Download I. The theme urgency

Vinnytsya National Pirogov Memorial Medical University
Department of Children Infectious Diseases
“Approved”
at sub-faculty meeting
“__”_____2012, protocol №_____
Head of Department
prof. _______I.I. Nezgoda
Study Guide for Practical Work of Students
Topic: “Pseudotuberculosis, Scarlet fever”
Course V
English-speaking Students’
Medical Faculty
Duration of the class-180min.
Composed by assistant O.V. Bodnariuk
Vynnytsa
2012
I.
The theme urgency
Pseudotuberculosis is an acute infectious disease of the zoonotic group, characterized by
toxemia, fever, scarlet fever-like rash, lesions of other organs and systems.
Scarlet fever (known as scarlatina in older literature references) is an exotoxin-mediated
disease arising from group A beta-hemolytic streptococcal infection. Ordinarily, scarlet fever
evolves from a tonsillar/pharyngeal focus, although the rash develops in fewer than 10% of cases
of "strep throat." The site of bacterial replication tends to be inconspicuous compared to the
possible dramatic effects of released toxins. Exotoxin-mediated streptococcal infections range
from localized skin disorders (eg, bullous impetigo) to the systemic rash of scarlet fever to the
uncommon but highly lethal streptococcal toxic shock syndrome.
ІІ.
Primary aims of the study
A student should know:
1. Etiology of pseudotuberculosis and scarlet fever.
2. Epidemiology (source of infection, ways of transmission, age-old receptivity and
morbidity) of pseudotuberculosis and scarlet fever.
3. Pathogenesis of disease, pathomorphologic changes in the staggered organs.
4. Classification of clinical forms of pseudotuberculosis and scarlet fever.
5. Clinical manifestations of pseudotuberculosis and scarlet fever.
6. Clinic of typical forms of pseudotuberculosis . and scarlet fever
7. Complications of pseudotuberculosis and scarlet fever.
8. Differential diagnostics pseudotuberculosis and scarlet fever.
9. Methods of laboratory research.
10. Principles of therapy of pseudotuberculosis and scarlet fever.
11. Measures of prophylaxis of pseudotuberculosis and scarlet fever.
A student should be able:
1. To follow the basic rules of work with a patient sick with pseudotuberculosis and scarlet
fever.
2. To take anamnesis with the estimation of epidemiology information (taking into account
seasonality, origin of febricities, polymorphism of clinical signs of illness).
3. To examine a patient and reveal the basic clinical signs of illness.
4. To represent information of anamnesis and objective inspection in a hospital chart and
formulate the preliminary diagnosis.
5. To write a plan of examination.
6. To write a clinical diagnosis (form of disease, type, severity, course of disease)
7. To make differential diagnostics pseudotuberculosis and scarlet fever.
8. To prescribe the treatment taking into account age, severity of illness.
9. To write out a prescription.
10. To organize disease measures in the hearth of infection (to find out the source of
infection, fill an urgent report in SES, to set a quarantine, to define the circle of contact
persons).
11. To write epicrisis with the estimation of development of illness, results of inspection,
efficiency of treatment, prognosis, by recommendations for a subsequent supervision or
treatment depending on the form of pseudotuberculosis and scarlet fever.
III. Educational aims of the study
- forming the deontological presentations, skills of conduct with the patients
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- to develop deontological presentations, be able to carry out deontology approach to the
patient
- to develop the presentations of influence of ecological and socio-economic factors on the
state of health
- to develop sense of responsibility for a time illness and loyalty of professional actions
- to be able to set psychological contact with a patient and his family.
IV. Control materials for the preliminary and final stage of the class
1. A 8- year-old girl complained of fever up to 38,6 C, sore throat, rash. In medical examination lacunar tonsillitis, hyperemia and enanthema of soft palate, punctiform rash which is localized
mainly on flexor surface of the extremities was discovered. Nasolabial area was pale. What
antibacterial medications should be administered?
A. Gentamycin
B. Penicillin
C. Chloramphenicol
D. Lincomycin
E. Tetracyclinl
2. A 8 - year-old boy fell ill abruptly fever up to 39 C, headache, recurrent vomiting, sore throat.
There was punctiform rash on reddened skin on his trunk, upper part of the abdomen, and in the
skin folds, especially in axillae, cubital, inquinal. The soft palate is covered with erithematous
punctiform lerions and scattered petechiae. Tonsils were enlarged, reddened with superficial
necrosis in the form of patches. Submaxillary lymph nodes were enlarged, dense and tender. BP
is 140/90; Ps is 120 per min. What is your diagnosis?
A. Adenoviral infection
B. Scarlet fever
C. Diphtheria
D. Measles
E. Leukosis
3. A child of 5 years old attends a kindergarten, he fell ill yesterday when the temperature
elevated up to 39°C, repeated vomiting and a sore throat was marked. His mother gave him
paracetamol. Today in the morning the temperature was 38.5°С, he complained of a pain in the
throat. His mother called in a local physician.
On examination: redness in the cheeks, a pale nasolabial triangle, plentiful fine dotty rash on
the skin of the trunk, extremities (mainly on the flexion surfaces) against the hyperemic
background of the skin. Bright hyperemia of the tonsils, arches, white-yellow coatings in both
tonsil lacunas are seen in the pharynx. The tongue is coated. Tonsil lymph nodes are enlarged
and painful. There are no changes in other organs.
In the blood analysis: Eryt- 3.5х1012/l, L - 14,3х109/l, eu - 3 %, stab neutrophils - 12 %, s-59 %, l
- 25 %, m - 5 %; ESR - 23 mm/hr.
1. Make the clinical diagnosis.
2. What diseases should we make a differential diagnosis with?
3. Administer treatment.
4. A 10-year-old girl complained of fever, rash, abdominal pain, artralgiae on admission. In
medical examination scarlet fever-like rash, symptoms of ,,hood", ,,gloves" and ,,socks" have
been discovered.
What is your preliminary diagnosis?
A. Measeles
B. Allergic rash
3
C. Rubella
D. Scarlet fewer
E. Pseudotuberculosis
5. A 5-year-old boy fell ill abruptly: fever up to 38,5, sore throat, abdominal pain. Scarlet feverlike rash, artralgiae and frequently passed stools occurred on the 4th day f illness. In medical
examination hyperemia and edema of skin on the face, hands and feet, hyperemia of palatal
arches, soft palate, uvula back walls of pharynx, ,,raspberry tongue", pains in epigastrium and
near the umbilicus was discovered. Watery stools occured 4-6 times a day with small admixture
of mucus. Padalka's symptom was positive.
What's your preliminary diagnosis?
A. Enteroviral infection
B. Scarlet fewer
C. Abdominal typhoid
D. Pseudotuberculosis
E. Rubella
6. A 7-year-old boy has moderate form of pseudotuberculosis.
Which antibacterial medication should be administered for etiotropic therapy?
A. Penicillin
B. Ampicillin
C. Chloramphenicol
D. Erytromycin
E. Cefalosporins of the first generation
7. A 7-year-old boy fell ill abruptly: fever up to 40 C with rigor, artralgia, myalgia,
abdominal pain. Polymorphic rash with macular and scarlet fever like elements appeared on the
4th day of illness. Ictericity of skin and sclerae occurred on the 6th day of illness. Liver and spleen
were enlarged and tender. Padalka's symptom was positive.
What's your preliminary diagnosis?
A. Measles
B. Rubella
C. Scarlet fewer
D. Pseudotuberculosis
E. Abdominal typhoid
8. A 8 - year-old boy fell ill abruptly, fever up to 39 C, headache, recurrent vomiting, sore throat.
There was punctiform rash on reddened skin on his trunk, upper part of the abdomen, and in the
skin folds, especially in axillae, cubital, inquinal. The soft palate is covered with erithematous
punctiform lerions and scattered petechiae. Tonsils were enlarged, reddened with superficial
necrosis in the form of patches. Submaxillary lymph nodes were enlarged, dense and tender. BP
is 140/90; Ps is 120 per min. What is your diagnosis?
A. Adenoviral infection
B. Scarlet fever
C. Diphtheria
D. Measles
E. Pseudotuberculosis
4
TASK 1
A child of 5 years old attends a kindergarten, he fell ill the day before yesterday when the
temperature elevated up to 39°C, repeated vomiting and a sore throat was marked. His mother
gave him paracetamol. Today in the morning the temperature is 38.5°С, he complains of a pain
in the throat, rash on the skin of the trunk. His mother called in a local physician.
On examination: there was punctiform rash on reddened skin on his trunk, upper part of the
abdomen, and in the skin folds, especially in axillae, cubital, inquinal. In medical examination
hyperemia and edema of skin on the face, hands and fee. Tonsils were enlarged, reddened with
superficial necrosis in the form of patches. Submaxillary lymph nodes were enlarged, dense and
tender. There are no changes in other organs.
In the blood analysis: Eryt- 3.5х1012/l, L - 14,3х109/l, eu - 7 %, stab neutrophils - 12 %, s-56 %, l
- 22%, m - 3 %; ESR - 23 mm/hr.
1. Make the clinical diagnosis.
2. What diseases should we make a differential diagnosis with?
3. Administer treatment.
TASK 2
A 15-year-old boy fell ill abruptly: fever up to 39,5°C, sore throat, abdominal pain.
Scarlet fever-like rash, artralgiae and frequently passed stools occurred on the 4th day f illness. In
medical examination hyperemia and edema of skin on the face, hands and feet (symptoms of
,,hood", ,,gloves" and ,,socks"), ictericity of skin and sclera, hyperemia of palatal arches, soft
palate, uvula back walls of pharynx, ,,raspberry tongue", pains in epigastrium and near the
umbilicus was discovered. Submaxillary, axillae, cubital lymph nodes were enlarged. Liver and
spleen were enlarged and tender. Watery stools occured 4-6 times a day with small admixture of
mucus. Padalka's symptom was positive.
1. Formulate the clinical diagnosis.
2. What diseases should we make a differential diagnosis with?
3. Administer treatment.
4. What laboratory examinations should be administered?
5. What complications this disease you know?
IV. Literature
№
Author(s)
Mikhailova A.M.,
1. Minkov I.P., Savchuk
A.I.
2. Jonathan Cohan
Name of source
(textbook, manual, monograph,
etc.)
City,
Publishing
house
Year of
edition,
vol.,
issue
Number
of
pages
Infection diseases in children.
Odessa
2003
219
4. Duker - Krugman's
Harcourt
Publishers
limited
Infectious diseases The clinician
WebMD
guide to Diagnosis, Treatment and Corporatio
Prevention.
n
Infectious Diseases of Children.
Mosby
5. Gary R. Fleisher,
Stephen Ludwig
Textbook of Pediatric Emergency
Medicine.
6. Robert M. Kliegman
Textbook of Pediatrics
3. David C Dale
Infectious disease.
5
Lippincott
Williams
& Wilkins
NY,
2004
2nd
edition
2004
edition
2136
11th
edition
6th
edition
2010
2007
1574
310
2052
3121
et al.
SAUNDE
RS
6