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MINISTRY OF HEALTH OF UKRAINE
Vinnitsa National Medical University. MI Pirogov
"Approved uyu"
Vice Rector for Academic Affairs
__________________
Professor Huminskyy Yu.Y.
(Signature)
"_____" ____________ 200
Methodological development
for c tudentiv in preparation for practical classes.
Subject number 2
Academic discipline
"Clinical Immunology and Allergology"
Module number 1
"Clinical Immunology and Allergology"
Modules № 1
Immune status and age
characteristics. Immunodeficiency disease and other
immunodependent - principles of diagnosis,
immunotherapy, and immunoprophylaxis
immunorehabilitation.
Study subject
Immunological research methods. The concept of
imunohramu.Basic rules for assessing immune
status. The main symptoms of the immune
system. Features immunity parameters in different age
groups.
5th
"Medicine", "Pediatrics", "Medical and preventive care"
4
Rate
Faculty
Number of hours
2009
I. Background: In respect of a large number of factors that cause
decrease immune reactivity and participation immunopathological mechanisms in the
development of many diseases is an important study of modern clinical and laboratory
methods diagnose the state of the human immune system.
V I. Plan and organizational structure classes
The main stages of employment, their functions and
contents
1. Preparatory stage:
Organisation of classes
Educational objectives
The control input of knowledge
skills:
serological methods for
immunological diagnosis
modern immunology
laboratory methods
2. Principal Stage
Formation of professional knowledge,
abilities and skills:
collection immunological and
allergic history
clinical examination of the
patient
data evaluation of instrumental
methods of examination
purpose of laboratory
immunological assay
data interpretation of clinical
and laboratory examination and
identification of immunogenic
or allergic-Pathology
3.Zaklyuchnyy stage
Control and correction profsiynyh
knowledge, abilities, skills
-Be able to select the appropriate stage
of the immunological laboratory testing
-Determine the prognosis of the disease
based on immunological evaluation
To sum up the lessons
Homework to the next topic
Levels of
assimilation
Methods for monitoring and
training
Materials
methodological
support
Time in
minutes
Frontal survey
Quick Survey
Test (input)
Tests circuits
25
Individual survey
(control issues)
Professional training
in dealing with
common problems
("Step 2")
Table
160
Schemes
Microscopic
preparations
Results of
laboratory tests
Testing (baseline)
Individual survey
Solving atypical
situation tasks
Diagrams,
tables, custom
case studies
1
2
2
2
3
3
3
35
3
VII. Methods of educational process in the practice (seminar) class.
7.1. The preparatory phase.
7.2. The main stage
20
Number
1.
Task
What are the figures relate to laboratory tests of immunological II Level?
2.
3.
4.
Which of the following immunological parameters characterizing the innate immune system?
Which of the following immunological parameters characterizing the humoral response?
What is the concentration of IgE in serum of adults:
5.
6.
What is the most affordable method for detection of T lymphocytes?
Determined at lower humoral immunity in proteyinohrami?
7.
Which is a characteristic sign of hemogram with acquired immune deficiency?
8.
9.
10.
11.
What feature distinguishes immunocompetent cells from cells of the nervous and endocrine
systems?
Which of the following studies be performed with the patient in hay fever?
Which of the following reactions include reactions to reahinovoho type?
Feature of the secondary immune response is as follows:
12.
13.
14.
Acquired (adaptive) immunity is realized through:
On the membranes of cells which are receptors for reagin?
The cells, which are often fixed pathogenic circulating immune complexes
15.
The biological function of natural killer cells:
Key Answer
This phase involves performing each student independently and under the supervision of the teacher
below
specified practical work.
Task 1
Students conduct survey and objective examination of the patient with immunological disorders,
using review lpatsiyu na, auscultation, percussion and determine the necessary laboratory
serological and immunological diagnostic methods.
Task 2
Task 3
1.
What types of leukocytes containing wbc (leykotsytohrama)?
2. What is meant by the immune status of the patient?
3. What are the clinical signs can be suspected combined immunodeficiency?
4. What are the signs of an infectious syndrome in patients with combined immunodeficiency?
5. What is phagocytosis?
Objectives Level 2
Task 4
№/№
1.
2.
3.
Task
What are the signs we are characteristic for infectious
dis syndrome immune system function?
As modes of transmission are the most dangerous in the presence
of immunodeficiency state?
Identify the main causes of immunodependent diseases and conditions:
4.
5.
Related to the stages of phagocytosis?
What character is not typical for infectious diseases
in patients with combined immunodeficiency?
6.
7.
The diagnosis is confirmed by specific disease ...?
What factors can specify activation T-helperiv/induktoriv
and serve as a trigger of an autoimmune process?
8.
What histaminopeksiya?
9.
10.
Enter stage patients studied to identify immunopathology:
What are the signs of an allergic immune dysfunction syndrome?
11.
Which of the following processes does not require the
participation of complement fragment C 3?
12.
With the methods used equipment monoclonal antibodies?
13.
What are the functions of interferons?
14.
How cells belonging fundamental importance in the
development stage patohimichnoyi allergy reahinovoho type?
15.
How is the place to antigens to which the antibody binds?
16.
What laboratory test helps evaluate the functional activity of phagocytes?
17.
Proliferative activity of lymphocytes can be defined by which method?
Objectives of Level 3
Problem number 1.
'19 The patient appealed to the district physician complaining of shortness of breath,
swelling in the neck and face. Swelling developed gradually after tooth extraction, which was
performed 5 hours ago. The patient entered tavegil 2,0 ml / m, but the symptoms of breathlessness
and swelling continued to increase, reinforced by a cough, hoarseness of voice. In compiling the
history revealed that the patient of 8 years periodically developed swelling of various sites, whose
appearance has always been associated with emotional stress or trauma. They never accompanied
by urticaria and itching. Similar swelling was observed in grandfather. Allergies, adverse reactions
to medications history not found.
OBJECTIVE: Swelling occupies a large surface of the neck and face,
diffuse, pale, tight on palpation.
1.
Your diagnosis and its rationale.
2.
Define the scope of the emergency room.
Problem number 2.
Patient 31 years, turned to the doctor complaining of lumps on the left collarbone. Pain in
the chest and abdomen, night itching. Ill during the year. During the physical examination:
palpable enlarged lymph nodes are not painful left and supraclavicular area. The liver and spleen
were not enlarged. Analysis of blood: hemoglobin - 70 g / L, WBC - 19.6 * 109 / L, eosinophils 1
\% §-8 \%, p-83 \%, limf.-2 \% mon.-6 \%., ESR-55 mm / h., platelets 58 000. In Rh-graphy of the
chest at the top of the right lung infiltrate determined that contrasts with the lung tissue. What
research is necessary to confirm the diagnosis for?
Problem number 3.
The patient is 63 years old, retired, used to work at a chemical plant. At admission
complains of weakness, dizziness, pohuda tion, poor appetite, swelling in the neck and
armpits. Review: pale, mild lymphadenopathy, hepato-, and splenomegaly. In blood: heme. 85 g
/ l, эr.2, 5 * 1012 / l, k.p.1, 0 Lake. 220 * 109 / L, platelets, 130 * 109 / l, e - 2 \% n 4 \%, p 5 \%,
lymphoma 85 \% m 4 \%, ESR 23 mm / h. What is the most likely diagnosis?
Problem number 4.
Male 23 years, complains of weakness, a feeling of compression in the occipital region, head pain,
oliguria. Three weeks ago, underwent follicular tonsillitis. OBJECTIVE: temperature - 37.2 C,
respiratory rate - 18 per min., Pulse - 86ud./hv., AT -140/100 mmHg The skin is pale, swollen
eyelids. Above the lungs - vesicular breathing. Heart sounds are muffled rhythm right, the
emphasis II tone of the aorta. Abdomen soft, smooth. Symptom Pasternatsky negative on both
sides. On legs - soft swelling. In blood: red blood cells, 3.5 * 1012 / L, Hb - 112 g / l, leyokotsyty8.8 * 109 / L, ESR -18mm/hod. In urine specific gravity -1.014, protein - 3.3 g / l, erythrocytes 6-7 in n. / View leucocytes - 4-6 c. / View, hyaline cylinders - 6-8 in n. / View , granular cylinders
- 3-5 in n. / view. What is the mechanism of disease is most likely in this patient?
Problem number 5.
Patient A., 20, admitted to the hospital on lunochnoyi bleeding after tooth extraction. Blood
test: Ep. - 2.8 g / dL, Hb - 80 g / l Lake. - 4.0 g / l, e - 2, n - 3, C - 62, L - 28 m - 5, trombotsyy 24 g / l, ESR 25 mm / hWhat disease you expect?
Problem number 6
A woman in '25 during fluoroscopy symmetrically in both roots revealed increased
bronchopulmonary lymph nodes with distinct polycyclic contours. No complaints there. An
objective examination revealed no pathology. Normal hemogram. Mantoux test with 2
negative. Add a probable diagnosis.
Problem number 7.
Patient 43, an accountant by profession, three times during the year was on treatment for
acne rosacea. The last time the study revealed the contents of pustules mite Demodex
folliculorum. The patient suffers from chronic and chronic gastro adneksit smokes. Which of the
pathogenetic factors should be considered in the event of relapse leading dermatosis in this case?
Problem number 8.
A man aged 60 complained of severe pain in the left side and a skin rash. Sick 4
days. OBJECTIVE: along the intercostal spaces on erythematous background are linearly grouped
blisters with serous exudate, single erosion. Rash accompanied by pain. Who is the most likely
diagnosis?
Problem number 9.
Patient B., 40, complained of cough with a small number of specimens, pale yellow,
weakness, sweating, low-grade fever. OBJECTIVE: auscultation over some areas of pulmonary
rales auscultated dribnomihurkovi.Radiological findings revealed focal infiltration in different
parts of the lungs. Infiltrates heterogeneous with indistinct contours. In sputum eosinophil large
number, in Eosinophilia of blood to 60 \%. In history - bitsilinoterapiya.What is the pathology of
these most likely?
7.3. The final stage.
VIII. Apps
8.1. Theoretical questions preparatory phase:
1. Immunological and allergy history
2. Basic approaches to clinical examination of organs and systems in patients with immuno-and
alerhopatolohiyeyu.
3. Instrumental methods of examination of patients with suspected immune-and alerhopatolohiyu.
4. Methods for assessing cellular factors of nonspecific (innate) immunity.
5. Methods for evaluation of humoral factors of nonspecific (innate) immunity.
6. Methods for assessing cellular factors specific (adaptive) immunity.
7. Methods for assessing humoral factors specific (adaptive) immunity.
8. Methods for in-depth evaluation of the immune system
9. Modern laboratory technology
10. Approaches to the interpretation of laboratory immunological assays.
8.2 Practical Skills:
- To be able to collect immunological and allergy history;
- Be able to objectively examine the patient's organs and systems under conditions of allergy and
immunopathology;
- To be able to determine the required serological and immunological methods of laboratory
diagnosis;
- To be able to justify the feasibility of implementation of patient immunological laboratory
investigations and give an overall evaluation.
X I. Conclusions:
9.1. Possessed knowledge of serological and immunological diagnostic methods
immunopathology ..
9.2. The current understanding of the fundamentals of clinical and laboratory assessments
do conclusions about the state of the immune system of the patient.
9.3 Acquired skills and nterpretuvaty leykohramy and immunological data on the basis of clinical
data, the stage of the immune response, immunological history.
9.4 acquired skills and original nalizuvaty changes in immune status based on the patient's age,
health status and season.
9.5 Acquired skills substantiation using basic diagnostic methods used in clinical immunology,
define the indications and contraindications for their conduct.
The tasks for independent work on the subject:
1) mastering skills to analyze data imunolohichhyh research methods:
A) orienting tests (Level 1) (quantitative cellular and humoral factors of innate and specific
immunity, evaluation of phagocytosis et al.).
B) analytical tests (level 2) (estimate proliferative activity of T-and B-lymphocytes, natural
kilkriv assessment activity, determination of the various components of the complement system
and so on.).
2) mastering the skills of interpretation of these physical examination of the patient with
disorders of immune sysetmy (ultrasound, renhenolohichne, immunohistochemistry, etc.)..
Haifa. Literature
D A B B A L N A (main)
1. "Clinical Immunology and Allergology 'Handbook, ed. prof. GM Drannik.-C. : Health "I
2006.-888 p.
2. Drannyk GN "Clinical and ymmunolohyya allerholohyya" Textbook for students, doctors ynternov, ymmunolohov, allerholohov, doctors lechebnogo the Profile âñåõ specialties. - 3 ed.,
Ext. - Kiev: - OOO "POLYHRAFPLYUS."-2006.-482 p.
3. Kazmirchuk VE, LV Kovalchuk Clinical Immunology and Allergology. - Kiev: NEW
KNYHA.-2006.-528.
4. Sokolov EI Clinical ymmunolohyya / M: Medytsyna.-1998.-272p.
5. Yakobisyak Immunology M. Ed. V.Chop 'as / Kiev: New knyha.-2003.-705 p.
D A B B A L N A (optional)
6. Bazhora Y. "Clinical Immunology" - Odessa, Odessa State Medical universytet.-2000.-384 p.
7. Belozerov ES Illness ymmunnoy system Elista: APP "Jangar", 2005, pp. -267.
8. GI Nazarenko, AA Kiskun Clinical evaluation of laboratory of results ыh IP sledovanyy / N:
Medytsyna.-2000.-544p.
9. Klynycheskoy ymmunolohyy Fundamentals (Textbook for Medical Universities) lane. with the
English. E.. Chepel, M. Hein, S. Mysbah, N. Snovden, M: HЭOTAR-Media, 2008, pp. -416.
10. Stolyarov Y.D. Ymmunodyahnostyka and immunocorrection in klynycheskoy Practice / St.
Petersburg: Sotys.-1999.-176 p.
11. Khaitov RM "Ymmunolohyya" Textbook for Medical Universities - M. Ed. HЭOTAR Media.
- 2006. - + CD ROM
RESEARCH
1 2. Ymmunolohyya Clinical. Pod. Red. G. Lolora Jr., T. Fisher and D. Adelman. Per. with the
English. - Moscow, Practice, 20 00. - 806s.
1 3. Munode im fytsytnыe Status / ed. - V.S.Smyrnov and IS Freydlyn-SP to "Folyant" 2000 58os.
1 4. Reutte A. Brostrof J. Mayle, D. Ymmunolohyya.Per. with the English. - M.Myr, 2002.592s.
1 5. S.dzh.Sekret West Û revmatolohyy Trans. s English-M.SPb.: Byonom publishing house ",
1999.-768p.
16. Periodical "Immunology and Allergology", "Ymmunolohyya", "Clinical ymmunolohyya",
"Rheumatology", "Neurology" "Gastroenterology", "Pulmonology", "Medicine of Ukraine",
"doctor", "graphic treatment of" 2000 2003rik .
METHODOLOGICAL:
17. Mileryan VE Methodological Basis of preparation and conduct of studies in medical
universities (handbook).-K. "Globus", 2004.-80.
Guidelines prepared
Associate Professor of OB Bondarchuk
Guidelines approved at a meeting of .........
"__" ___________ "200 9 years Protocol number
Head. Department
MD, Professor
BM Puhlyk