MINISTRY OF HEALTH UKRAINE
Vinnytsya National Medical University
them. Pirogov
"Approved"
upon methodical conference
Department of the rate of tuberculosis
Clinical Allergy and Immunology
Head of Department
Professor B. Puhlyk
_________________________
(signature)
„_29___”__avgusta 2013 р.
GUIDELINES
INDIVIDUAL WORK OF STUDENTS
WHILE PREPARING FOR THE PRACTICAL LESSON
AND WORK IN THE CLASSROOM
Academic discipline
Module number 1
Subject classes
Course
Faculty
Phthisiology
Phthisiology
Pulmonary tuberculosis combined with
professional dust diseases. Tuberculosis in patients
with HIV / AIDS. Ambulatory diagnosis.
4 th
of Medicine
Vinnytsya – 2013
1.Background
Tuberculosis - an infectious disease, which is based on the formation of caseous
necrotic changes in the lungs or other organs. Some groups, professional activities
which are connected with harmful factors are at increased risk of contracting
tuberculosis. These patients often are forms that occur with a covert, asymptomatic
clinical course, or there are certain diagnostic difficulties to detect tuberculosis
against changes in the lungs due to the influence of occupational factors.
These patients often are forms that occur with a covert, asymptomatic clinical course,
or there are certain diagnostic difficulties to detect tuberculosis against changes in the
lungs due to the influence of occupational factors. In regard to the timely detection of
tuberculosis and the appointment of an adequate treatment regimen should be able to
properly collect complaints data history of life and disease, conduct physical and
Radiological Examination required.
Koniotuberkulosis - pulmonary tuberculosis combined with professional dust disease
of the lungs.
In recent years Ukraine simultaneously developing two socially dangerous epidemic
diseases - tuberculosis and HIV / AIDS, which often affect the same groups.
Tuberculosis is the most common opportunistic disease was the main cause of
morbidity and mortality in patients with AIDS. Among HIV-infected and AIDS
patients the most common opportunistic infection is tuberculosis. HIV infection
increases the risk of active tuberculosis and, conversely, tuberculosis adversely affect
the course of HIV infection. WHO experts believe that the incidence of HIV / AIDSassociated tuberculosis is a sensitive indicator of HIV prevalence in the general
population. According to the literature summarized above 30% of HIV-infected
people suffering from tuberculosis and about 30-40% of ill die from tuberculosis.
Due to the deterioration of the epidemiological situation of tuberculosis in Ukraine
and worldwide, increasing morbidity and mortality from tuberculosis, ineffective TB
control activities in Ukraine implemented DOTS therapy DOTS therapy (Directly
Observed Treatment Short-course - strictly controlled treatment short course
chemotherapy).
2. Learning Objectives:
The task of the teacher - to teach students basic diagnostic stages of diagnosis
koniotuberculosis.
With
the
participation
of
the
teacher,
students
must:
1. Familiar with the method of collecting history, especially attracting attention in
professional history and clinical symptoms and physical methods of examination
(percussion,
auscultation,
palpation)
TB
patients.
2. To study the radiological implications of different forms of pulmonary
tuberculosis.
3. To study the radiological implications silikosis, antrokosis, asbestosis.
4. Determine the required level of laboratory diagnosis, to be able to evaluate this
spirometry, ECG abnormalities.
5. Master the stages of the diagnostic process.
6. Teach students the proper collection of complaints, medical history and life, hold
on "subjective test to determine the X-ray shadow of the main pathological
characteristic of tuberculosis. In addition, the student must know certain social groups
(drug addicts, prostitutes), which primarily require screening for tuberculosis. Future
Specialist must have the ability to explain the necessity renhenolohichnoho or
laboratory testing for tuberculosis, know the basic steps to test and pissing
konsultuvnnya, possess basic rules of ethics and deontology in the diagnosis of HIV /
AIDS-associated tuberculosis.
7. Determination of basic principles, objectives, methods and conditions of DOTS
therapy. Future specialist must possess basic questions about diagnosis and treatment
of TB patients through DOTS system.
3. Basic knowledge, skills necessary for studying the topic (interdisciplinary
integration)
The names of previous
subjects
1. Human Anatomy
2. Normal physiology
3. Physiopathology
4. Pathologic anatomy .
5. Microbiology, Virology
and Immunology
6. Pharmacology
7. General hygiene
Received skills
. General plan of structure of the lungs.
The structure of the membrane wall air ways.
Value for breathing organism.
Ventilation of the lungs and alveoli, its uneven in
different regions of the lungs.
. General pathology, respiratory pathology. Ways of
penetration and distribution of mycobacteria in humans
Tuberculosis. Etiology and pathogenesis. Productive
granulomatous inflammation. Structure specific
granulomas in tuberculosis. Changes in lung
parenchyma arising in koniozah.
Study of infectious process. Mycobacteria (the causative
agent of tuberculosis), its structure, properties,
resistance. Types of MBT and their epidemiological
significance.
Pharmacokinetics of drugs. TB antibiotics and
chemotherapy, classification, dosage, methods of
administration.
Concept of occupational hazards and diseases. Rising
incidence of tuberculosis among health care workers.
Fundamentals of nutrition, physical education and
hardening in the prevention of tuberculosis.
4. Tasks for independent work in preparation for employment.
The list of basic terms, parameters, characteristics, which the student must learn in
preparation for the Session:
Term
Pneumokoniosis: silikoz,
silikatoz (asbestosis, talkoz,
cement) metalokoniozy
(Berlioz, siderosis, alyuminlz,
barytoz) karboniozy
(anthracosis, hrafitoz, soot
pneumoconiosis),
pneumoconiosis from
smishanoho dust
penvmokoniozy from
orhanchnichnohor dust (cotton,
corn, cork, trostnikovoyi)
2. Complaints in patients Coney
tuberculosis.
3. "Fireplace"
4.. Infiltration
5. Dissemination
6. . Active detection of HIV /
AIDS-associated TB.
7. Passive detection of HIV /
AIDS-associated tu-TB
8. . DOTS therapy
9. Category
10. The effectiveness of therapy
Definition
Group of diseases that are characterized by
changes in the pulmonary system by getting
outside certain dusting compounds.
Intoxication syndrome.
Bronhoplevrapulmonary syndrome.
Shadow to 1 cm
Shadow than 1 cm
Centers shadows that capture 3 or more segments.
Diagnosis of tuberculosis in patients with HIV /
AIDS infection in the registration of new cases of
HIV infection in the annual preventive screening
patients rest of this contingent.
Diagnosis of tuberculosis in patients with HIV /
AIDS infection in facing the health facility with
symptoms similar to tuberculosis.
Controlled treatment short course chemotherapy.
The set of patients by type of tuberculosis
Termination bacteria, healing cavities collapse,
positive radiological speaker disappearance of
signs of intoxication and clinics
bronchopulmonary syndrome.
Theoretical question for the class:
Теоретичні питання до заняття:
1. The main epidemiological indicators in Ukraine and abroad.
2. Recent developments in the treatment of tuberculosis.
3. The main objectives, principles and objectives of DOTS therapy.4
4. . Terms implementation of DOTS therapy.
5. Concept adapted DOTS treatment in Ukraine.
6. The effectiveness of DOTS therapy.
7. Main clinical features of the course of tuberculosis in patients with AIDS
8. Features of the collection and the life history of the disease in patients with
HIV / AIDSassociated tuberculosis.
9. The main clinical symptoms of tuberculosis in patients with HIV / AIDS.
10. Radiographic methods (fluorography plain film, tomogram).
11. Basic radiological syndromes in respiratory diseases.
12. Use of tuberculin for the diagnosis of tuberculosis in patients with AIDS.
13. Features of the collection and the life history of the disease in patients
koniotuberculosis.
14. The main clinical symptoms in patients koniotuberculosis.
15. Radiographic methods (fluorography plain film, tomogram) at
koniotuberculosis.
16. Basic radiological syndromes in k koniotuberculosis.
17. Stages diagnosis " koniotuberculosis "
Practical
studies
performed
in
preparation
4.3.1. Fill in the table
Task
Key answer
List the laboratory methods for
detection of Mycobacterium tuberculosis.
2. What bacterioscopic detection
methods MBT ?
3. What do you know types of
mycobacteria?
4. What are the ways of human
infection with TB?
5. What are the most characteristic
changes hemogram with active
tuberculosis?
6. What is tuberculin?
7. What are the results of the
Mantoux test you know?
8. What methods of radiologic
diagnosis you know?:
9. What is DOTS strategy?
10. What are the basic principles of the
aims and objectives of DOTS?
1.
11. Which category of patients
includes DOTS system for
standard treatment?
for
the
Session:
12. What schemes DOTS therapy exist
for certain categories of patients?
13. What provides adapted to the
conditions of Ukraine DOTS
strategy for the diagnosis and
treatment of TB?
14. What is the role of general
practitioners in the early detection
of tuberculosis?
15. What complaints comprises
intoxication syndrome?
16. What complaints comprises
bronhopleuralpulmonary
syndrome?
17. What are the ways HIV you know?
18. What are the main clinical features
of the course of tuberculosis in
AIDS patients?
19. What properties have enlarged
peripheral lymph gland
tuberculosis patients with HIV /
AIDS?
20. What forms koniotuberkulosis you
know?
21. What complaints from a patient
koniotuberculosis?
22. What features collection that the
history of life in patients with
koniotuberculosis?
23. What are the major changes
spirohrami in patients with
koniotuberculosis
24. What the methods of X-ray
diagnosis koniotuberculosis you
know?
4.3.2. Solve test tasks:
1. How many fractions in the right lung?
A. Two
V. * Three
C. Ten
D. Eleven
2. What is the focal shadow?
A. * Shadow to 1 cm
B. Shadow than 1 cm
S. Shadow 2 cm
3.What is coughing up blood?
A. Isolation of more than 100 ml of blood per day
V. * Select up to 50 ml of blood per day
C. Selection of more than 50 ml of blood per day
4. What are the main method of X-ray examination to detect cavities in the lungs?
A. X-ray
B. Plain radiographs in the direct projection
S. * tomogram
D. Bronhografiya
5. Practical tasks performed on classes:
5.1. Run gathering complaints, medical history, occupational history, history of life.
5.2. Carry out inspection, palpation, percussion and auscultation of a patient with
tuberculosis.
5.3. Describe survey radiographs of the chest cavity in a straight projection.
5.4. Аn assessment of the results of laboratory testing, ECG data, spirohramy.
5.5. denitify changes in parameters hemogram in patients with active tuberculosis.
5.6.To be able to palpate increased peripheral lymph gland.
5.7. Be able to identify positive symptoms Franko, Vederhofera.
5.8. Learn to read radiographs, tomograms with signs of primary TB.
5.9. Categorize the patient to the standard treatment regimen based on the results of
X-ray and laboratory examinations.
5.10. A standard scheme for DOTS therapy system for certain categories of patients.
5.11. Learning basic diagnostic steps in establishing a diagnosis of HIV / AIDSassociated tuberculosis.
5.12. Run gathering complaints, medical history, occupational history, history of life.
5.13. Describe survey radiographs of the chest cavity of a patient with direct
projection koniotuberculosis.
Content topics:
1.
Vyzel
A.A.,
Hurylyova
2. Occupational illness.
M.E/
"Tuberculosis."
Moscow,
6. Materials for self-control and the final level of learning material:
№№
Завдання
1.
The patient on examination found the lag
of the chest in breathing, bulging
intercostal spaces, sharply reduced voice
Відповідь
2001.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
tremor on this side, lower respiratory
rumors. What do you expect to see on
radiographs of the chest?
The patient koniotuberculosis lungs.
Suddenly, after a severe attack of
coughing, chest pain appeared, which
gradually increases. What this could mean
and what test should be done?
An examination of the patient revealed a
shift of the trachea toward the midline of
the body. Who was described this
symptom and what processes in the lungs
it can cause?
In Miner at x-ray of the lungs revealed
syndrome dissemination. What kind of
disease to think about in the first place
and that more tests should be done to
elucidate the origin of dissemination?
From what method should begin in a
hospital X-ray screening for lung
koniotuberculosis:
and / fluorography;
b / fluoroscopy;
in / radiography;
g / imaging;
d / elektro-X-ray
Which segments of the lung often
localized tuberculosis processes?
What may appear radiographically change
root lungs koniotuberculosis?
Define radiographic term focus:
A / shadow within the segment;
b / shade smaller than 1 cm;
in / shade more than 1 cm;
g / availability clarification sizes up to 1
cm in the center of the eclipse.
What pathological processes lead to a
shift of the mediastinum (with unilateral
lesions):
a/
towards
destruction;
b / in the opposite direction
What are the main radiological syndromes
in koniotuberculosis lungs?
What is the minimum radiographic
examinations should be used to detect
cavities?
and / Plain radiography;
b / imaging;
in / fluorography;
g / bronchoscopy;
d / lateral radiography
12.
13.
14.
15.
16.
17.
18.
19
20
21
22
23
24
25
The patient appeared hemoptysis,
increased body temperature. What
radiographic examination and in which
order should I do?
On what type of violations going on
spirohramy in patient koniotuberculosis
lungs and what type of dyspnea is most
typical of these patients?
Patient D, a strong cough, hemoptysis.
Last month he lost 5 kg. What auxiliary
examination methods necessary for
diagnosis?
How does the X-ray phase collapse?
At what stages of development
koniotuberculosis observed changes in the
roots of the lungs?
What is an invasive method to confirm the
diagnosis koniotuberculosis?
What are the basic principles of the DOTS
strategy?
What are the main criteria for categories
of patients under the DOTS system.
A patient with disseminated tuberculosis
with collapse and there is bacteria. Which
category should include the patient?
The patient appeared relapse of
tuberculosis. Which category should
include this patient?
At the end of the intensive phase of
treatment the patient achieved a positive
X-ray dynamics, termination of bacteria.
What further tactics patient?
What is the abbreviation with anti-TB
drugs?
specify regimen therapy according 1,2,3
categories.
After being discharged from the hospital
the patient is recommended to continue
26
27
28
29
30
31
32
33
treatment at the place of residence. Who
is responsible for the out pathient
treatment?
A patient who is registered with the center
for prevention and control of AIDS
present cough for two months. Do I need
to perform X-ray examination of the
chest, where the survey was carried out 4
months ago?
In a patient with HIV infection present
bronchopulmonary
syndrome.
On
radiographs of pathological changes were
detected. Do I need to perform in this case
of sputum for MBT?
In a patient with HIV infection present
bronchopulmonary
syndrome.
On
radiographs of pathological changes were
detected, MBT (-) three times. What
should be the doctor's tactics in this case?
In a patient with HIV infection in the
lungs x-ray revealed a round shadow.
What kind of disease to think about in the
first place and that more tests should be
done to elucidate the etiology of the
shadows?
What are the contraindications to perform
tuberculin exist in patients with HIV /
AIDS?
What changes are possible in the
hemogram in patients with HIV / AIDSassociated TB?
What changes in immunogram possible in
patients with HIV / AIDS-associated TB?
What agents can cause inflammation in
the lungs of patients with AIDS?
Literature.
Summary
1.
"Tuberculosis"
I.T.
P"yatnochka.
Ternopil.
"Ukraine".,
2005.
2. Pylypchyk MS, Petrenko VI , Phthisiology. Textbook. Kyiv: High School, 1998. –
296 p.
3. Savula MM, AJ Ladny Tuberculosis. Textbook. Ternopil 'Ukrmedknyha ", 1999. 323 p.
4. NV Putov, GB Fedoseev "Guide to pulmonolohyy", 1964.-455 p.
5. Tuberculosis respiratory organs / Ed. A.H.Homenko. - Moscow: Medicine, 1988. 576 p.