Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
METHODOLOGICAL INSTRUCTIONS TO PRACTICAL LESSONS FOR 4-nd COURSE STUDENTS OF DENTISTRY FACULTY LESSON №4 (6 HOURS) Themes: 1. Lichen simplex chronic (Neurodermitis limited). 2. Diagnostic criteria and dermatological symptoms of collagen vascular diseases. Systemic lupus erythematosus. Discoid lupus erythematosus. 3. Systemic sclerosis (dermatosclerosis): progressive systemic sclerosis. Morphea localized. Scleroderma striata. Sclerodactylia. Dermatopolymiositis. Aim: To develop skills in methods of skin assessment, identification of skin lesions, working out plan of general examination, treatment and prophylaxis of lichen simplex chronic, systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), systemic sclerosis. Professional orientation of students: Connective tissue disorders include a family of more than 200 different disorders that affect connective tissues. Connective tissue disorders are caused primarily by gene mutations affecting the production of tissue and by a number of different specific and overlapping autoimmune diseases. In autoimmune connective tissue disorders, specific organs (organ-specific diseases) or multiple organs (systemic diseases) may be affected. Up until the late 70’s, most systemic or rheumatological autoimmune diseases were referred to as connective tissue diseases or collagen diseases. Today, connective tissue diseases are classified as either 1) autoimmune connective tissue disorders such as lupus disorders, rheumatoid arthritis, and dermatomyositis or 2) heritable connective tissue disorders (HCTDs) such as Ehlers-Danlos syndrome, epidermolysis bullosa, and Marfan syndrome caused by gene mutations. In the HCTDs, alterations in affected genes may change the structure and development of connective tissue in specific organs. Inflammatory myopathies. Inflammatory myopathies, including dermatomyositis and polymyositis, are a heterogeneous group of acquired diseases of skeletal muscle characterized by weakness and inflammation. They are rare, involving 5-10 per million adults. Dermatomyositis, which includes skin involvement, is seen most often. It can involve internal organs like the heart and lungs. Polymyositis mainly affects only the muscles. Although these disorders can be life threatening, with modern treatment most patients achieve good long-term outcomes1. Inflammatory myositis impacts on many aspects of life including employment, social activities and family relationships. Mainly this is due to muscle weakness. But fatigue and general ill health associated with persistent inflammation and the involvement of internal organs such as the lungs also have debilitating effects2. Patients with myositis are seen by several specialists including rheumatologists, neurologists and dermatologists and this creates particular challenges in delivering high-quality care for people with a rare condition. Scleroderma.Scleroderma (systemic sclerosis) is an uncommon connective tissue disease affecting around 1 in 10,000 of the population but has a major impact on those who develop the disease. It is a multi-system connective tissue disease that affects the musculoskeletal system and skin but also can involve internal organs such as the heart, lung and kidneys. It can be life-threatening and has the highest mortality per case of any of the connective tissue diseases. Scleroderma impacts on almost all aspects of the life of someone with the condition, including employment, social interactions and family relationships by restricting function, causing fatigue and by affecting vital organs such as the heart, lungs, kidneys and gastrointestinal tract. The diversity of scleroderma presents a real challenge to developing recommendations for management but without these, care will be fragmented and inadequate, and there is a real possibility that important treatable aspects of the condition will be neglected. Sjogren's syndrome. Sjogren's syndrome causes severe dryness of the eyes and mouth with an accompanying arthritis. It usually starts over the age of 50 and prevalence figures between 0.5% and 3% of the population have been claimed. Swelling of the lymph glands in the head and neck and of the parotid gland are well recognized complications, as are poor circulation, fatigue and 1neurological complications. It is not usually a fatal disease but is associated with a greatly increased risk (up to 40 times) of a non-Hodgkin's B cell lymphoma. The treatment of Sjogren's syndrome is principally symptomatic using replacement eye drops and saliva solutions to keep the eyes and mouth as moist as possible. Our increased understanding of the causes of this disease is also leading to the development of some newer therapies for it. System lupus erythematosus. Systemic lupus erythematosus (SLE or sometimes known just as lupus) is a connective tissue disease which is mostly found in women during the childbearing years. It affects between 40 and 200 people per 100,000, being commonest in the black population. Although the skin and joints are the most commonly affected organs, lupus is a disease which can affect any organ or system. Though the mortality and morbidity rates for lupus have improved significantly, it retains a life threatening capacity and has major effects on the quality of life of people living with the condition. It causes a huge range of problems from severe fatigue to renal failure requiring renal dialysis and/or transplantation. It is a great mimic of other conditions and one of the ongoing challenges is to recognize the condition as soon as possible and thus to treat it appropriately. Important advances in our understanding of the cause of this disease are leading to some exciting new developments in its treatment. Methodology of Practical Class (9.00-12.00) Methodic of Student s Practical Activity: 1. To prepare to communication with a patient and examination (clean warm hands, cut off nails, if necessary - gloves, spatula, needed instruments). 2. Greeting and identification (name, level of competence), get the agreement of patient. 3. At the receiving of agreement of patient to set confidential mutual relations (a friendly face, respect and concern, soft talk during conversation). 4. To collect complaints, anamnesis of illness to explain to the patient the reason of finding out of separate questions. 5. To explain the results of questioning. 6. To explain to the patient, what examination will be done and its reasonability, to get an agreement. 7. To notify about the possibility of the occurrence of unpleasant feelings during examination. 8. To conduct the examination of patient (to estimate the general state, consciousness status, position of patient in the bed, detail history of the disease, inspection of unigured skin areas (color – pale, icteric, cyanotic etc.); dermatological status (inspection; palpation; scraping; diascopy), skin lesions (type, shape, and arrangement). It is necessary to reveal features of clinical motion of lichen simplex chronic, systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), systemic sclerosis. 9. To explain the results of examination understandably for patient. 10. To finish a conversation, thank for communication, wish favorable flow of illness and rapid convalescence. Practical work 1. To diagnose sites of predilection of Discoid lupus erythematosus Practical work 2. To diagnose sites of predilection of Systemic sclerosis. Break (12. 00-12.30) Students’ independent Study Program: 1. Anatomy, histology, and physiology of the skin – layers of skin, epidermal layers, cell of the epidermis, dermis layers, and cells of the dermis, hypodermis, functions of the skin, glands of the skin, hair and nails. 2. Skin lesions and methods of examination of patients with skin diseases – terms used to describe skin lesions (type, shape, and arrangement), investigations. 3. Features of clinical motion of lichen simplex chronic, systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), systemic sclerosis. Principles of their differential diagnosis, prophylaxis, and treatment. Seminar discussion of theoretical questions and practical work (12.30-14.00) Break (14. 00-14.15) Individual students work (14.15-15.00) Test evaluation and situational tasks. Tests: 1) The localized form of Morphoea may present as all, except: A. Guttate. B. Plaque. C. Linear. D. Burrow. E. Both are wrong. 2) Scleroderma is a disease characterized by all, except: A. Sclerosis of the skin. B. Sclerosis of the visceral organs. C. Vasculapathy (Raynaud’s phenomenon). D. Presence of autoantibodies. E. Discoid lupus erythematosus. 3) Coetaneous manifestations of progressive systemic sclerosis (PSS) can be divided into such stages: A. Edematous. B. Atrophic. C. Indurative or sclerotic. D. Both are correct. E. Both are wrong. 4) Lupus erythematosus (LE) means: A. Discoid lupus erythematosus (DLE). B. Subacute cutaneous lupus erythematosus (SCLE). C. Systemic lupus erythematosus (SLE). D. Both are correct. E. Both are wrong. 5) Discoid lupus erythematosus (DLE) mens all, except: A. Localized discoid lupus erythematosus . B. Lupus profundus ( lupus panniculitis ). C. Hypertrophic DLE. D. Morphoea. E. Both are correct. 6) When the scale is removed (Benye-Meschersky sign), according to great pain, patient throw back it’s: A. Head. B. Hand. C. Leg. D. Hand and leg. E. Head and leg. 7) When the scale is removed (“Carpet tack” sign), its undersurface shoes keratotic spikes which have occupied the dilated: A. Pilosebaceous canals. B. Sebaseous glands. C. Sweat glands. D. Sebaseous glands and sweat glands. E. Both are correct. Students should know: 1. Classification of connective tissue diseases. 2. Pathogenesis of connective tissue diseases. 3. Types of lupus erythematosus (LE). 4. Types of discoid lupus erythematosus (DLE). 5. Types of subacute cutaneous lupus erythematosus (SCLE). 6. Types of systemic lupus erythematosus (SLE). 7. Etiology of discoid lupus erythematosus (DLE). 8. Complications of discoid lupus erythematosus (DLE). 9. Diagnosis of subacute cutaneous lupus erythematosus (SCLE). 10.Complications of subacute cutaneous lupus erythematosus (SCLE). 11.Etiology of systemic lupus erythematosus (SLE). 12.Named clinical features of systemic lupus erythematosus (SLE). 13.ARA criteria for classification of systemic lupus erythematosus (SLE). 14.Diagnosis of systemic lupus erythematosus (SLE). 15.Treatment of systemic lupus erythematosus (SLE). 16.Etiology of dermatomyositis. 17.Clinical features of dermatomyositis. 18.Skin biopsy in dermatomyositis. 19.Diagnosis of dermatomyositis . 20.Forms of scleroderma. 21.Named forms of localized Scleroderma (Morphea). 22.Named stages of coetaneous manifestations of progressive systemic sclerosis. 23.Raynaud’s phenomenon. 24.Diagnosis of scleroderma. 25.Symptomatic treatment of scleroderma. 26.Immunosuppressive treatment of scleroderma. Students should be able to: 1. To describe skin lesions. 2. To assess nails, hair, and mucosal surfaces, even if these are recorded as unaffected. 3. To perform diascopy, to investigate dermographism. 4. To work out plan of review; appropriate treatment and preventive of lichen simplex chronic, systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), systemic sclerosis. 5. Write out of prescription of drugs for topical and systemic treatment of lichen simplex chronic, systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), systemic sclerosis. Answers to the Self-assessment: Test evaluations: 1) Burrow. 2) Discoid lupus erythematosus. 3) Both are correct. 4) Both are correct. 5) Morphoea. 6) Head. 7) Pilosebaceous canals. Reference: Basic: 1. Savchak V., Kovalchuk M. Skin diseases in the family doctor practice. – Ternopil, Ukrmedknyha, 2005.-397p. 2. M. Kovalchuk. Skin diseases. Color atlas. – Ternopil, Ukrmedknyha, 2007.210 p. 3. Savchak V., Halnykina S. Sexually transmitted diseases. – Ternopil, Ukrmedknyha, 2001.-506 p. 4. Patient’s photo, phototests №204-205, 210-213. 5. Materials for practical class 4 Additional: 1. Color atlas of and Synopsis of clinical dermatology (Thomas B. Fitzpatrick at al, 1988, p. 1-5. 2. Thomas P.Habif. Clinical Dermatology. Mosby, 2004. – 1004 p. 3. P.N. Behl, A. Aggarwal. Practice of dermatology (tenth edition). Bangalore, 2005. – 500 p. 4. Alan B. Fleischer Dermatology. Common problems. New York, 2000. – 303 p. 5. Virendra N Sehgal. Clinical Dermatology. New Delhi, 2004. – 305 p. Internet links: 1. Systemic lupus erythematosus, SLE, how to diagnosis, Etiology and Pathogenesis.Video. http://www.youtube.com/watch?feature=player_detailpage&v=sQCsZef2BUk 2. Oral mucosal ulceration in systemic lupus erythematosus. http://www.ncbi.nlm.nih.gov/pubmed/623694 3.Oral Manifestations of Systemic Disease. http://www.aafp.org/afp/2010/1201/p1381.html 4. Management of Erythematous Oral Lesions . http://emedicine.medscape.com/article/2066299-overview#aw2aab6b5 The methodical instruction has been done: by ass. Shkilna M.I. Methodical instruction was discussed at the Department sitting 14/06/2013 Minute N 10.