery, dehydration of the 1 degree.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
8. The child of the 6 months was admitted to the hospital for the 3-rd day of illness.
During this days: the temperature is 38,0оС, vomiting - 2-3 times per day, stools - 8-10
times, liquid, bright yellow color. Objectively : general condition is worse, the baby is
restless, weaken, body weight decreases rapidly, the skin and the mucous membranes are
dry, turgor of tissue is decreases. Stools up to 12 times per day containe much orange
17
water. are wetted. Blood test: leucocytosis, neutrophilosis.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
NEUROINFECTIOUS IN CHILDREN OF THE EARLY AGE.
MENINGOCOCCAL INFECTION
Duration: – 7 hour.
Actualizes of this problem: the rate of neuroinfectious and meningococcal infection is
still high and of course is especially severe in children at the early age. The district doctor
must not only know how to determine the disease timely, but also learn how to use the
methods of therapy, master the complex of anti-epidemic methods in the district to
prevent the spreading of infectious diseases, leading to an epidemic outbreak.
Aim
To study the information about etiology, epidemiology, pathogenesis, pathophysiology,
clinical manifestations, diagnosis, differential diagnosis, complications, prognosis,
treatment, prevention of neuroinfectious and meningococcal infection. In description of
these nosologic forms special attention is paid to questions of clinical picture in newborns, in children of the 1 st year of life and also of differential diagnosis.
Tasks
Students must to know:
8. To study information about epidemiology, pathogenesis of neuroinfectious and
meningococcal infection.
9. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
neuroinfectious and meningococcal infection.
10. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
the meningitis.
11. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
the meningococcemia and the hypertoxic form of meningococcal infection.
12. To teach students clinical peculiarities of neuroinfectious and meningococcal
infection in newborns and children of the 1 st year of life.
13. To discuss questions of complications, prognosis of neuroinfectious and
meningococcal infection.
14. To study information about modern diagnostics of neuroinfectious and
meningococcal infection in children.
15. To teach students to prescribe etiotropic and pathogenetic of neuroinfectious and
meningococcal infection in children.
16. To teach students to prescribe etiotropic and pathogenetic treatment of the meningitis
in children.
17. To teach students to prescribe etiotropic and pathogenetic treatment of the hypertoxic
form of meningococcal infection in children.
18. To teach students to prescribe treatment of infective-toxic shock in children.
19. . To discuss questions of prevention and vaccine prophylaxis of neuroinfectious and
meningococcal infection in children.
18
Students must to make (skills):
1.
2.
To ask the parents or the child about the complaints.
To ask the patients about the family history, the past history, the history of the
present illness.
3. To prescribe to patients of the laboratory and instrumental investigations.
4. To value of the patient’s result of the laboratory and instrumental investigations.
5. To make an initial diagnosis.
6. To make a differential diagnosis.
7. To make a complete diagnosis.
8. To apply a new method of treatment.
9. To elaborate of the prophylactic measures for prevention of children infection
Place of lesson carrying out:
Classroom, hospital departments (department of neuroinfections, resuscitation
department), biochemical, clinical laboratories.
Starting level of knowledge:
Programme of microbiology, normal and pathologic physiology departments of Medical
University.
Didactic equipment:
Tables, codograms, case histories and other medical documents.
Contents.
The determination of meaning of neuroinfectious and meningococcal infection. Etiology,
epidemiology, pathogenesis of neuroinfectious and meningococcal infection. Clinical
manifestations of neuroinfectious and meningococcal infection. Clinical peculiarities of
neuroinfectious and meningococcal infection in newborns and children of the 1 st year of
life. Modern diagnostics of neuroinfectious and meningococcal infection. Diagnosis,
differential diagnosis of neuroinfectious and meningococcal infection. Complications,
prognosis of neuroinfectious and meningococcal infection in children. Etiotropic and
pathogenetic treatment of neuroinfectious and meningococcal infection in children.
Prevetion and vaccine prophylaxis neuroinfectious and meningococcal infection in
children.
General plan of lesson.
The theme is studied during 1 lesson.
Student’s self-education includes the study of textbook and lecture materials according to
the tasks of the lesson.
The lesson consists of four parts: introduction, main part of the lesson, independent
curation of in- patients in hospital departments, final part of the lesson.
1. During introductory part of the lesson the control of initial knowledge and
effectiveness of out-class training must be done by the teacher in written form with use of
test control or verbal form with the mark according to five mark system. This part of the
lesson is conducted in the class.
2. The main part of the lesson includes the demonstration of the patients with various
forms of infectious diseases by the teacher. The teacher demonstrates the work of
different departments: department of neuroinfections, resuscitation department,
biochemical, clinical laboratories. During the demonstration of out-patient the teacher
19
acquaints students with clinical picture of neuroinfectious and meningococcal infection in
children, with clinical and laboratory-instrumental methods of investigation for
diagnostics, with prescription of an adequate therapy, conducting of prophylactic
measures for prevention of children infection. The teacher demonstrates some types of
medical documents: case histories, results of clinical examination, laboratoryinstrumental investigations and others.
3. During the third part of the lesson students examine in-patients in hospital
departments without assistance. They describe clinical picture of different infectious
diseases, study medical documents: case histories, results of clinical examination,
laboratory-instrumental investigations and others.
4. The final part of the lesson must be conducted in the class. Final control may be done
using situation tests. Final mark includes the mark of initial knowledge and of situation
tests.
Control questions.
1. Comment the terms “meningococcal infection”, “meningococcemia” and
“meningitis”. Ground the actuality of this problem concerning the children of the 1st year
of life.
2. What is etiology of neuroinfections and meningococcal infection?
3. What do you know about epidemiology of neuroinfections and meningococcal
infection?
4. What do you know about pathogenesis of neuroinfections and meningococcal
infection?
5. What do you know about pathogenesis of infective-toxic shock?
6. Describe the clinical picture of meningococcemia in children.
7. Describe the clinical picture of the meningitis in children.
8. Describe the clinical picture of neuroinfections and meningococcal infection in
children of the 1 st years of life.
9. What do you know about clinical and laboratory methods of investigation in
diagnostics of neuroinfections and meningococcal infection?
10. What do you know about clinical and laboratory methods of investigation in
diagnostics of the meningitis?
11. To make differential diagnosis of the meningococcemia and other infection diseases.
12. To make differential diagnosis of the meningitis and other infection diseases.
13. What do you know about complications and prognosis of neuroinfections and
meningococcal infection?
14. Prescribe an adequate therapy of meningococcal infection to children.
15. Prescribe an adequate therapy of the meningitis to children.
16. Prescribe an adequate therapy of infective-toxic shock to children.
17. What do you know about prophylaxis of neuroinfections and meningococcal
infection?
Tests of the 1-st level
1. The urgent help from the septic forms of a meningococcal infection before
hospitalization is immediate introduction:
20
A.
B.
C.
D.
E.
Steroid hormones
Antibiotics
Hemostatic mixture
Heparin
Cardiac glucosides
2. For treatment of meningococcal meningitis are applied all antibiotics except for:
A. Ampiccilin
B. Cephtriaxon
C. Penicilin
D. Cephasolin
E. Levomicetin-sukcinat
3. For treatment septic forms of a meningococcal infection penicillin should be
administered in the dosage of 300-400 units per kilogram of body weight. It is explained:
A. Low bioavailability of the penicillin in cerebrospinal fluid
B. Severe form of a meningococcal infection
C. Stability of a menigococcus outside the organism
D. Shape form of a menigococcus
E. Size of a menigococcus
4. The most important diagnostic ad for diagnosis of meningism is:
А. Absence of neutrophilosis cytosis
В. Increased of fiber in cerebrospinal fluid
С. Normal contents of glucoses in cerebrospinal fluid
D. Absence of changes in cerebrospinal fluid
Е. Absence of lymphocytosis cytosis
5. For differentiation of meningitis and meningism is necessary:
А. Viruslogy research of cerebrospinal fluid
В. Common analysis of blood
С. Bacterioscopical research of cerebrospinal fluid
D. Bacteriological research of cerebrospinal fluid
Е. Common analysis of cerebrospinal fluid
Tests of the 2-nd level
1. The girl of the 2 years old was ill acutely from increase of temperature up to 39 ОС and
appearance on a skin hemorrhage elements of a rash, which fast was increased in sizes.
Physical examination: the state is severe, skin is pale, marble, cold to the touch,
hemorrhagic rush, arterial pressure is reduced, oligouria, tachycardia. A doctor has
exhibited the diagnosis - meningococcemia, infective-toxic shock II degree.
What urgent help should a doctor conduct before the admittance of the patient at the inpatient department?
A. Introduction of euphyllin.
B. Introduction of large dosages of steroid hormones.
21
C. Introduction of penicillin.
D. Introduction of contrical.
E. Introduction of heparin.
2. The child of the two years was ill suddenly with fever, myalgias, weakness, and
headache. In 7 hours the rash has appeared on legs and buttock.
A state of the child is heavy, multiple hemorrhage into skin, cyanosis, falling of the
arterial pleasure , the pulse is rapid. The minigeal signs are not present.
What express method of diagnostics will meningococcal etiology of disease confirm?
A. Lumbar puncture.
B. Common analysis of blood.
C. Bacteriological test.
D. Hemoculture.
E. Method "of a thick drop ".
3. For treatment of the meningococcal meningitis we use the high daily dozes of
penicillin. That is explained:
A. Low sensitivity of the meningococcal to penicillin.
B. Heavy current of illness
C. Bad penetration penicillin in spinal fluid
D. Preventive maintenance of the edema of a brain
E. Preventive maintenance of the ITS.
4. The child of the 3-rd years was ill acute with fever, vomiting. Objectively: Kernig’s
and Brudzinsky’s signs are positive, clonic and tonic convulsion.
What manipulation is necessary for confirmation of the diagnosis?
A. Lumbar puncture.
B. Sternal puncture.
C. Pleural puncture.
D. Abdominal puncture.
E. Venal puncture.
5. At the child of the 2 years: the temperature 39оС, several headache, vomiting, positive
meningeal signs; in spinal fluid –neutrophil’s pleocytosis.
What is start’s antibiotic therapy?
A. Cephtriaxon.
B. Penicilin.
C. Cephazolin.
D. Polymicsin.
E. Levomicitin
6. At the child with weight of 10 kg is diagnosed purulent meningitis. This child was
administered of large doze of penicillin.
What scheme of antibiotic therapy is necessary?
A. Of 100000 units 4 times per day
22
B. Of 300000 units 5 times per day
C. Of 1000000 units 4 times per day
D. Of 500000 units 6 times per day
E. Of 100000 units 6 times per day
7. The child of the 5 years was ill in 3 days: temperature up to 38 ОС, cough, rhinitis,
pharingitis, the meninengeal symptoms are negative. The second child from this family is
at hospital with meningococcal infection, meningococcemia, purulent meningitis in 7
days.
What does pediatrician have to do in this situation?
A. Prescribe interferon.
B. Prescribe penicillin.
C. Prescribe erythromycin.
D. Bacteriological test on meningococc from rhinopharinx.
E. To admit of the patient to an infectious hospital.
8. The child of the 10 years with meningococcal meningitis has been received the
antibiotic therapy in 7. The state was stabilized, symptoms of toxicosis, meningeal signs
are absent. Is conducted control lumbar puncture.
What is result of research of the spinal fluid for cancel antibiotics?
A. Cytosis is lower than 150 cells, lymphocytes.
B. Cytosis is lower than 150 cells, neutrophilosis
C. Cytosis is lower than 100 cells, lymphocytes
D. Cytosis is lower than 100 cells, neutrophilosis
E. The cerebrospinal fluid is unchanged.
9. Meningism and meningitis can be accompanied of the toxicosis, headache, vomiting,
meningeal symptoms.
For their differentiation it is necessary to conduct:
A. Bacteriological test of the spinal fluid.
B. General analysis of the spinal fluid.
C Bacterioscopic test of the spinal fluid.
D Virologist test of the spinal fluid.
E. All researches are equally necessary.
10. At the child of the 5 years, who has contact with the patient with a meningococcal
infection was revealed: headache, painful swallowing, subfebrile temperature, hyperemia
of the nasopharyngeal mucosa and hyperplasia of lymphoid nodes, rhinitis.
What method is it possible to confirm the diagnosis " Meningococcal nasopharingitis"?
A. Bacteriological test of slime from nasopharinx.
B. Bacteriological test of blood.
C. Bacteriological test of feces.
D. Serological test.
E. All listed methods.
23
11. The doctor of first aid has diagnosed at the child 10 months a meningococcal
infection, meningococcemia. What antibiotic is necessary to introduce to the patient
before admission to the hospital?
A. Penicillin
B. Gentamicine
C. Levomicetin-succinat
D. The introduction of antibiotics is contra-indicated
E. Cepasolin
12. At the child of the 5 months is diagnosed meningococcal infection,
meningococcemia, ITS II degree.
What minimum start doze of steroid is necessary to conduct (on prednizolon)?
A. 3 mg/kg.
B. 5 mg/kg.
C. 10 mg/kg.
D. 20 mg/kg.
E. 30 mg/kg.
Tests of the 3-rd level
1. At the child of the 4 months the diseases is accompanied with high temperature,
general restless, vomiting, convulsions, hyperesthesia of the skin, positive meningeal
symptoms. In lumbar puncture spinal fluid flows under increased pressure, turbit
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
2. At the child of the 8 months with the ARVI, for the 2-nd day of illness a state has
worsened: hyperthermia, vomiting, clonic and tonic convulsions. Objectively: stiffness of
the occupital muscles, the positive symptoms of Kernigan. In lumbar puncture spinal
flows under increased pressure, but one is unchanged.
A. What complication of the ARVI was developed at the child?
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
3. The child of the 1 year was ill acutely with high fever, vomiting, hyperesthesia of the
skin, hemorrhagic rash on the buttocks and lower extremities. He is lying on his side with
head tossed back and legs flexed to the abdomen.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
4. The child of the 7 months was ill acutely with high fever, general toxemia, mental
disturbances, stiffness of the occipital muscles and hemorrhagic rush with macular
lesions.
A. The most probably diagnosis.
24
B.
C.
To prescribe of the plan of the investigations to this patient.
To prescribe of the treatment to this patient
5. At the child with meningococcemia are revealed hemorrhagic on a skin,
thrombocytopenia, increased speed of a coagulation of blood.
A. The main reason of these symptoms.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
6
At the boy of the 4 months with a purulent meningitis, the common state has worsened
for 2 day - has lost consciousness, were developed clonic and tonic convulsions, the
symptom of Grephe is positive, has appeared nistagm.
A. What syndrome has complicated of the current of the purulent meningitis?
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
VIRAL HEPATITIS IN CHILDREN OF THE 1ST YEAR OF LIFE.
DIFFERENTIAL DIAGNOSIS OF THE ICTERIC IN CHILDREN OF THE 1ST
YEAR OF LIFE
Duration: – 7 hour.
Actualizes of this problem: the rate of the viral hepatitis is still high and of course is
especially severe in children at the early age. The district doctor must not only know how
to determine the disease timely, but also learn how to use the methods of therapy, master
the complex of anti-epidemic methods in the district to prevent the spreading of
infectious diseases, leading to an epidemic outbreak.
Aim
To study the information about etiology, epidemiology, pathogenesis, pathophysiology,
clinical manifestations, diagnosis, differential diagnosis, complications, prognosis,
treatment, prevention of viral hepatitis. In description of these nosologic forms special
attention is paid to questions of clinical picture in new-borns, in children of the 1 st year
of life and also of differential diagnosis of icteric.
Tasks
Students must to know:
1. To study information about etiology, epidemiology, pathogenesis, pathophysiology
of Viral Hepatitis A, B, C in children.
2. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
the Viral Hepatitis A, B, C in children.
3. To teach students clinical peculiarities of the Viral Hepatitis A, B, C in children of
the 1 st year of life.
4. To make differential diagnosis of the Viral Hepatitis A, B, C and icteric in children
of the 1 st year of life.
5. To discuss questions of complications, prognosis of the Viral Hepatitis A, B, C in
children of the 1 st year of life.
25
6. To study information about modern diagnostics of the Viral Hepatitis A, B, C in
children.
7. To teach students to prescribe treatment of the Viral Hepatitis A, B, C in children of
the 1 st year of life.
8. To discuss questions of prevention of the Viral Hepatitis A, B, C in children of the 1
st year of life.
Students must to make (skills):
1. To ask the parents or the child about the complaints.
2. To ask the patients about the family history, the past history, the history of the
present illness.
3. To prescribe to patients of the laboratory and instrumental investigations.
4. To value of the patient’s result of the laboratory and instrumental investigations.
5. To make an initial diagnosis.
6. To make a differential diagnosis.
7. To make a complete diagnosis.
8. To apply a new method of treatment.
9. To elaborate of the prophylactic measures for prevention of children infection
Place of lesson carrying out:
Classroom, hospital departments (department of viral hepatitis, resuscitation department),
biochemical, clinical laboratories.
Starting level of knowledge:
Programme of microbiology, normal and pathologic physiology departments of Medical
University.
Didactic equipment:
Tables, codograms, case histories and other medical documents.
Contents.
The determination of meaning of viral hepatitis. Etiology, epidemiology, pathogenesis of
viral hepatitis. Clinical manifestations of viral hepatitis. Clinical peculiarities of viral
hepatitis in newborns and children of the 1 st year of life. Modern diagnostics of viral
hepatitis a. Diagnosis, differential diagnosis of viral hepatitis and icteric. Complications,
prognosis of viral hepatitis in children. Etiotropic and pathogenetic treatment of viral
hepatitis in children. Prevetion and vaccine prophylaxis of viral hepatitis in children.
General plan of lesson.
The theme is studied during 1 lesson.
Student’s self-education includes the study of textbook and lecture materials according to
the tasks of the lesson.
The lesson consists of four parts: introduction, main part of the lesson, independent
curation of in- patients in hospital departments, final part of the lesson.
1. During introductory part of the lesson the control of initial knowledge and
effectiveness of out-class training must be done by the teacher in written form with use of
test control or verbal form with the mark according to five mark system. This part of the
lesson is conducted in the class.
2. The main part of the lesson includes the demonstration of the patients with various
forms of infectious diseases by the teacher. The teacher demonstrates the work of
different departments: department of viral hepatitis, resuscitation department,
26
biochemical, clinical laboratories. During the demonstration of out-patient the teacher
acquaints students with clinical picture of viral hepatitis in children, with clinical and
laboratory-instrumental methods of investigation for diagnostics, with prescription of an
adequate therapy, conducting of prophylactic measures for prevention of children
infection. The teacher demonstrates some types of medical documents: case histories,
results of clinical examination, laboratory-instrumental investigations and others.
3. During the third part of the lesson students examine in-patients in hospital
departments without assistance. They describe clinical picture of different infectious
diseases, study medical documents: case histories, results of clinical examination,
laboratory-instrumental investigations and others.
4. The final part of the lesson must be conducted in the class. Final control may be done
using situation tests. Final mark includes the mark of initial knowledge and of situation
tests.
Control questions.
1. Comment the terms “Viral Hepatitis A, B, C”, “Icteric”. Ground the actuality of this
problem concerning the children of the 1st year of life.
2. What is etiology of Viral Hepatitis A, B, C and icteric?
3. What do you know about epidemiology of Viral Hepatitis A, B, C in the children of
the 1st year of life?
4. What do you know about pathogenesis of Viral Hepatitis A, B, C and icteric in the
children of the 1st year of life?
5. ?Describe the clinical picture of Viral Hepatitis A, B, C in children.
6. Describe the clinical picture of Viral Hepatitis A, B, C in children of the 1 st years of
life.
7. Describe the clinical picture of malignant form of Viral Hepatitis B in children of the
1 st years of life.
8. .What do you know about clinical and laboratory methods of investigation in
diagnostics of Viral Hepatitis A, B, C?
9. What do you know about clinical and laboratory methods of investigation in
diagnostics of malignant form of Viral Hepatitis B in children of the 1 st years of life.
10. Make differential diagnosis of Viral Hepatitis A, B, C, icteric and other infection
diseases.
11. What do you know about complications and prognosis of Viral Hepatitis A, B, C in
children of the 1 st years of life.
12. Prescribe an adequate therapy of the Viral Hepatitis A, B, C to children of the 1 st
years of life.
13. What do you know about prophylaxis of Viral Hepatitis A, B, C?
Tests of the 1-st level
1. What of laboratory methods are not applied for diagnostics of the enteroviral
infections:
А. Selection of a virus from nasopharynx
В. Selection of a virus from feces
С. Selection of a virus from spinal fluid
D. Serologic
27
Е. Bacteriological
2. For paralytic form of the Acute Epidemic Poliomyelitis is characteristic all, except for:
А. Loss of reflexer
В. Hypotonia
С. Muscular weakness
D. Asymmetrical of paralysis
Е. Violation of sensitivity
3. For diagnosis of the Acute Epidemic Poliomyelitis is necessary:
А. Examination of spinal fluid
В. To make myographia
С. Select of polyovirusis from feces
D. Sera obtained during the first days of the disease
Е. All answers are correct
4. The Acute Epidemic Poliomyelitis is necessary to differentiate from following
diseases:
А. Peter’s diseases
В. Gien-Barre’s syndrom
С. Myelitis
D. Paralysis of the facial nerve
Е. All answers are correct
5.The main biochemical criteria of severity for viral hepatitis A is:
А. Hyperbilirubinemia
В. Higher activity of the ALT, AST
С. Higher activity of the GGT`
D. Higher concentration of lipoproteins
Е. All answers are correct
Tests of the 2-nd level
1. The child of the 6 years is staying in clinic 3 days with the diagnosis: Virus hepatitis A,
icteric mild form.
What the antiviral therapy is the most acceptable to this patient?
A. Introduction of laferon.
B. Introduction of intron.
C. Introduction of ganciclovir.
D. Introduction of ribovirin.
E. The antiviral therapy is not required.
2. Acute beginning of disease, elevation temperature up 39-40оС, weakness, headache,
muscular pain, catarrh of the respiratory tract, maculopapular rash has enabled to suspect
at the child enteroviral infection.
What results of additional methods of an investigation will confirm the diagnosis?
28
A. Increasing of the specific antibodies 4 times.
B. High titer of the specific antibodies.
C. Selection of the virus from blood.
D. Definition of the IgG in blood of the patient.
E. Selection of the virus from feces.
3. At the child of the 3 years with the acute peripheral paralysis (hypotonia, muscular
weakness, loss of reflex) of the lower limb is suspected the diagnosis of the poliomyelitis.
What investigation is it necessary to nominate for confirmation of the diagnosis?
A. Survey of a neurology.
B. Common analysis of blood.
C. Electromiographia.
D. Feces and nasopharyngeal washings for poliovirus.
E. Echoencephalographia.
4. At the child of the 12 years diseases begins with weakness, bad appetite. Objectively:
subicteric scleras, the liver +2sm. In blood – anti-HAV IgM. What kind of treatment is it
necessary to the patient?
A. Interpferonotherapy.
B. Basic therapy.
C. Glucocorticoid therapy.
D. Infusion therapy.
E. Antiviral therapy.
5. What the etiological form of the acute viral hepatitis with parenteral way of infection,
despite of easy current, is forming of chronic hepatitis at half of the patients?
A. Viral hepatitis А.
B. Viral hepatitis B.
C. Viral hepatitis C.
D. Viral hepatitis D.
E. Viral hepatitis E.
6. At the child of the 5 years with acute viral hepatitis, several form was admitted to
infection hospital. Epidemiological anamnesis: parenteral manipulations were not present
in last 6 months. In blood are not revealed HBsAg, anti-HBs Ig M, anti - HAV Ig M, anti
- HCV IgM.
What diagnosis is most probable?
A. Viral hepatitis А.
B. Viral hepatitis В.
C. Viral hepatitis С.
D. Viral hepatitis Е.
E. Viral hepatitis D.
7. At the child of the 12 years are presented weakness, decrease of appetite. Objectively:
subicteric scleras, increase of a liver up to 2 sm. In blood are detected HBs Ag.
29
What kind of treatment is it necessary to the patient?
A. Interpheronotherapy.
B. Basic therapy
C. Steroid therapy
D. Infusion therapy
E. Antiviral therapy.
8. At the child of the 10 years in 7 days were marked weakness, bad appetite, dark urine
and jaundice. Epidemiology anamnesis: 4 months ago this patient was operated at
department of purulent surgery. Objectively: skin and scleras are icteric, liver + 2,5 sm.
Common bilirubin is 60 mkmole/l; unassociated - 40 mkmole/l; АЛТ - 7 mmole/l; timol
test - 2 un.
What from the listed diagnoses is most probably?
A. Viral hepatitis А.
B. Viral hepatitis В.
C. Viral hepatitis С.
D. Viral hepatitis Е.
E. Viral hepatitis Д.
Tests of the 3-rd level
1. The child was born from the first pregnancy in time, with weight of a body 3500. In 36
week of pregnancy the mother was ill virus hepatis. In the age of the 3-rd months the
child was ill from appearance vomiting, loss of appetite. Then has appeared of icteric
scleras and skin, dark urine, and doscolored excrements. The liver + 3 sm, the lien + 1
sm, in blood – common bilirubin-160 mkmole/L, associated-120 mkmole/L, ALT-8
mmole/L.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
2. The child of the 1,5 years sick in the 5 day with fever up to 38-39оС, vomiting,
abdominal pain, diarrhea up to 7-8 times per day, catarrhal signs, herpangina.
Bacteriological tests for acute intestinal infections are negative.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
3. At the child of the 4 months with virus hepatitis for the third day of illness: several
intoxication, hemorrhagic syndrome, temperature rises to 390C, adinamia followed by
excitement, vomiting, decreasing liver. Laboratory: common bilirubin is 280 mkmole/l
(unassociated – 160mkmole/l), ALT is 2.8 mmole/l, the protrombin index is 30%.
A. What from the listed syndromes is leading at the child?
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
30
4. At the child of the 7 years in 10 days were marked weakness, bad appetite, dark urine
and jaundice. Epidemiology anamnesis: 4 months ago this patient was operated at
department of purulent surgery. Objectively: skin and scleras are icteric, liver + 2,5 sm.
Common bilirubin is 60 mkmole/l; unassociated - 40 mkmole/l; АЛТ - 7 mmole/l; timol
test - 2 un.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
5. The child of the 5 years was ill acutely: temperature 39-40оС, vomiting, headache, pain
in a throat, abdominal pain. Objectively: the pharynx is hyperemic, vesicular on the soft
palate, uvula, tonsils, pharyngeal wall, and occasionally the posterior buccal surfaces is
surrounded by an erythematous ring that varies in size up to 10 mm in diameter. The
major site of the lesions is the anterior tonsillar pillars. Stools are watery without blood or
fecal leukocytes 3-4 times per day. Positive meningeal signs. In spinal fluid – 200
lymphocitis in 1 mkl. Bacteriolodical tests of the feces are negative.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
6. The child of the 6 years is sick within four days. The disease begins acutely, with
intoxication, vomiting, weakness, then has been appeared dark urine and discolored
feces, icteric mucous membrane and scleras. Epidemiology anamnesis: in group of a
children's garden there are cases of viral hepatitis.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
DIFFERENTIAL DIAGNOSIS OF THE ACUTE RESPIRATORY VIRAL
INFECTIOUS AND INFLUENZA IN CHILDREN
Duration: – 7 hour.
Actualizes of this problem: the rate of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection is still high and of course is
especially severe in children at the early age. The district doctor must not only know how
to determine the disease timely, but also learn how to use the methods of therapy, master
the complex of anti-epidemic methods in the district to prevent the spreading of
infectious diseases, leading to an epidemic outbreak.
Aim
To study the information about etiology, epidemiology, pathogenesis, pathophysiology,
clinical manifestations, diagnosis, differential diagnosis, complications, prognosis,
treatment, prevention influenza, parainfluenzal infection, respiratory syncytial infection,
adenoviral infection, rhinoviral infection. In description of these nosologic forms special
attention is paid to questions of clinical picture in new-borns, in children of the 1 st year
of life and also of differential diagnosis.
31
Tasks
Students must to know:
1. To study information about etiology, epidemiology, pathogenesis, pathophysiology
of influenza, parainfluenzal infection, respiratory syncytial infection, adenoviral
infection, rhinoviral infection.
2. To discuss questions of clinical manifestations, diagnosis, differential diagnosis of
influenza, parainfluenzal infection, respiratory syncytial infection, adenoviral infection,
rhinoviral infection.
3. To teach students clinical peculiarities of influenza, parainfluenzal infection,
respiratory syncytial infection, adenoviral infection, rhinoviral infection in newborns and
children of the 1 st year of life.
4. To discuss questions of complications, prognosis of influenza, parainfluenzal
infection, respiratory syncytial infection, adenoviral infection, rhinoviral infection in
children.
5. To study information about modern diagnostics of influenza, parainfluenzal
infection, respiratory syncytial infection, adenoviral infection, rhinoviral infection in
children.
6. To teach students to prescribe etiotropic and pathogenetic treatment of influenza,
parainfluenzal infection, respiratory syncytial infection, adenoviral infection, rhinoviral
infection in children.
7. . To discuss questions of prevention and vaccine prophylaxis of influenza,
parainfluenzal infection, respiratory syncytial infection, adenoviral infection, rhinoviral
infection in children.
Students must to make (skills):
1. To ask the parents or the child about the complaints.
2. To ask the patients about the family history, the past history, the history of the
present illness.
3. To prescribe to patients of the laboratory and instrumental investigations.
4. To value of the patient’s result of the laboratory and instrumental investigations.
5. To make an initial diagnosis.
6. To make a differential diagnosis.
7. To make a complete diagnosis.
8. To apply a new method of treatment.
9. To elaborate of the prophylactic measures for prevention of children infection
Place of lesson carrying out:
Classroom, hospital departments (department of neuroinfections, resuscitation
department), biochemical, clinical laboratories.
Starting level of knowledge:
Programme of microbiology, normal and pathologic physiology departments of Medical
University.
Didactic equipment:
Tables, codograms, case histories and other medical documents.
Contents.
The determination of meaning “influenza”, “parainfluenzal infection”, “respiratory
syncytial infection”, “adenoviral infection”, “rhinoviral infection”. Etiology,
32
epidemiology, pathogenesis of influenza, parainfluenzal infection, respiratory syncytial
infection, adenoviral infection, rhinoviral infection. Clinical manifestations of influenza,
parainfluenzal infection, respiratory syncytial infection, adenoviral infection, rhinoviral
infection. Clinical peculiarities of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection in newborns and children of
the 1 st year of life. Modern diagnostics of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection. Diagnosis, differential
diagnosis influenza, parainfluenzal infection, respiratory syncytial infection, adenoviral
infection, rhinoviral infection. Complications, prognosis of influenza, parainfluenzal
infection, respiratory syncytial infection, adenoviral infection, rhinoviral infection in
children. Etiotropic and pathogenetic treatment of influenza, parainfluenzal infection,
respiratory syncytial infection, adenoviral infection, rhinoviral infection in children.
Prevetion and vaccine prophylaxis influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection in children.
General plan of lesson.
The theme is studied during 1 lesson.
Student’s self-education includes the study of textbook and lecture materials according to
the tasks of the lesson.
The lesson consists of four parts: introduction, main part of the lesson, independent
curation of in- patients in hospital departments, final part of the lesson.
1. During introductory part of the lesson the control of initial knowledge and
effectiveness of out-class training must be done by the teacher in written form with use of
test control or verbal form with the mark according to five mark system. This part of the
lesson is conducted in the class.
2. The main part of the lesson includes the demonstration of the patients with various
forms of infectious diseases by the teacher. The teacher demonstrates the work of
different departments: department of neuroinfections, resuscitation department,
biochemical, clinical laboratories. During the demonstration of out-patient the teacher
acquaints students with clinical picture of neuroinfectious and meningococcal infection in
children, with clinical and laboratory-instrumental methods of investigation for
diagnostics, with prescription of an adequate therapy, conducting of prophylactic
measures for prevention of children infection. The teacher demonstrates some types of
medical documents: case histories, results of clinical examination, laboratoryinstrumental investigations and others.
3. During the third part of the lesson students examine in-patients in hospital
departments without assistance. They describe clinical picture of different infectious
diseases, study medical documents: case histories, results of clinical examination,
laboratory-instrumental investigations and others.
4. The final part of the lesson must be conducted in the class. Final control may be done
using situation tests. Final mark includes the mark of initial knowledge and of situation
tests.
Control questions.
33
1. Comment the terms: influenza, parainfluenzal infection, respiratory syncytial
infection, adenoviral infection, rhinoviral infection. Ground the actuality of this problem
concerning the children of the 1st year of life.
2. What is etiology of influenza, parainfluenzal infection, respiratory syncytial
infection, adenoviral infection, rhinoviral infection?
3. What do you know about epidemiology of influenza, parainfluenzal infection,
respiratory syncytial infection, adenoviral infection, rhinoviral infection?
4. What do you know about pathogen of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection?
5. Describe the clinical picture of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection in children.
6. Describe the clinical picture of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection in children of the 1 st year of
life.
7. What do you know about clinical and laboratory methods of investigation for
diagnostics of influenza, parainfluenzal infection, respiratory syncytial infection,
adenoviral infection rhinoviral infection?
8. To make differential diagnosis with other infectious diseases.
9. What do you know about complications and prognosis of influenza, parainfluenzal
infection, respiratory syncytial infection, adenoviral infection rhinoviral infection?
10. Prescribe an adequate therapy of influenza, parainfluenzal infection, respiratory
syncytial infection, adenoviral infection, rhinoviral infection for children.
11. What do you know about prophylaxis of influenza, parainfluenzal infection,
respiratory syncytial infection, adenoviral infection, rhinoviral infection?
Tests of the 1-st level
1. Hematological parameters in pertussis are all following ones, except:
A. Hyperleukocytosis with shift to the left
B. Hyperleukocytosis
C. Lumphocytosis
D. Monocytosis
E. ESR is normal
2. What peculiarities are not typical for children of the 1 st year of life?
A. Atypical paroxysms of coughing
B. The incubation period is longer
C. The catarrhal stage is shorter
D. Respiratory complications are more frequent
E. The fits of coughing often cause apnoea
3. What aren’t central nervous system complications in children with pertussis?
A. Menigoencephalitis
B. Epileptiform convulsions
C. Apnoea
D. Hypoxemical encephalopatia
34
E. Subarahnoid hemorrhage
4. Main thing in treatment of pertussis is:
A. Regimen, nursing and aerotherapy
B. Application of antibiotics
C. Oxygen therapy
D. Aminazine
E. All methods are equally important
5. In children under 1 year for treatment of pertussis one need not to apply:
А. Amicacin
В. Ampicillin
С. Cephtriacson
D. Erythromycin
Е. Levomicetin
Tests of the 2-nd level
1. At the child of the 2 years with symptoms of catarrh of the respiratory tract and
conjunctivitis for the 3-rd day of illness – liquid dyspeptic stools up to 5 times per day.
What virus disease is it?
A. Adenoviral infection.
B. Rhinoviral infection.
C. Parainfluezal infection.
D.Respiratory syncytial infaxtion.
E.Influenza.
2. At the child of the 3 years old with clinic of influenza, general toxemia, instability
hemodinamics a doctor of the first aid have diagnosed ITS II degree.
What kind of treatment necessary to apply first of all before the admittance of the patient
at the in-patient department?
A. Oxygen therapy.
B. Infusion therapy.
C. Hemodialys
D. Introduction of antibiotics.
E. Introduction of steroid hormones.
3. The child of the 3 years wasn't given vaccination against pertusis within the 1-st year
of life. It was connected with a perinatal encephalopatia.
When will the vaccination be given in this child?
A. After 3 years.
B. After 4 years.
C. After 5 years.
D. After 6 years.
E. It won't de done in general
35
4. At the child of the 3 years was ill in 2 days. The temperature is 38,5С, hoarsened of a
voice, rough cough and hypoxia. Is diagnosed stenosing laringotracheitis. The child is
admitted to a hospital.
What investigation is necessary first of all for the patients with such disease?
A. Blood test.
B. Blood on viruses.
C. Feces on viruses.
D. Bacteriological test on meningococcal.
E. Bacteriological test on BL.
5. At the child of the 10 months was diagnosed the typical form of pertusis. He had got
several paroxysms of coughing. Objectively: adinamia, disturbed sleep, mental
confusion.
What from listed is the main reason of a defeat of the nervous system in this case?
A. Hypoproteinemia.
B. Hypokaliemia.
C. Hypoglicemia.
D. Several toxicosis.
E. Hypoxia.
6. The child of the 1,5 years was ill acutely with increasing of the temperature and catarrh
of the upper respiratory tract. Objectively: hoarsened of a voice, rough cough and
symptoms of the hypoxia. Is diagnosed virus croup. What additional investigation is it
necessary to confirmation of this diagnosis?
A. Rentgenographia.
B. Blood on viruses.
C. Feces on viruses.
D. Bronchscopia.
E. Laryngoscopia.
7. At the child of the 5 years: the temperature is 38-39оС, dry cough, headache, weakness,
rhinitis. Epidemiology anamnesis: contact to the patient by influenza.
What investigation can confirm influenza in this patient?
A. Serologic test once
B. Virological test of blood.
C. Serologic test twice.
D. Bacteriological test.
E Virological test of feces.
8. At the children’s department has been stayed a patient with pertusis.
What preventive measures are necessary to conduct at concerning of this patient?
A. To discharged from children’s department.
B. To transferred in separate chamber.
C. To transfer at the infectious department.
D. To prescribe antibiotics and to keep at children’s department.
36
E. To prescribe immunoglobulin and to keep in children’s department.
9. The child of the 2 years is sick ARVI in 2 days. Night has been developed an attack of
rough, barking, loud cough, which was accompanied by a stenosis breath, Objectively:
increase of temperature of a body up to 38,5 ОС, conjunctivitis, nasopharyngitis.
Laryngoscopy: hyperemia and edema of mucosa under the vocal ligaments.
Your preliminary diagnosis is:
A. Acute bronchitis.
B. Pertusis.
C.Stenosing laringotracheitis.
D. Bronchiolitis.
E. Diphtheritic croup.
10. The diphtheria carrier complained of elevating of the temperature up to 38 ОС, pain in
a throat.
What result of a laboratory test will indicate not diphtheria carrier, but diphtheria,?
A. Normal contents of specific antibodies.
B. Increase subtitle of specific antibodies in dynamics.
C. Low subtitle of specific antibodies.
D. Positive bacteriological test on BL.
E. Negative bacteriological test on ВL.
11. At the child of the 8 years old, who was vaccinated against diphtheria, the diseases
has an acute onset with fever up to 39-40оС, weakness, headache, pain in throat. A doctor
has exhibited the diagnosis quinsy.
What antibiotic is not applied for treatment of this disease?
A. Ampicillin.
B. Cephasolin.
C. Azitromicin.
D. Gentamicin.
E. Penicillin.
12. At the child of the 5 years old with clinical picture of quinsy for the 3-rd day of
illness an assistant laboratory have defined 42 % atypical mononuclear cells in the
general analysis of blood. A doctor diagnosed infectious mononucleosis.
Which antibiotic is contra-indicated to the patient?
A. Ampicillin.
B. Cephasolin.
C. Azitromicin.
D. Cephtriaxon.
E. Penicillin.
Tests of the 3-rd level
1. The child of the 2 years was ill acutely with high fever, several headache, adinamia,
sleepiness, muscular pain, a dry cough. Objectively: the fauces and posterior and lateral
37
walls of the pharynx are hyperemic, laryngitis. Kernig’s and Brudzinsky’s signs are
negative. Epidemiology anamnesis: three patients in family have got similar clinical
picture.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
2. At the child of the 3 years, with stenosic breath, soundless cough, ansonority voice,
symptoms of respiratory insufficiency, increase of the temperature up 38,5 0C is suspected
of virus croup.
A. What from the diseases, first of all, it is necessary to differentiate this disease with?
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
3. The child of the 3-rd years was ill acutely with increasing of the temperature up to
38ОС, rhinitis, weakness, cough, conjunctivitis. Objectively: the pharynx is hyperemic,
lymphatic nodes are enlarge, the tonsils are rather enlarged, the conjunctiva and eyelids
look hyperemic, granular, edema of the eyelids. The liver +2 sm, lien +1 sm.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
4. The child of the 3 years within the last 2 weeks is disturbed with dry persistent cough,
which in the last days has become more often, paroxysmal. During an attack the face of
the child become red, the tongue is forcibly protruded to the limit and its tip curves
upward, sometimes at the attack – vomiting.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
5. At the child of three years in the two weeks is marked fever up to 38,5-39оС, congested
nose, weakness. Objectively: lacunar quinsy, enlarged lymph nodes, a liver + 5sm, a
lien+ 8 sm.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
6. At the child of the 11 years: the temperature is 38-39оС, weakness, pain in a throat.
Objectively: bright hyperemia of mucous membrane, hypertrophia of the tonsils,
yellowish-white liquid pus in lacunas are removed easily, enlarged of cervical lymph
nodes.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
38
7. The child of the 7 years was ill from rise of temperature up to 38,5 ОС, appearance of
weakness, headache. For the next day have been detected swelling of the parotid gland,
the swelling obliterates the fosa retromaxillaris, the centre of the swelling is elastic-solid
on palpation and painful when pressed. The skin over the inflamed gland is tense and
normal color. On the side of internal bodies of pathology is not revealed.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
8. At the child of the 6 years within a week: temperature 37,5-38,0оС, weakness, pain in a
throat. Objectively: moderately toxicosis, lacunar tonsillitis, hepatosplenomegalia,
polyadenopatia.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. To prescribe of the treatment to this patient
9. The child of the 4 years has been admitted to the hospital for 4 day from a beginning of
disease. He was treated of the erythromycin concerning quinsy. He was vaccination with
APDT vaccine. Bacteriological test: is selected C. diphtheria gravis, toxigen culture.
Objectively: a common state is satisfactory. In oropharigeas - moderate hyperemia of
mucous membrane, membranes are not present.
A. The most probably diagnosis.
B. To prescribe of the plan of the investigations to this patient.
C. What doze of the ADS is necessary to prescribe to the patient?
Nosological form of the children’s infectious diseases for study of the students of
the 6 years.
1. Measles
2. Rubella
3. Scarlet fever
4. Psevdotuberculosis
5. Diphtheria
6. Pertusis
7. Epidemic parotitis
8. Infectious mononucleosis
9. Varicella
10. Herpes zoster, simplex, cytomegaloviral infection
11. Influenza
12. ARVI
13. Poliomyelitis
14. Meningicoccal infection
15. Toxic syndrome in acute intestinal infections
16. Shigellosis
17. Salmonellosis
39
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Escherichiosis
Intestinal infections of staphylococcal etiology
Rotaviral infectioun
Cholera
Typhoid fever
Viral hepatitis A,B,C,D,E
Yersiniosis
AIDS
DIC-syndrom
ITS
40
Literature
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University, 2003. – 219p.
2. Figueroa JE, Densen P: Infectious diseases associated with complement
deficiencies. Clin Microbiol Rev 4:359, 2001.
3. Figueroa JE, Densen P: Infectious diseases associated with complement
deficiencies. Clin Microbiol Rev 4:359, 2001.
4. Butler T, Islam A, Kabir I, Jones PK: Patterns of morbidity and mortality in
typhoid fever dependent on age and gender: A review of 552 patients
hospitalized with diarrhea. Rev Infect Dis 13:85, 2011.
5. Centers of Disease Control: Typhoid immunization: recommendations of the
Immunization Practices Advisory Committee. MMWR 39:1, 2000.
6. Edelman R, Levine MM: Summary of an international workshop on typhoid
fever. Rev Infect Dis 8:329, 2006.
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five years of age. Pediatr Infect Dis J 12:627, 2003.
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Escherichia coli strains to adhere in vitro to human intestinal mucosa. Infect
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11. Bhattacharya SK, Bhattacharya MK, Balakrish-Nair G, et al: Clinical profile
of acute diarrhoea cases infected with the new epidemic strain of Vibrio cholerae
O139: Designation of the disease as cholera. J Infect 27:11, 2003.
12. Calia KE, Murtagh M, Ferraro MJ, et al: Comparison of Vibrio cholerae
O139 with V. cholerae O1 classical and El Tor biotypes. Infect Immun 62:1504,
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13. Fasano A, Baudry B, Pumplin DW, et al: Vibrio cholerae produces a second
enterotoxin, which affects intestinal tight junctions. Proc Natl Acad Sci USA
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(Ace), the third toxin of a Vibrio cholerae virulence cassette. Proc Natl Acad Sci
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15. World Health Organization: WHO guidelines for cholera control. Geneva,
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17. Krugman’s infections diseases of children 11th tdition. – 2003. – 820 p.
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th
18. Nelson textbook 18 Edition by Robert M. Kliegman, MD, Richard E.
Behrman, MD, Hal B. Jenson, MD and Bonita F. Stanton, MD. Видавництво:
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N.G., Palatnaya L.O., Shpak I.V., Doroshenko V.O., Voronov O.O., Lishenyk
S.A., Shostakovych-Koretskaya L.R., Chernyshova L.I. //Pediatric infectious
diseases Edited by prof. S.O. Kramarev and prof. O.B. Nadraga.- К.: ВСВ
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