The chair of pediatrics with children’s surgery, course of children infectious
diseases
Methodological instructions to self activities for the 5th course foreign students
No 1
Theme: Urgent stages in case of influenza and acute viral upper respiratory tract
infections: hyperthermia, seizures. Croup. Clinical features, diagnostic, therapy.
Aim: to learn how to diagnose hyperthermia, seizures, croup syndrome in children with
upper respiratory tract viral infection; find complications, perform differential diagnosis,
prophylaxis and treatment.
Professional motivation: hyperthermia, seizures, croup syndrome in children often are
connected with upper respiratory tract viral infection. That’s why it requires from the
doctor to know diagnostic criterions, duration, treatment and prevention of this
pathology.
Basic Level
1. Etiology, epidemiology of influenza, upper respiratory tract viral infections
(infectious diseases).
2. Pathogenetical mechanisms of hyperthermia, seizures, croup syndrome development
(pathological physiology).
3. Peculiarities of history asking in children (Propedeutic pediatrics).
4. Clinical examination of child by systems and organs. (Propedeutic pediatrics).
5. Interpretation
of
child’s
laboratory
and
instrumental
examination
results.
(Biochemistry, normal physiology, pathological physiology, roentgenology, Propedeutic
pediatrics).
6. Pathogenetical and symptomatical treatment of hyperthermia, seizures, croup
syndrome (pharmacology, infection diseases).
Students’ Independent Study Program
1. Causes and clinical features of hyperthermia in children with upper respiratory tract
viral infection.
2. Causes and clinical features of seizures in children with upper respiratory tract viral
infection.
3. Pathogenetical mechanisms of croup syndrome in children with upper respiratory
tract viral infection.
4. Prehospital and hospital treatment of hyperthermia, seizures, croup syndrome in
children.
Result Level
Students must know
 Pathogenetical mechanisms of hyperthermia, seizures, croup syndrome in children
with upper respiratory tract viral infection.
 Clinical features of hyperthermia, seizures, croup syndrome in children with upper
respiratory tract viral infection.
 Prehospital and hospital treatment of children with this pathology.
Students should be able to do:
 To diagnose hyperthermia, seizures, croup syndrome in children with upper
respiratory tract viral infection.
 Interpret results of laboratory and instrumental examination of the child,
 Prescribe prehospital and hospital treatment to children with this pathology.
A real life situation to be solved
1. A boy, 1 year old, is treated in the hospital from influenza, which complicated by
seizures.
1. What investigation must be done?
2. Account a dose of Na oxybutiras to this boy.
Answer:
1. Lumbar puncture with CSF analysis.
2. 50 mg/kg x 10 kg = 500 mg (2.5 ml of 20% solution).
2. A boy, 3 years old, has upper respiratory tract viral infection. At night body
temperature increased to 39C; dry cough became barking, inspiratory dyspnea has
appeared. Lung sound is “box”-like; during auscultation – rough breathing. Breathing
rate is 36 per minute, cardiac rate – 126 per minute.
1. What is the reason of status worsening?
2. What treatment must be done on prehospital stage?
Answer:
1. Development of croup syndrome.
2. Fever control and attempts to alleviate respiratory symptoms and patient anxiety
(calming, and exposing the child to the cool night air).
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988, - P. 602-605, 611-615, 618-623, 753755.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992. – P. 38-40, 44-45, 49-51.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 2
Theme: Rubella. Etiolology, pathogenesis, differential diagnosis with measles, scarlet
fewer, allergic exanthema. Inborn rubella. Treatment, prevention.
Aim: To know diagnostic criterions of rubella in children, how to examine the child
with rubella and prove the diagnosis, differentiate, give the individual treatment
and prevention.
Professional motivation:
Rubella in children has predominantly mild duration. Last years cases of rubella in
adults have increased. Especially it is dangerous in pregnant women, because infection
of the fetus will lead to inborn defects. That’s why it requires from the doctor to know
diagnostic criterions, duration, treatment and prevention of this pathology.
Basic Level
1. Etiology, epidemiology of rubella (infectious diseases, epidemiology).
2. Pathomorphological changes in case of rubella (pathological anatomy).
3. Peculiarities of history asking in children (Propedeutic pediatrics).
4. Clinical examination of child by systems and organs. (Propedeutic pediatrics).
5. Interpretation
of
child’s
laboratory
and
instrumental
examination
results.
(Biochemistry, normal physiology, pathological physiology, Propedeutic pediatrics).
6. Pathogenetical and symptomatical treatment of viral diseases (pharmacology,
infection diseases).
Students’ Independent Study Program
1. Etiology, epidemiology, pathogenesis of rubella.
2. Main diagnostic criteria of acquired and inborn rubella.
3. Differential diagnostics of rubella.
4. main principles of acquired and inborn rubella treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis of rubella.
 Main diagnostic criteria of acquired and inborn rubella.
 Differential diagnosis of rubella.
 Methods of laboratory and instrumental examination in case of acquired and inborn
rubella
 Complications of rubella.
 Main principles of rubella treatment and prevention.
Students should be able to do:
 to diagnose acquired and inborn rubella,
 interpret results of laboratory and instrumental examination of the child in case of
acquired and inborn rubella,
 perform differential diagnosis of rubella,
 prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
7 years old girl complaints on: rashes on the skin, that appears today. During
examination: maculopapular eruption, pallor-pink, on the normal skin, on the unbend
surfaces, is separated from each other, body temperature is 37.3 С, enlargement of
occipital lymph nodes.
1. Name previous diagnosis.
2. What diseases it must be differentiated from?
Answers:
1. Rubella, typical mild form.
2. Measles, scarlet fever, infectious mononucleosis.
2. In one group of kindergarten a boy has rubella. His mother is pregnant (10 weeks) but
is not vaccinated against this disease and was never ill.
1. What measures should be done in the kindergarten?
2. What measures should be done to the pregnant woman?
Answers:
1. Boy mustn’t visit kindergarten up to 5th day from the beginning of the disease.
Quarantine in the group on 21 days after isolation of this boy.
2. Serological investigation that must be repeated in 2 weeks. If titer of antibodies
against rubella will increase – pregnancy must be interrupted.
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992..
Additional:
1. Cherry JD: Rubella virus. In: Feigin RD, Cherry JD, eds. Textbook of Pediatric
Infectious Diseases. Vol 2. 4th ed . WB Saunders Co; 1998:1922-1949.
2. Maldonado YA: Rubella virus. In: Long SS, Pickering LK, Prober CG, eds.
Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone;
1997:1228-1237.
3. Viral Infections of Humans. Epidemiology and Control. 4th edition. New York,
NY: Plenum Medical Book Company, 1997.
4. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
5. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 3
Theme: Angina in children. Etiolology, making the diagnose, treatment. Treatment of
angina at home.
Aim: To know diagnostic criterions of angina in children, how to examine the child with
angina and prove the diagnosis, differentiate, give the individual treatment and
prevention.
Professional motivation:Angina in children is one of the most often diseases. It may be
caused by different agents (bacteria, viruses and fungi). That’s why it requires from the
doctor to know diagnostic criterions, to perform the diagnose in time, give adequate
treatment and prevent complications of this pathology.
Basic Level
1. Etiology, epidemiology of anginas (infectious diseases, epidemiology).
2. Pathomorphological changes in case of different anginas (pathological anatomy).
3. Peculiarities of history asking in children (Propedeutic pediatrics).
4. Clinical examination of child by systems and organs. (Propedeutic pediatrics).
5. Interpretation
of
child’s
laboratory
and
instrumental
examination
results.
(Biochemistry, normal physiology, pathological physiology, Propedeutic pediatrics).
6. Etiological, pathogenetical and symptomatical treatment of anginas (pharmacology,
infection diseases).
Students’ Independent Study Program
1. Etiology, epidemiology of anginas.
2. Clinical features of different anginas (bacterial, viral and fungal).
3. Anginas’ complications.
4. Differential diagnosis of angina.
5. Main principles of anginas’ treatment and prevention/
Result Level
Students must know
 Etiology, epidemiology of anginas.
 Diagnostic criterions of different anginas (bacterial, viral and fungal).
 Differential diagnosis of angina.
 Anginas’ complications.
 Methods of laboratory examination of the child, who has angina (bacteriological,
virusological)
 Anginas’ treatment.
Students should be able to do:
 to diagnose angina in examined child
 to prescribe laboratory examination of the child,
 to interpret results of the child’s laboratory examination,
 perform differential diagnosis of angina,
 to prescribe etiological, pathogenetical and symptomatical treatment to ill child.
A real life situation to be solved
1. A girl, 6 years old complaints on sore throat, fever 39.2 C. She is ill for 2 days.
During examination of the patient: pharyngeal and tonsillar erythema, purulent tonsillar
exudate, enlargement of anterior cervical lymph nodes were found.
1. Name the diagnose.
2. Account a dose of penicillin G for this patient.
Answers:
1. Lacunar noncomplicated angina, mild stage.
2. 100000 IU/kg x 22kg = 2,200,000 IU per day. 2,200,000:4=550,000 IU four times
daily.
2. A boy, 3 years old is treated in infectious department from infectious mononucleosis,
hard duration. He receive penicillin, aspirin, antihistamine drugs, multivitamins and
local treatment with antiseptic fluids.
1. Which diseases it should be differentiated from?
2. What you can add to the treatment of this patient?
Answers:
1. Diphtheria, adenovirus infection, acute leukemia, lymphogranulomathosis.
2. Corticosteroids (prednisone 1-2 mg/ kg/ day), a short course.
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988. -p.31-34, 47-49, 193-195.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992.-p. 58-59; 254, 265, 315-319; 329-330.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 4
Theme: Bowel yersiniosis. Peculiarities of epidemiology, pathogenesis, clinical features,
making the diagnose. Treatment, prevention.
Aim: To know diagnostic criterions of yersiniosis in children, how to examine the child
with yersiniosis and prove the diagnosis, differentiate, give the individual treatment and
prevention.
Professional motivation: yersiniosis is an acute infectious disease which is characterized
by polysyndromal clinical features; may have recedival, or hard duration. It occurs all
over the world, previously in children and teenagers. Clinical polymorphism and widely
spreading of the yersiniosis – are reason that doctors of all specialties must know how to
diagnose this disease.
Basic level
1. To know how to ask complaints, history of the disease, life history in children
(propedeutic pediatrics).
2. To perform clinical examination of the child (propedeutic pediatrics).
3. To know microbiology, pathophysiology and pathomorphology of yersiniosis.
4. To diagnose yersiniosis after clinical and laboratory examinationof the child
(infectious diseases, propedeutic pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis of yersiniosis.
2. Clinical diagnostic features of yersiniosis.
3. Laboratory examination of patient with yersiniosis.
4. Differential diagnosis of yersiniosis.
5. Main principles of treatment of yersiniosis.
6. Profilaxys of yersiniosis. Work in the epidemical focus.
Result Level
Students must know:
 Etiology, epidemiology, pathogenesis of yersiniosis.
 Clinical diagnostic features of yersiniosis.
 Laboratory examination of patient with yersiniosis.
 Differential diagnosis of yersiniosis.
 Main principles of treatment of yersiniosis.
 Profilaxys of yersiniosis.
Students should be able to:
 Separate anamnestic data, which told us about yersiniosis.
 Find diagnostic clinical criterions of yersiniosis, during examination of the
patient.
 To perform differential diagnosis among diseases, which have the similar clinical
features.
 To learn the main tendentions of the yersiniosis treatment.
 To prevent yersiniosis.
A real life situation to be solved
1. A girl 13 years old was hospitalized to infectious department with diagnose:
yersiniosis, typical form.
1. What diseases it must be differentiated from?
2. What laboratory investigation confirm diagnose?
Answers:
1. Pseudotuberculosis, acute bowel infections.
2. Bacteriological examinations of feces, urine, nasopharyngeal swab; serological
investigations.
2. A girl 5 years old goes to kindergarten. Now she has yersiniosis, middle stage.
1. What preventive measures should be done in the kindergarten?
2. Prescribe etiotrope therapy.
Answers:
1. Disinfection, contacts’ observation during 3 weeks (thermometry, examination
of the skin, throat, feces), one bacteriological investigation of the feces.
2. Furazolidone: 10 mg x 20 kg = 200 mg/day : 4 = 50 mg per dose, 4 times per
day.
Rp: Tab. Furazolidoni 0.05
D.t.d. №20
S. 1 tablet 4 times per day
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992.
Additional:
1. Cleary TG: Yersinia. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson
Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders; 2000: 857-859.
2. Pickering L, ed: Yersinia enterocolitica and Yersinia pseudotuberculosis infections.
In: Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove
Village, Ill: American Academy of Pediatrics; 2000: 642-643.
3. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
4. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 5
Theme: Urgent stages in case of meningococcal infection (toxic shock syndrome, brain
edema), making the diagnose, treatment on prehospital and hospital stage.
Aim: To know diagnostic criterions of meningococcal infection complications in
children, how to examine the child with meningococcal infection complications and
prove the diagnosis, differentiate, give the individual treatment and prevention.
Professional motivation: duration of meningococcal infection’s generalized forms very
often is complicated by brain’s edema, life threatened hemorrhages into inner organs
(suprarenal glands), toxic shock syndrome, hemodynamic and metabolic disorders.
These processes develop very quickly, may have lethal exit. That’s why, knowledge of
their diagnostic criterions, treatment and prevention is very actual.
Basic Level
1. Etiology,
epidemiology
of
meningococcal
infection
(infectious
diseases,
epidemiology).
2. Pathogenetical mechanisms of brain’s edema, toxic shock syndrome development
(pathological physiology).
3. Peculiarities of history asking in children (Propedeutic pediatrics).
4. Clinical examination of child by systems and organs. (Propedeutic pediatrics).
5. Interpretation
of
child’s
laboratory
and
instrumental
examination
results.
(Biochemistry, normal physiology, pathological physiology, Propedeutic pediatrics).
6. Etiological, pathogenetical and symptomatical treatment of brain’s edema, toxic
shock syndrome (pharmacology, reanimathology).
Students’ Independent Study Program
1. Causes and clinical features of brain’s edema in children with meningococcal
infection.
2. Causes and clinical features of toxic shock syndrome in children with meningococcal
infection.
3. Prehospital treatment of brain’s edema, toxic shock syndrome.
4. Hospital treatment of brain’s edema, toxic shock syndrome.
Result Level
Students must know
 Pathogenetical mechanisms of brain’s edema, toxic shock syndrome development in
children with meningococcal infection.
 Clinical features of brain’s edema, toxic shock syndrome development in children
with meningococcal infection.
 Prehospital and hospital treatment of children with this pathology.
Students should be able to do:
 To diagnose brain’s edema, toxic shock syndrome in children with meningococcal
infection.
 Interpret results of the laboratory and instrumental examination of the child,
 Prescribe prehospital and hospital treatment to children with this pathology.
Real situations to be solved:
1. A boy of 1 year old was hospitalized in infectious department. The disease has begun
4 hours before. Objectively: hard condition, adynamia, cold extremities, body
temperature is 39.5°C. Skin is pallor, with hemorrhagic ''star-like'' rashes of different
size on buttocks, legs. Conjunctiva and pharynx are hyperemied. Heart beats are
rhythmic, 176 per minute. Heart tones are dull. Arterial pressure on arms – 75/45 mm
Hg. Breathing is puerile, 62 per minute. Abdomen is soft, painless. Meningeal
symptoms are absent.
1. Name the diagnosis;
2. what etiothrope therapy should be prescribed? Account its dose.
Answers:
1. Meningococcal infection, generalized form, meningococcemia, toxic shock
syndrome 2nd stage.
2. Chloramphenicol (Laevomycetin) parenterally 80-100 mg/kg/day in 4 devided
doses. 10 kg x 100 mg/kg = 1,000 mg per day, 250 mg per dose.
2. A girl, 2.5 years old was hospitalized in infectious department. The disease has begun
yesterday: increased body temperature to 39°C, excitement, and tremor, repeated
vomiting. Today seizures have appeared. 3 days ago was in a contact with brother, who
now is treated from meningococcemia.
Objectively: hard condition, adynamia, unconsciousness, seizures that periodically
repeat. Meningeal symptoms are positive. Anisocoria, asymmetry of reflexes. Body
temperature is 39.2°C. Skin is pallor. Heart beats are rhythmic, 100 per minute. Heart
tones are dull. Breathing is superficial, 52 per minute. Abdomen is soft, painless.
1. Name the diagnosis;
2. Prescribe pathogenetical treatment to this child in the hospital.
Answers:
1. Meningococcal infection, generalized form, meningitis. Brain’s edema.
2. manitol 1 g/kg IV droplet; in 2-5 hours lasix 1-2 mg/kg IV;
 dexazone 1 mg/kg, prednizone 5 mg/kg, hydrocortizone 20-30 mg/kg IV,
 albumin 10-20% – 10 ml/kg, concentrated plasma 10 ml/kg IV droplet,
anticonvulsants (lytic suspension 0.1 ml/kg)
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988, - P. 134-138, 285.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992. – P. 570-574; 255.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
3. Nadel S, Levin M, Habibi P: Treatment of meningococcal disease in childhood. In:
Meningococcal Disease. John Wiley & Sons; 1995:207-43.
4. Tunkel AR, Scheld WM: Acute meningitis. In: Principles and Practice of Infectious
Diseases. 4th ed. Churchill Livingstone; 1995:831-65.
5. Krugman, Saul, et al. Infectious Diseases of Children . St. Louis: Mosby Year Book,
1992.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 6
Theme: Herpes virus infection (herpes simplex, herpes zoster). Etiology, epidemiology,
pathogenesis, clinical features, making the diagnose, treatment, prevention.
Aim: To know diagnostic criterions of Herpes virus infection in children, how to
examine the child with Herpes virus infection and prove the diagnosis, differentiate, give
the individual treatment and prevention.
Professional motivation: Herpes virus infection – diseases that predominantly are
characterized by skin and mucosal membranes damage. In newborns have severe, septic
duration with high mortality. In elder children have recedival duration that tell us about
immunodeficiency (often in case of AIDS, leukemia, malignant tumors). This has some
prognostic meaning. That’s why, knowledge of their diagnostic criterions, treatment and
prevention is very actual.
Basic level
1. To know how to ask complaints, history of the disease, and life history in children
(propedeutic pediatrics).
2. To perform clinical examination of the child (Propedeutic pediatrics).
3. To know microbiology, pathophysiology and pathomorphology of Herpes virus
infection (microbiology, pathophysiology, pathomorphology).
4. To diagnose Herpes virus infection after clinical, laboratory examination of the child
(infectious diseases, propedeutic, pediatrics, microbiology, and pathophysiology).
5. To give etiological, pathogenetical, symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of Herpes virus infection.
2. Classification of Herpes virus infection.
3. Main diagnostic criterions of Herpes simplex infection.
4. Main diagnostic criterions of Herpes zoster infection.
5. Complications of Herpes virus infection.
6. Differential diagnosis of Herpes virus infection.
7. Main principles of Herpes virus infection treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of Herpes virus infection.
 Classification of Herpes virus infection.
 Main diagnostic criterions of Herpes simplex infection.
 Main diagnostic criterions of Herpes zoster infection.
 Complications of Herpes virus infection.
 Differential diagnosis of Herpes virus infection.
 Main principles of Herpes virus infection treatment and prevention.
Students should be able to do
 To diagnose Herpes virus infection.
 Interpret results of laboratory and instrumental examination of the child in case of
Herpes virus infection.
 Perform differential diagnosis of Herpes virus infection.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. A girl, 5 years old has herpes simplex infection, localized form (labial’s herpes),
recedival duration.
1. What laboratory methods will prove this diagnose?
2. Prescribe treatment to this child.
Answers:
1. Serologic examination, virusological examination of vesicles’ contents.
2. Unguent of acyclovir on damaged region 5-6 times per day. Adaptogens
(Echinacea 5 drops 3 times per day during 1-2 months). Group B vitamins (B1,
B2).
2. A boy, 10 years old complaints on pain, rashes on left lateral surface of the chest. 3
days ago had increased body temperature to 38.7 о С, pain in the same region. Rashes
had appeared today. During examination: in left lateral surfase of the chest, along the 4th
intercostal spase: hyperemia, infiltration of the skin with groupe of vesicles on it.
General condition is satisfactory.
1. What disease must be suspected?
2. What evolution of rashes in this case?
Answers:
1. Herpes zoster infection
2. Groupe along nerws’ branches: spot → papule → vesicle with transparent then
cloud contents → crust → pigmentation.
References:
Main:
1. Ambulatory Pediatric care/edited by Robert Derchewitz;- 2nd ed.-LippingcotRaven,1992.- p.151-153.
2. Current therapy in pediatric infections disease-2/edited by John D. Nelson, M.D.- B.
C. Decker inc. Toronto. Philadelphia,1988.-p.247-251.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 7
Theme: Parapertussis. Etiology, epidemiology, pathogenesis, clinical features, making
the diagnose, treatment, prevention.
Aim: To know diagnostic criterions of Parapertussis in children, how to examine the
child with Parapertussis and prove the diagnosis, differentiate, give the individual
treatment and prevention.
Professional motivation: Parapertussis clinically looks like pertussis or acute viral upper
respiratory tract infection. Absence of active immune prophylaxis of parapertussis leads
to epidemic flashes in kindergartens. That’s why, knowledge of Parapertussis diagnostic
criterions, treatment and prevention is very actual.
Basic Level:
1. To know how to ask complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of parapertussis
(microbiology, pathophysiology, pathomorphology).
4. To diagnose parapertussis after clinical and laboratory examination of the child
(infectious diseases, Propedeutic Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of parapertussis.
2. Classification of parapertussis.
3. Main diagnostic criterions of parapertussis.
4. Differential diagnosis of parapertussis.
5. Parapertussis treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of parapertussis.
 Classification of parapertussis.
 Main diagnostic criterions of parapertussis.
 Differential diagnosis of parapertussis.
 Parapertussis treatment and prevention.
Students should be able to do
 To diagnose parapertussis.
 Interpret results of the laboratory and instrumental examination of the child in case of
parapertussis.
 Perform differential diagnosis of parapertussis.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. In the kindergarten 5 children became ill. All are coughing, cough is increasing. All
children are vaccinated against pertussis.
1. What disease must be suspected?
2. Prescribe laboratory investigations.
Answers:
1. Parapertussis
2. A culture of nasopharyngeal secretions for B. Parapertussis and B. Pertussis
2. A child, 3 years old complaints on cough, which progresses for last 10 days, is dry,
and troubles him at nighttime. 2 days ago cough became spasmatic, near 10 times per
day. Boy goes to kindergarten, is vaccinated against pertussis. 3 weeks ago exposured
with a boy, who had the same cough. Other signs of disease are absent.
1. Name the diagnose.
2. What preventive measures should be done in the kindergarten?
Answers:
1. Parapertussis, pertussis like form, mild stage, uncomplicated.
2. Disinfection, contacts’ observation during 2 weeks, cultural examination of
nasopharyngeal secretions for B. Parapertussis and B. Pertussis.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992. – P. 742-747.
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988. – P. 46-47.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 8
Theme: Poliomyelitis. Etiology, epidemiology, pathogenesis, clinical features, making
the diagnose. Treatment, prevention. Differential diagnosis with ECНO and Coxsackie’s
infection.
Aim: To know diagnostic criterions of Poliomyelitis in children, how to examine the
child with Poliomyelitis and prove the diagnosis, differentiate, give the individual
treatment and prevention.
Professional motivation: Poliomyelitis is a viral disease that predominantly
develops in preschoolers (75–90%). Due to vaccination its frequency decreased more
than 100 times. But in many countries last years sporadic paralytic forms of
Poliomyelitis have been registered. In that cases mortality was 9–10%.
That’s why, knowledge of Poliomyelitis diagnostic criterions, treatment and prevention
is very actual.
Basic Level:
1. To know how to ask complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of Poliomyelitis
(microbiology, pathophysiology, pathomorphology).
4. To diagnose Poliomyelitis after clinical and laboratory examination of the child.
(infectious diseases, Propedeutic Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of poliomyelitis.
2. Classification of poliomyelitis.
3. Main diagnostic criterions of poliomyelitis.
4. Differential diagnosis of poliomyelitis.
5. Poliomyelitis treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of poliomyelitis.
 Classification of poliomyelitis.
 Main diagnostic criterions of poliomyelitis.
 Differential diagnosis of poliomyelitis.
 Poliomyelitis treatment and prevention.
Students should be able to do
 To diagnose poliomyelitis.
 Interpret results of the laboratory and instrumental examination of the child in case of
poliomyelitis.
 Perform differential diagnosis of poliomyelitis.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. A boy, 7 years old became ill 3 days ago: body temperature 39,6о С, repeated
vomiting, headache, weakness. On the 3rd day he couldn’t close right eye, face
asymmetry during speaking has appeared. The boy wasn’t vaccinated.
1. What disease is suspected?
2. What his family doctor must do?
Answers:
1. Poliomyelitis, typical pontine form, paralytic period, severe stage.
2. Hospitalize the boy into infectious hospital, where he must be isolated for 40
days; inform sanitary-epidemiologic structures; look after contact persons.
2. A health boy, 3 months old was brought to ambulatory clinic to perform plane
vaccination.
1. What vaccine against poliomyelitis he would receive, when next doses of primary
vaccination must be given?
2. What specific complication may occur?
Answers:
1. Oral poliomyelitis vaccine, in 4, 5 months.
2. Vaccinal poliomyelitis.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992.
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 9
Theme: Enterovirus infection. Etiology, epidemiology, pathogenesis, clinical features,
making the diagnose, treatment, prevention
Aim: To know diagnostic criterions of Enterovirus infection in children, how to examine
the child with Enterovirus infection and prove the diagnosis, differentiate, give the
individual treatment and prevention.
Professional motivation: ECНO and Coxsackie’s viruses caused several acute infections,
that have vide spectrum of clinical features: from mild temperature increase and
asymptomatic carrying up to severe meningoencephalitis, myocarditis and other. That’s
why, knowledge of Enterovirus infection diagnostic criterions, treatment and prevention
is very actual.
Basic Level:
1. To know how to ask complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of Enterovirus
infection (microbiology, pathophysiology, pathomorphology).
4. To diagnose Enterovirus infection after clinical and laboratory examination of the
child (infectious diseases, Propedeutic Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of Enterovirus infection.
2. Classification of Enterovirus infection.
3. Main diagnostic criterions of Enterovirus infection.
4. Differential diagnosis of Enterovirus infection.
5. Enterovirus infection treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of Enterovirus infection.
 Classification of Enterovirus infection.
 Main diagnostic criterions of Enterovirus infection.
 Differential diagnosis of Enterovirus infection.
 Enterovirus infection treatment and prevention.
Students should be able to do
 To diagnose Enterovirus infection.
 Interpret results of the laboratory and instrumental examination of the child in case of
Enterovirus infection.
 Perform differential diagnosis of Enterovirus infection.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. A boy, 5 years old became ill 3 days ago: body temperature 38.6о С, vomiting, sore
throat, headache. On the 3rd day maculopapulous rashes all over the body have appeared.
Conjunctives are hyperemied, hyperemia of pharynx, tonsils; they are covered with
small papules and vesicles that are fulled with transparent exudate.
1. Name previous diagnose.
2. What laboratory investigations could prove it?
Answers:
1. Enterovirus infection, combined form: exanthema, herpangina, moderate duration.
2. Virusological investigation of nasopharyngeal mucus, paired serological
investigation.
2. A girl, 12 years old complaints on: high body temperature (39.2о С), headache, severe
spasmodic pain in the neck, chest, upper part of abdominal wall. Pain increases with
deep breathing. Objectively: conjunctives are hyperemied, hyperemia of pharynx,
tonsils. Heart tones are loud, heart rate – 100 per minute. Breathing – vesicular.
Breathing rate – 20 per minute. Abdomen is soft, slight painful in upper parts. Peritoneal
signs are absent.
1. Name previous diagnose.
2. What diseases it must be differentiated from?
Answers:
1. Enterovirus infection, epidemic myalgia, moderate duration.
2. From influenza, pleuritis, pleuropneumonia, “acute abdomen”.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992.
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988.
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 10
Theme: Acute bowel infections, caused by relative pathogenic bacteria.
Bacteriological and serological diagnostic.
Aim: To know diagnostic criterions of acute bowel infections, caused by relative
pathogenic bacteria in children, how to examine the child with acute bowel infections,
caused by relative pathogenic bacteria and prove the diagnosis, differentiate, give the
individual treatment and prevention.
Professional motivation: last years, acute bowel infections, caused by relative
pathogenic bacteria in children, appeared more often predominantly in maternal houses
and children’s hospitals.
That’s why, knowledge of diagnostic criterions of acute bowel infections, caused by
relative pathogenic bacteria in children, their treatment and prevention are very actual.
Basic Level:
1. To know how to ask the complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of acute bowel
infections, caused by relative pathogenic bacteria (microbiology, pathophysiology,
pathomorphology).
4. To diagnose acute bowel infections, caused by relative pathogenic bacteria after
clinical and laboratory examination of the child (infectious diseases, Propedeutic
Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of acute bowel infections,
caused by relative pathogenic bacteria.
2. Classification of acute bowel infections, caused by relative pathogenic bacteria.
3. Main diagnostic criterions of acute bowel infections, caused by relative pathogenic
bacteria.
4. Differential diagnosis of acute bowel infections, caused by relative pathogenic
bacteria.
5. Treatment and prevention of acute bowel infections, caused by relative pathogenic
bacteria.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of acute bowel infections,
caused by relative pathogenic bacteria.
 Classification of acute bowel infections, caused by relative pathogenic bacteria.
 Main diagnostic criterions of acute bowel infections, caused by relative pathogenic
bacteria.
 Differential diagnosis of acute bowel infections, caused by relative pathogenic
bacteria.
 Treatment and prevention of acute bowel infections, caused by relative pathogenic
bacteria.
Students should be able to do
 To diagnose acute bowel infections, caused by relative pathogenic bacteria.
 Interpret results of laboratory and instrumental examination of the child in case of
acute bowel infections, caused by relative pathogenic bacteria.
 Perform differential diagnosis of acute bowel infections, caused by relative
pathogenic bacteria.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved.
1. A child, 5.5 years old enters the infectious department from the kindergarten, where
some cases of acute gastrointestinal infection were noticed. The disease has acute
beginning: fever 38.5 ºC, vomiting, abdominal pain, liquid feces, and defecation 5 times
per day. Objectively: skin pallor, tachycardia, tenderness of abdomen in the left inguinal
region, spasms of the sigmoid colon. Feces are brown-green, with mucus. During feces
bacteriological examination Proteus vulgaris was found.
1. Name main syndromes of disease.
2. what number of Proteus vulgaris give us possibility to diagnose proteosis?
Answers:
1. Toxic, colitis.
2. more than 1х106 in 1 gram of feces.
2. A child, 2 years old is treated in the infectious department for 4 days because of
klebsiellosis caused by Klebsiella pneumoniae, gastrointestinal form, moderate stage.
1. When patient can be discharged from department?
2. Name prevention in the epidemical focus.
Answers:
1. When he becomes healhy, and after normalization of complete blood analysis.
2. Fecal culture from contacts, looking after contacts for 7 days, disinfection.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992. – p. 404-411
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.80-81
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 11
Theme: Toxicosis and exicosis in case of acute bowel infections. Pathogenesis, clinical
features, making the diagnose, treatment, oral rehydration.
Aim: to learn how to diagnose toxicosis and exicosis syndrome in children, determine its
type, period and phase, perform differential diagnosis, and treatment.
Professional motivation: Toxicosis and exicosis are nonspecific generalized answer on
infectious agent or its products in case of massive toxins’ income in blood with
development of endotoxemia. Main pathologic processes in organism are connected
with development of dehydration and loss of electrolytes. Progress of these processes
leads to impairment of blood circulation, hypoxia of tissues, metabolic acidosis, toxic
shock syndrome, and polyorganic insufficiency. That’s why it requires from the doctor
to know diagnostic criterions, duration, treatment and prevention of this pathology.
Basic Level
1. Etiology, epidemiology of acute bowel diseases (infectious diseases).
2. Pathomorphological changes in organs and systems, pathogenetical mechanisms in
case of toxicosis with exicosis (pathological anatomy, pathological physiology).
3. To know how to ask the complaints, disease history and life history in children
(Propedeutic Pediatrics)
4. To perform clinical examination of the child (Propedeutic Pediatrics).
5. To interpret results of laboratory and instrumental examination of the child.
(Biochemistry, normal physiology, pathological physiology, roentgenology, Propedeutic
pediatrics).
6. Pathogenetical
and
symptomatical
treatment
of
toxicosis
(pharmacology, infection diseases).
Students’ Independent Study Program
1. Etiology, pathogenesis of toxicosis with exicosis.
2. Classification of toxicosis with exicosis.
3. Diagnostic criterions of different types of toxicosis with exicosis.
with
exicosis
4. Differential diagnosis of toxicosis with exicosis between neurotoxicose.
5. Prehospital and hospital treatment of toxicosis with exicosis, prognosis and
prophylaxis.
Result Level
Students must know
 Etiology, pathogenesis of toxicosis with exicosis.
 Classification of toxicosis with exicosis.
 Diagnostic criterions of different types of toxicosis with exicosis.
 Differential diagnosis of toxicosis with exicosis between neurotoxicose.
 Prehospital and hospital treatment of toxicosis with exicosis, prognosis and
prophylaxis.
Students should be able to do:
 ask complaints, disease and epidemiologic history,
 examine the patient,
 interpret results of laboratory and instrumental examination of the child,
 perform differential diagnosis of toxicosis with exicosis,
 prescribe to child prehospital and hospital treatment of toxicosis with exicosis.
A real life situation to be solved.
1. A boy 6 months old has repeated vomiting, appetite is absent; is ill for 2 days. Disease
has developed after he had drunk unboiled milk. During examination: malaise, skin is
pallor, mucus membranes of oral cavity are dry. Moderate thirst is present. Large
fontanel is lower than skull bones. Weight loss is 4 %. Tachycardia – 130 per minute.
Body temperature 38° C. Abdomen is soft, tender when colon is palpated. Feces are
liquid, dark yellow without blood and mucus 12 times per day. Urination was 8 times
per day.
1. Name previous diagnose.
2. What type of dehydration has developed? How to prove it?
Answers:
1. Escherichiosis, moderate form, toxicosis with exicosis, 1st stage.
2. Isotonic. To measure electrolytes in the blood.
2. A boy, 8 months old, entered the infectious department. The disease had acute
beginning. Now: doesn’t want to drink anything; repeated vomiting, body temperature is
35.5 ºC. Objectively: skin pallor, with “marble” paint, skin and mucus membranes are
dry; large fontanel is lower than skull bones; cold extremities; tachycardia, tenderness of
abdomen in the left inguinal region. Feces are in a large amount, looks like mud, with
mucus. In entrance room he became unconscious, tonico-clonic seizures has appeared.
Body weight is 8 kg.
1. What type of exicosis has developed?
2. Accoun daily amount of fluids to this child for the 1st stage of rehydration.
How many saline and water fluids must be given?
Answers:
1. Salt defficiensy (hypotonic).
2. 220 ml/kg x 8 kg = 1760 ml. 1 part (600 ml) of saline fluids, 2 parts (1200 ml)
of water fluids.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot
– Raven, 1992. – p. 404-411
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson,
M.D. – B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.80-81
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 12
Theme: Cholera in children. Pathogenesis and clinical peculiarities in children. Making
the diagnose, treatment
Aim: To know diagnostic criterions of cholera in children, how to examine the child
with Cholera and prove the diagnosis, differentiate, give the individual treatment and
prevention.
Professional motivation: cholera is quarantine infection. 7 pandemias of this disease are
known. The last one has begun since 1961. South-Eastern Asia is en endemic center of
cholera. That’s why, knowledge of Cholera diagnostic criterions, treatment and
prevention is very actual.
Basic Level:
1. To know how to ask complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of Cholera
(microbiology, pathophysiology, pathomorphology).
4. To diagnose Cholera after clinical and laboratory examination of the child (infectious
diseases, Propedeutic Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of Cholera.
2. Classification of Cholera.
3. Main diagnostic criterions of Cholera.
4. Differential diagnosis of Cholera.
5. Cholera treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of Cholera.
 Classification of Cholera.
 Main diagnostic criterions of Cholera.
 Differential diagnosis of Cholera.
 Cholera treatment and prevention.
Students should be able to do
 To diagnose Cholera.
 Interpret results of laboratory and instrumental examination of the child in case of
Cholera.
 Perform differential diagnosis of Cholera.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. A girl, 13 years old became ill 5 hours ago. Nausea, repeated vomiting, nonstop
diarrhea without abdominal pane are present. Body temperature is 36º C. Has developed
3rd stage of dehydration. Feces and vomits looks like rice-water.
1. Name previous diagnose.
2. Prescribe etiotrope treatment to this girl.
Answers:
1. Cholera.
2. Chloramphenicol (Laevomycetin) enterally 50 mg/kg/day in 4 devided doses.
40kg x 50 mg/kg = 2,000 mg per day; 500 mg per dose.
2. A girl, 10 years old is hospitalized in infectious department with previous diagnose
cholera.
1. What diseases it must be differentiated from?
2. What contra epidemic measures in the focus of infection must be done?
Answers:
1. Rotaviral infection; enterotoxigenic escherichiosis.
2. Isolation of the girl into “choleric hospital”, disinfection, contacts’ supervising, in
case of appearing in them suspect symptoms – isolation into “provisor hospital”.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992. – p. 404-411
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.80-81
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 13
Theme: Rota-viral infection. Etiology, epidemiology, pathogenesis, clinical features,
making the diagnose, treatment, prevention
Aim: To know diagnostic criterions of rotavirus infection in children, how to examine
the child with Rotavirus infection and prove the diagnosis, differentiate, give the
individual treatment and prevention.
Professional motivation: rotavirus infection is the main cause of viral gastroenteritis in
infants. This infection is widely spread all over the world. Secretory diarrhea leads to
moderate or severe exicosis that needs to perform differentiation of rotavirus infection
between cholera, enterotoxigenic escherichiosis, and other secretory diarrheas. That’s
why, knowledge of Rotavirus infection diagnostic criterions, treatment and prevention is
very actual.
Basic Level:
1. To know how to ask complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of Rotavirus
infection (microbiology, pathophysiology, pathomorphology).
4. To diagnose Rotavirus infection after clinical and laboratory examination of the child
(infectious diseases, Propedeutic Pediatrics, microbiology, pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of Rotavirus infection.
2. Classification of Rotavirus infection.
3. Main diagnostic criterions of Rotavirus infection.
4. Differential diagnosis of Rotavirus infection.
5. Rotavirus infection treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of Rotavirus infection.
 Classification of Rotavirus infection.
 Main diagnostic criterions of Rotavirus infection.
 Differential diagnosis of Rotavirus infection.
 Rotavirus infection treatment and prevention.
Students should be able to do
 To diagnose Rotavirus infection.
 Interpret results of laboratory and instrumental examination of the child in case of
Rotavirus infection.
 Perform differential diagnosis of Rotavirus infection.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
A boy 3 years old is ill for 2 days. Main syndromes are: toxic with hyperthermia;
dyspeptic with vomiting, diarrhea (like rice-water); catarrhal changes in upper
respiratory tract; moderate exicosis.
1. What infection can cause this signs?
2. How to prove the diagnosis?
Answers:
1. Rotaviral
2. Virusological investigation of feces, serological reactions.
2. A girl, 1.5 years old has rotaviral infection.
1. What diseases it must be differentiated from?
2. What type of diarrhea is typical for it?
Answers:
1. Cholera; enterotoxigenic escherichiosis.
2. Secretory.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992. – p. 404-411
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.80-81
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 14
Theme: Typhus abdominals, paratyphus А and В in children. Clinical, pathogenetical
peculiarities in age aspect. Early diagnostic criterions
Aim: To know diagnostic criterions of typhus abdominals, paratyphus А and В in
children, how to examine the child with Rotavirus infection and prove the diagnosis,
differentiate, give the individual treatment and prevention.
Professional motivation: typhus abdominals, paratyphus A and B are spread all over the
world. In 2-10 % of cases will form carrying of infection that even may be chronic.
Discharge of bacteria will support epidemic process. That’s why, knowledge of Typhus
abdominals, paratyphus A and B diagnostic criterions, treatment and prevention is very
actual.
Basic Level:
1. To know how to ask the complaints, disease history and life history in children
(Propedeutic Pediatrics)
2. To perform clinical examination of the child (Propedeutic Pediatrics).
3. To know microbiology, pathophysiology, and pathomorphology of Typhus
abdominals, parayphus A and B (microbiology, pathophysiology, pathomorphology).
4. To diagnose Typhus abdominals, parayphus A and B after clinical and laboratory
examination of the child (infectious diseases, Propedeutic Pediatrics, microbiology,
pathophysiology).
5. To give etiological, pathogenetical, and symptomatical treatment (pharmacology).
Students' Independent Study Program
1. Etiology, epidemiology, pathogenesis, pathomorphology of Typhus abdominals,
paratyphus A and B.
2. Classification of Typhus abdominals, paratyphus A and B.
3. Main diagnostic criterions of Typhus abdominals, paratyphus A and B.
4. Differential diagnosis of Typhus abdominals, paratyphus A and B.
5. Typhus abdominals, paratyphus A and B treatment and prevention.
Result Level
Students must know
 Etiology, epidemiology, pathogenesis, pathomorphology of Typhus abdominals,
paratyphus A and B.
 Classification of Typhus abdominals, paratyphus A and B.
 Main diagnostic criterions of Typhus abdominals, paratyphus A and B.
 Differential diagnosis of Typhus abdominals, paratyphus A and B.
 Typhus abdominals, paratyphus A and B treatment and prevention.
Students should be able to do
 To diagnose Typhus abdominals, paratyphus A and B.
 Interpret results of laboratory and instrumental examination of the child in case of
Typhus abdominals, paratyphus A and B.
 Perform differential diagnosis of Typhus abdominals, paratyphus A and B.
 Prescribe treatment to children with this pathology and its prevention.
A real life situation to be solved
1. A child, 10 years old enters the infectious department. He is ill for 1.5 week. The
disease has gradual beginning: temperature subfebril, than 38.5-40.2 ºC, head ache,
abdominal pain, cramps. Objectively: skin is pallor, near 20 roseols on chest and
abdomen; tongue is covered with gray, enlarged; bradycardia, dull heart tones; rough
breathing; tenderness of abdomen in the right inguinal region, liver and spleen are lower
costal ribs.
1. What infection is suspected?
2. What laboratory investigations should be done?
Answers:
1. Typhus abdominals.
2. Blood-, urine-, fecal-culture, Vidal reaction; complete blood and urine analyses.
2. A child, 8 years old, is treated in infectious department from: Typhus abdominals,
typical, moderate form.
1. What diseases it must be differentiated from?
2. When patient could be discharged from hospital?
Answers:
1. Paratyphus A and B; salmonellosis, typhoid form; enterovirus infection;
pseudotuberculosis; yersiniosis; infectious mononucleosis.
2. Clinically health, not earlier 21st day of normal temperature, after 3 negative fecal
and urinal cultures (on the 5th, 10th, 15th day of normal temperature), 1 negative bile
culture (on 12th day of normal temperature). Antibiotic therapy could be abolished
not earlier than 11th day of normal body temperature.
References:
Main:
1. Ambulatory pediatric care/ edited by Robert A. Derchewitz; - 2nd ed. – Lippincot –
Raven, 1992. – p. 404-411
2. Current therapy in pediatric infections disease – 2/ edited by John D. Nelson, M.D. –
B.C. Decker Inc. Toronto, Philadelphia, 1988. – p.80-81
Additional:
1. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London, 1989.661p.
2. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 15
Theme: Neurotoxicose syndrome in infection diseases in children. Pathogenesis, clinical
features, making the diagnose, treatment.
Aim: to learn how to diagnose neurotoxicose syndrome in children, determine its period
and phase, perform differential diagnosis, and treatment.
Professional motivation: Neurotoxicose is nonspecific generalized answer on infectious
agent or its products in case of massive toxins’ income in blood with development of
endotoxemia. Neirotoxicose may develop in severe duration of many infectious diseases.
Clinically it looks like neuroinfections. That’s why it requires from the doctor to know
diagnostic criterions, duration, treatment and prevention of this pathology.
Basic Level
1. Anatomic-physiological peculiarities of child’s CNS (propedeutic pediatrics).
2. Pathomorphological changes in organs and systems in case of neurotoxicose
(pathological anatomy).
3. Signs of CNS pathology (propedeutic pediatrics).
4. To interpret results of laboratory and instrumental examination of the child.
(Biochemistry, normal physiology, pathological physiology, roentgenology, Propedeutic
pediatrics).
5. Pathogenetical and symptomatical treatment of neurotoxicose (pharmacology,
infection diseases).
Students’ Independent Study Program
1. Etiology, pathogenesis of neurotoxicose.
2. Classification of neurotoxicose.
3. Diagnostic criterions of different phases of neurotoxicose.
4. Interpretation of the laboratory and instrumental examination results.
5. Differential diagnostics of neurotoxicose between neuroinfection, toxicosis with
exicosis.
6. Prehospital and hospital treatment of different phases of neurotoxicose, prognosis
and prophylaxis.
Result Level
Students must know
 Etiology, pathogenesis of neurotoxicose.
 Classification of neurotoxicose.
 Diagnostic criterions of different phases of neurotoxicose.
 Differential diagnostics of neurotoxicose between neuroinfectons.
 Prehospital and hospital treatment of different phases of neurotoxicose, prognosis
and prophylaxis.
Students should be able to do:
 ask complaints, disease and epidemiologic history,
 examine the patient,
 interpret results of laboratory and instrumental examination of the child,
 perform differential diagnosis of neurotoxicose,
 Prescribe prehospital and hospital treatment of neurotoxicose.
A real life situation to be solved
1. A boy, 3 years old, has been treated in the hospital from influenza. Next day has
increased body temperature to 39,7о С, and head ache. Vomiting has appeared. During
examination: stiff neck, positive Kernig’s and Brudzinsky signs.
1. What syndrome has developed?
2. How to differentiate it from meningitis?
Answers:
1. Neurotoxicose, meningeal syndrome.
2. To perform CSF investigation.
2. A boy, 5.5 years old, entered the infectious department. The disease had acute
beginning: fever 40.5 ºC, repeated vomiting. Objectively: skin pallor, tachycardia,
tenderness of abdomen in the left inguinal region, spasms of the sigmoid colon. Feces
are in a small amount, predominantly mucus and blood. In entrance room he became
unconscious, tonico-clonic seizures has appeared.
1. Name main syndromes of disease.
2. What infection is suspected?
Answers:
1. Neurotoxic, distal colitis.
2. Shigellosis, acute form.
References:
Main:
1. Current therapy in pediatric infectious diseases – 2 edited by John D. Nelson, M. D. –
B.C. Decker inc. Toronto, Philadelphia, 1988, - P. 134-138, 285, 602-605, 611-615,
618-623, 753-755.
2. Ambulatory pediatric care (edited by Robert A. Derchewitz; - 2 nd ed. – Lippincot –
Raven, 1992. – P. 38-40, 44-45, 49-51, 570-574; 255.
Additional:
3. Textbook of Pediatric Nursing. Dorothy R. Marlow; R. N., Ed. D. –London,
1989.-661p.
4. Pediatrics ( 2nd edition, editor – Paul H.Dworkin, M.D.) – 1992. – 550 pp.
Prepared by I.L.Goryshna
Adopted at the chair sitting 22.01.04
Minutes No 6
Revised at the chair sitting
Minutes No 1 August 29, 2006.
The chair of hospital and faculty pediatrics, course of children infectious diseases
Methodological instructions to self activities for the 5th course foreign students
No 16
Curation of the patient, writing the case history.
I. Y. GORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY
PEDIATRICS DEPARTMENT
The head of the department
Doctor of Medicine,
Professor O.Ye. Fedortsiv
Manager of the group
____________________
MEDICAL CARD
name, surname of the patient
_______________ age of the patient
Clinical diagnosis: basic diagnosis __________________________________________
__________________________________________
__________________________________________
Complication __________________________________________
__________________________________________
Concomitant disease __________________________________________
__________________________________________
__________________________________________
Mark for the writing
of the case history ______________
Mark for the defense
of the case history ______________
Curator ____________________________
The group __________, the course ______
TERNOPIL
2007
GENERAL INFORMATION ABOUT PATIENT
Name _________________________________________________________________
Surname _______________________________________________________________
Date of birth ____________________________, age ___________________________
Home address __________________________________________________________
Preschool or school institution _____________________________________________
Date of admission to the hospital ___________________________________________
Institution which has directed patient to the hospital ____________________________
Pre-admission diagnosis __________________________________________________
______________________________________________________________________
Patient’s department _____________________________________________________
I.
COMPLAINTS
Main: ________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Additional: ____________________________________________________________
_______________________________________________________________________
____________________________
______________________________________________________________________
II.
ANAMNESIS OF THE DISEASE
The onset of disease acute, subacute, gradually (the necessary underline). The duration of
the diseases is ______________. What preceded the disease (cooling, defects of nutrition,
viruses infection, the contact with ill person, etc) ___________________________________
_______________________________________________________________________
____________________________
______________________________________________________________________
The development of disease _______________________________________________
______________________________________________________________________
______________________________________________________________________
The result of previous additional methods of investigation (if they were presence) _______
______________________________________________________________________
______________________________________________________________________
The previous treatment (if it was presence): _____________________________________
_______________________________________________________________________
_____________________________________________________________________
The effect of previous treatment ____________________________________________
______________________________________________________________________
The reason of hospitalization _______________________________________________
______________________________________________________________________
III. ANAMNESIS VITAE
For children till 3 years
The child from ____ (behind the account) pregnancy, _____ delivery. Age of the mother
during the given pregnancy. The pregnancy proceeded (with, without) gestosis in ___
trimester, on a background (without) of the extragenital pathology ___________
________________________, or inflectional diseases ___________________________
___________________________________ or somatic illness ____________________
________________________________________________ in _______ trimester.
The mother used such medicines (to specify the trimester) _______________________________
______________________________________________________________________
Harmful habits at the mother: ______________________________________________,
at the father ___________________________________________________________.
Conditions of work of the mother during pregnancy ____________________________
Conditions of life of the mother during pregnancy ______________________________
Delivery at timed or premature (the necessary underline), in ___ weeks of gestation. Labor
via vaginal way or by cesarean section, with (without) medicamental stimulation
_______________________ (the necessary underline). The child was mature or immature,
according Apgar’s score _____ points at first min. and ____ points at 5 th min. Birth
weight was ______ g, length of the body was ___ сm, head circumference was ___ сm,
chest circumference was ___ cm. The umbilical stump (residual cord) has fallen off in
___ days. After the stump has fallen off, the state of cord base was dry, or was weeping
during __________ weeks.
The child discharged from maternity department on ____ day (when it was more than 56 days, specify the cause of delay) __________________________________________.
During the firs year the child was at ___________________ feeding. The reason of
artificial feeding was ____________________________________________________.
Mother used to such ______________________________________________________
formulas. The term of introduction of fruit juice __________, fruit puree ______, egg
yolk __________, cottage cheese ___________, meat ____________. The first addition
food was __________________ at _______ mo. The second addition food was _______
____________ at _____ mo. The third addition food was _____________ at _____ mo.
The dynamics of body weight ______________________________________________
______________________________________________________________________.
Dynamics of body length _________________________________________________
______________________________________________________________________.
Dynamics of head circumference __________________________________________.
Dynamics of chest circumference ___________________________________________.
The psychomotor development of the child ___________________________________
_______________________________________________________________________
_____________________________________________________________________.
For all children irrespective of age
The child had such diseases (before admission) ________________________________
______________________________________________________________________
______________________________________________________________________
Housing conditions of the child is satisfactory or not satisfactory (the necessary underline
and explain why) __________________________________________________________.
Character of nutrition before present disease (character of meal, schedule of feeding) __
_______________________________________________________________________
_____________________________________________________________________.
Allergological history
Presence of allergy symptoms _____________________________________________.
The intolerance of products _____________________________________________,
that accompanied with ___________________________________________________,
The intolerance of medicament (drug) _______________________________________
that accompanied with ___________________________________________________.
Prophylactic vaccinations _________________________________________________.
______________________________________________________________________
The nearest relatives have such chronic somatic illnesses ________________________
_______________________________________________________________________
_____________________________________________________________________,
genetical illnesses ______________________________________________________,
allergic reactions _______________________________________________________.
Epidemiological history
The child didn’t contact with patients who suffered with inflectional diseases last 3
weeks. The symptoms of diarrhea were _______________ during last three days.
Summery: ______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______________________________________________________________
Objective examination of the child
The patient’s general condition is extremely grave, grave, moderately grave,
satisfactory, good (the necessary underline).
The state of consciousness is clear, sopor, stupor, coma (the necessary underline).
The mental state is (not) adequate or not adequate (the necessary underline).
Position of the child in bed is active, passive, forced (attitude) (the necessary underline).
The patient is asthenic, hyposthenic, hypersthenic constitution (the necessary underline).
The
child
is
of
regular,
irregular
body
build
(the
necessary
underline)
_________________
______________________________________________________________________
Anthropometrical measurements
Criterion
In patient
Norm
according empirical formulas
Deviation, cm
Deviation, %
Weight, kg
Height (stature), cm
Head
circumference, cm
Chest
circumference, cm
The index of
fatness by
Chulitska
The index by
Erismann
-
Summery: _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___________________________________________________________________
The Skin and mucous membranes
Colour of a skin ________________________________________________________
______________________________________________________________________,
lip-nose triangle ___________________________________, cyanoses _____________
______________________________________________________________________.
Rashes (colour, characteristic lesions, localization, size, presence of warmth, itching, type of
distribution) _____________________________________________________________
______________________________________________________________________
Surface of a skin is (smooth, velvety, rough, dry, moist)__________________________________.
The elasticity of the skin is ________________________________________________.
Temperature of a skin ___________________________________________________.
The dermographism is ___________________________________________________
Sensitivity of the skin: temperature ___________, pain ______________, tactile _____.
Nails: (shape, colour, thickness, quality) _____________________________________,
______________________________________________________________________.
Hair: (color texture, quality, distribution, and elasticity) _________________________
______________________________________________________________________
______________________________________________________________________
Mucous membranes of a mouth (colour, moisture, presents of lesions) ______________
______________________________________________________________________
Gums: (colour, presents of lesions, ability to bleeding) __________________________
___________________________. Conjunctiva and sclera of eyes _________________
______________________________________________________________________.
The subcutaneous fat is distributed _________________________________________.
The skinfold thickness is _____ cm on abdomen, _____ cm under the scapula, _____ cm
on the shoulder, _____ cm on thigh. The oedema ___________________________
_____________________________________________________________________.
The skin turgor is kept, decreased, flabby (the necessary underline).
Lymphatic system
Such groups of lymph nodes are palpable (describe each group according their localization,
quantity, size, shape, mobility, consistency (elastic or dense), temperature, tenderness and visible
change of enlarged nodes) ____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_________________________________________________________________
The tonsils. The stage of enlargement of the tonsils ____________________________
they are reddened, loose, and tender on palpation (the necessary underline). Presence of
haemorrhages _______ , pus in the crypts _________, erosions ___________________
ulcers __________________, the tonsils are covered with a ___________ (colour) film in
size ____ cm.
Muscular system
The development of muscles is satisfactory, well-developed; symmetric, asymmetric (the
necessary underline), presence of atrophy on _______________________________.
Muscular tone is _______________, hypotonia of _____________________________,
atony of ______________________________________________________________,
hypertonia _____________________________________________________________,
presence of muscular dystonia _____________________________________________.
The range of motions is ___________________________________________________
______________________________________________________________________
The strength of muscles __________________________________________________.
Presence of pain during palpation of the muscles ______________________________.
Presence of infiltrations or consolidation of ___________________________________
groups muscles. Trousseau’s sign is _____________, Chvostek’s symptom _________,
Lust’s symptom _____________.
Bone system
Head circumference is _______ сm, (normal, microcephalia, macrocepalia (the necessary
underline)). The head is dolichocephalic, brachycephalic, mesocephalic (the necessary
underline). form (shape). There is hyperplasia of ________________________________
skull’s bones, occipital bones is _____ flat. Anterior fontanel (presence, size, shape,
mould of the skull bones and attitude against the skull bony edges (does it taut or
depressed) and pulsation) _________________________________________________
______________________________________________________________________
Posterior fontanel (fused, size, shape) _______________________________________.
Lateral fontanels ______________________. Sutures __________________________.
The tooth formula:
pd
permanent
–
deciduous
* - caries
O - growth
disorder
Chest is conical, cylindrical, asthenic, normosthenic, hypersthnic, symmetrical,
asymmetrical, barrel, funnel, keeled, phthinoid, rachitic breast (the necessary underline).
Beading of the ribs _________. An epigastric angle ______ degrees. Chest
circumference is _______ cm (normal, abnormal).
Spine (physiological curvatures, scoliosis and kyphosis) _________________________
______________________________________________________________________
______________________________________________________________________
The extremities are ___ symmetrical, ____ deformed with deformation _____________
______________________________________________________________________,
anomalies of development ________________________________________________,
______________________________________________________________________
The feet are ____ normal with deformations __________________________________
______________________________________________________________________
Others bone are ________________________________________________________
______________________________________________________________________
The joints (shape, size, temperature, the range of motion, tenderness, swelling, the
change of the skin over them) ______________________________________________
_______________________________________________________________________
_______________________________________________________________________
____________________________________________________________________
______________________________________________________________________
Gluteal folds are ___symmetrical, ___________________________________________
Angle of hip abduction is _____ degrees.
Cardiovascular system
Inspection: During inspection of the chest bulging ________ noted on left side, visible
pulsation ______ seen, in _______ intercostals space ____________ line, epigastric
pulsation _____ visible. Distended and pulsated neck veins ______ visible during
inspection of the neck. Cyanosis ____________________________________________
______________________________________________________________________,
edema
_______________________________________________________________,
______________________________________________________________________
Palpation: The apical or cardiac trust (beat) (the necessary underline). is located in ______
intercostals space ______________ line, area _____ сm2, is positive or negative (the
necessary underline). Systolic or diastolic vibratory thrills (the necessary underline) _________
palpable at __________________. Pericardial friction rubs _________________________.
Pulse (rate) is _________ beats per minute; is rhythmic, arrhythmic; is synchronic
asynchronic; is full, swift, galloping, large, small, soft, tense, thready; pulse deficit (the
necessary underline).
Blood pressure of upper extremities _____ mm Hg, of lower extremities _____ mm Hg.
Border’s of hearts relative dullness
Border
Right
In patient
Norma
Upper
Left
transversal
size
Border’s of hearts absolute dullness
Border
Right
Upper
Left
transversal
size
In patient
Norma
Auscultation: the heart sounds strong, weakened, muffled, rhythmical, arrhythmic (the
necessary underline), ________ beats per min. S1 is heard loudest at the _______ of the
heart, S2 is heard loudest at the _______ of the heart. Presence of accent ____________
_____________________________. Presence of organic, functional, systolic, diastolic,
holosystolic, (the necessary underline) murmurs, place of the best auscultation __________
______________________________________________________________________
______________________________________________________________________
duration ________________________________, intensity ________________, timbre
__________________, conductance _________________________________________
evaluation of its intensity in relationship to the child’s position ___________________
______________________________________________________________________.
Extracardiac murmurs ___________________ (pericardial friction rubs, pleurocardiac),
localization ____________________________. During auscultations of carotic,
subclavicular, femoral arteries, abdominal aorta, jugular veins are heard ______sounds,
___________________ murmurs.
Respiratory system
Cyanosis of nasolabial triangle, perioral region, nails plates, acrocyanosis __________
in rest or during physical exercises (the necessary underline). Nasal breathing is free,
difficult, absent (the necessary underline). Voice is normal, hoarse, soundless, snuffling,
silent, aphonic (the necessary underline). Cough __________ present, dry, moist,
troublesome, brassy paroxismal cough, pertussis-like, barking cough, constant, cough
of mucus, cough of pus, blood spitting (the necessary underline), frequent in _________
time of day. Dyspnea, asphyxia ____________________ occurs in rest, during physical
exercises (the necessary underline). Chest has cylindrical, conical, asthenic, normosthenic,
hypersthnic, symmetrical, asymmetrical ______________________________, barrel,
funnel, keeled, phthinoid, rachitic breast. The intercostal spaces are _______________,
Harrison’s groove ______________. Movements of etch parts of the chest are
symmetrical,
asymmetrical
(the
necessary
underline)
______________________________________________________________________
Marked retraction of intercostal, suprasternal supraclavicular (the necessary underline)
muscles ___________ noted. Type of breathing is thoracic, abdominal, combined (the
necessary underline). Dyspnea is absent, inspiratory, expiratory, mixed (the necessary
underline). The respiration rate is _____ per minute (normal, tachypnea, bradypnea).
The breathing is regular, irregular, deep, hard (difficult), paradoxical, periodic, shallow,
interrupted, whistling, stridulous, stenotic, Kussmaul’s breathing, Cheyne-Stokes
respirations, Biot’s breathing (the necessary underline).
Palpation: Pain is __________ in maxillary and frontal sinuses. Pain in chest ________
during palpations. Vocal fremitus is normal, decreased, increased, absent ___________
______________________________________________________________________
Pleural friction rubs, crepitation ____________________________________________.
In comparative percussing of the chest is heard ________________________________
______________________________________________________________________
The lower costal margin of the lungs according to topographic percussing
Line
right
left
midclavicular
midaxillary
vertebral
The excursion of the low margin of the lung (at midaxillary line) is ___ cm on left, ___
cm on right. The location of the apex of the lung _______________________________
______________________________________________________________________
The width of Crenig’s areas _______________________________________________
Auscultation of the lungs: the breathing is ___________________________________
______________________________________________________________________
presence of rales, rhonchi and crepitations ____________________________________
______________________________________________________________________
Bronchophony is ______________________________________________________.
Digestive system
Inspection: The colour of mucous membranes of oral cavity is ____________, dry or
moist (the necessary underline), incrustation (coating) _____________, fissure and aphtha
_____________________________, colour of the tongue is _______________, coated
with _______________ fur, state of papillas of tongue _______________________, dry,
moist, atrophic, smooth, enlarged, normal size (the necessary underline). Colour of tonsils is
____________, coating ______________________, moisture _________ fissure and
aphtha ______________. The odour from oral cavity __________________
In vertical position the abdomen has normal shape, distended, scaphoid, pendulous
symmetrical
or
asymmetrical
(the
necessary
underline)
enlarged
because
of
_________________________, abdominal circumference _____ cm, moves or doesn’t
move with breathing, visible peristalsis ___________________, the umbilicus is
centrally located, is flatten, inverted, everted, displased upwards (the necessary underline).
In horizontal position the abdomen has ___________ shape, moves or doesn’t move
with breathing, abdominal circumference _____ cm, the umbilicus is centrally located, is
flatten, inverted, everted, displased upwards (the necessary underline). Distended veins of
the anterior abdominal wall ______________, “caput Medusae” _________________.
In superficial palpation there is soft, mild, moderate, demonstrable, board-like
muscular tension of anterior abdominal wall (the necessary underline). Hyperesthesias
___________, the divergence of straight muscles _____ present, the tumour _______
present in region _____________________________. Blumberg’ sign is positive or
negative; painless, extreme tendernees in McBurney’s point (the necessary underline).
Deep palpation according to Obraztsov-Strazhesko
Sigmoid colon is localized in ________________________, _______________ shape,
________
size
(cm
in
diameter),
_______________
consistence,
___________________ character of surface, _________ painfulness, _____ movable,
_________ murmurs.
Caecum is localized in ________________________, _______________ shape,
________
size
(cm
in
diameter),
_______________
consistence,
___________________ character of surface, _________ painfulness, _____ movable,
_________ murmurs.
Colon transversum is localized in ________________________, _______________
shape,
________
size
(cm
in
diameter),
_______________
consistence,
___________________ character of surface, _________ painfulness, _____ movable,
_________ murmurs. Colon ascendens: is localized in ________________________,
_______________ shape, ________ size (cm in diameter), _______________
consistence, ___________________ character of surface, _________ painfulness,
_____
movable,
_________
murmurs.
Colon
descendens
is
localized
in
________________________, _______________ shape, ________ size (cm in
diameter), _______________ consistence, ___________________ character of surface,
_________ painfulness, _____ movable, _________ murmurs. Mendel’s symptom is
positive or negative (the necessary underline). The liver ______ palpable, ______ tender,
is extended ____ cm below the costal margin, shape of edge is sharp, rounded, smooth,
elastic, firm (the necessary underline). Ortner’s symptom is _________, Ker’s symptom is
_________, Murphy’s symptom is _________, Mussi-Georgievsky’s symptom is
_________. The spleen ______ palpable, ______ tender, is extended ____ cm below
the costal margin, shape of edge is sharp, rounded, smooth, elastic, firm (the necessary
underline). Meyo-Robson’s symptom is _________. The pancreas _____ palpable,
_________ consistency, ______ tender, smooth, elastic, firm (the necessary underline). In
auscultation intestinal peristalsis is absent, sluggish, increased, not impaired, (the
necessary underline). Stool is _____ time per day, formed, liquid, semi-liquid, regular,
irregular (the necessary underline), _________ colour, with or without an admixing
_______________________.
Urinary system
Inspection: _________ oedema on legs ___________, face, sacral part, on the lower
part of abdomen. The colour of lumbar region is ________. The odour of urine is _____
Examination of sacral area, lower abdominal part (changing of the color of the skin
___________________, protrude ______________________, edema______________,
asymmetry_______________________).
Examination of the external sex organs: stage of development ____________________.
Presence of excretion from urinal channel _____________________.
In boys: asymmetric, symmetric development of the scrotum (the necessary underline).
Testes _________ present in the scrotum; presence of inflammation of penis, _________
anomalies of penis development, phimosis, paraphimosis (the necessary underline).
In girls: colour of mucous membranes of external sex organs is __________________,
presence an excretions from vagina _________________________________________.
Kidneys ______ palpable in vertical or horizontal position, _______________shape,
_________________ consistency, _______ movable, ______ tender, smooth, firm (the
necessary underline). Pasternatsky’s symptom is _____ on right , ________ on left side.
Urinary frequency _____ per day, Daily urine flow _________ ml, proportion between
day and night diuresis ____________. Presence of uncontrolled urinations _________.
Endocrine system
Examination: face expression __________________, presence of the eyes symptoms
____________________________________________________________________,
changes of anterior cervical surface __________________. The level of development
subcutaneous fat is ____________________________________________________.
Thyroid gland _____ palpable, of _______ stage, ___________surface, ___________
consistence, ____________ pain.
Sex development (according formulas F, L, Ax, P, V for boys and for girls - Ma, Ax, P,
Me) __________________________________________________________________
Nervous system
The consciousness is kept, stupor, sopor, is absent (the necessary underline). The mental
development ______ corresponds to the age of child. Reaction on environmental is does
not adequate (the necessary underline). Dream is isn’t quiet (the necessary underline).
Expression of the face is ___________________. There are some minor abnormalities
______________________________________________________________________
______________________________________________________________________.
Nystagmus is ___________ horizontal, vertical. Pupils are (un)equal in size; presence of
mydriasis, miosis (the necessary underline). The light reflex is retained (absent). The
coordination of movement _______ kept.
The pain sensitivity is kept, (is absent, hyperesthesia, hypoesthesia) (the necessary
underline). Tactile sensitivity is kept (is absent, pathologic) (the necessary underline).
Thermoesthesia is kept (is absent, pathologic) (the necessary underline). Vibration sensation
is kept (is absent, pathologic) (the necessary underline).
Newborn reflexes (the necessary underline): Sucking - is normal, hypoactive, hyperactive;
Rooting
- is normal, hypoactive, hyperactive; Defence - is normal, hypoactive,
hyperactive; Lip or trunk reflex - is normal, hypoactive, hyperactive; Grasp - is normal,
hypoactive, hyperactive; Babinski's - is normal, hypoactive, hyperactive; Moro - is
normal, hypoactive, hyperactive; Supporting - is normal, hypoactive, hyperactive; Dance
or step - is normal, hypoactive, hyperactive; Perez - is normal, hypoactive, hyperactive;
Crawling - is normal, hypoactive, hyperactive;
Bauer's - is normal, hypoactive,
hyperactive; Galant - is normal, hypoactive, hyperactive. Upper Brudzinski’s reflex - is
normal, hypoactive, hyperactive; middle Brudzinski’s reflex - is normal, hypoactive,
hyperactive; low Brudzinski’s reflex - is normal, hypoactive, hyperactive. Tendon
reflexes brisk, (equally marked on both sides, more hyperactive on the ______ than on
______ side, equally diminished, increased) (the necessary underline). Karniga’s sing
positive,
negative
(the
necessary
underline).
The
paralyses
(palsy)
______________________________________________________________________
The hyperkinesias _____________________________________________________
The dermographism is red, white, stria with ____ см in wide, appears in ____ second,
disappears in ____ second, arises over surface of a skin (the necessary underline).
Substantiation of the provisional diagnosis
On the establishment of the patient’s complaints _______________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______
Anamnesis morbi ________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______
Epidemiological
history
_____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____
Anamnesis
vitae
__________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
Data
of
objective
examinations
______________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_________________
It possible to make provisional diagnosis : ____________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Results of additional methods of examination
Rooting blood analysis
date
Нb Eryth. CI Leuc eos bas juv. band seg. lym mon E S R
х1012
х109
Bloo
d
clotti
Blee
ng
ding
time
time
_______________________________________________________________________
____
The plan of examination of the patient
1)
___________________________________________________________________
2) ___________________________________________________________________
3) ___________________________________________________________________
4) ___________________________________________________________________
5) ___________________________________________________________________
6) ___________________________________________________________________
7) ___________________________________________________________________
8) ___________________________________________________________________
9) ___________________________________________________________________
10)
__________________________________________________________________
11)
__________________________________________________________________
12)
__________________________________________________________________
Urinal examination according to Nechepurenco _______________________________
Biochemical analysis of blood
date
protein
total
glucose
total
bilirubin
creatinine
conjugated
urea
ALT
AST
Amylase
Mucous
Cristals:
Casts
Erythrocy
tes
Leucoc
ytes
Epitheliu
m
ketonuria
Protein
uria
Glucos
uria
pH
Amoun
t
Spesific
gravity
date
The general examination of urine
Urinal examination according to Zymnitzky
Portion
Quantities
of urine
specific
gravity
1
2
3
4
5
6
7
8
Stool test ______________________________________________________________
______________________________________________________________________
______________________________________________________________________
Analysis of feces on worm ova _____________________________________________
______________________________________________________________________
Test on enterobiosis ______________________________________________________
______________________________________________________________________
Bacteriological
examination
________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
_______________________________________________________________________
_______________________________________________________________________
__
ECG: _________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_
USD __________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
Endoscopies examination of ______________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__
X-ray examination ______________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
Differential the diagnosis
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
Clinical diagnosis
On the establishment of the patient’s complaints _______________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______
Anamnesis morbi ________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______
Epidemiological
history
____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____
Anamnesis vitae ________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__
______________________________________________________________________
Data of objective examinations _____________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________________
_______________________________________________________________________
_
Data of additional methods of examination ___________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____________
_______________________________________________________________________
_
_______________________________________________________________________
_______________________________________________________________________
__
It possible to make clinical diagnosis:
basic diagnosis __________________________________________
__________________________________________
__________________________________________
Complication __________________________________________
__________________________________________
__________________________________________
Concomitant disease __________________________________________
__________________________________________
__________________________________________
The temperature list
data
B P T ME ME ME ME ME ME ME ME ME ME ME ME ME ME
P
Stool
Weight
diuresis
Treatment of the patient
Regimen
____________________________________________________________
______________________________________________________________________
Diet № ___ _______________________________________________________
_______________________________________________________________________
_____________________________________________________________________
The menu for infant:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________
Medicamental treatment:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
_______________________________________________________________________
_
Prevention
(primary
and
secondary)
_________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__________
Epicrisis
The patient ____________________________________________________________
_______ age, __________ date of birth, home address __________________________
_______________________________________________________________________
_______________________________________________________________________
_
received
treatment
in
_____________________________________________________
_______________________ from ________ 200_ on _______ 200_ with the diagnosis
of:
______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
The general state and data of objective examination of the patient on admission (shortly)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
х1012
Bloo
d
clotti
Blee
ng
ding
time
time
_______________________________________________________________________
____
Rooting blood analysis
date
Нb Eryth. CI Leuc eos bas juv. band seg. lym mon E S R
х109
Mucous
Cristals:
Casts
Erythrocy
tes
Leucoc
ytes
Epitheliu
m
ketonuria
Protein
uria
Glucos
uria
pH
Amoun
t
Spesific
gravity
date
The general examination of urine
Urinal examination according to Nechepurenco _______________________________
Biochemical analysis of blood
date
protein
total
glucose
total
bilirubin
creatinine
conjugated
Urinal examination according to Zymnitzky
Portion
1
2
3
4
urea
5
ALT
6
AST
7
Amylase
8
Quantities
of urine
specific
gravity
Stool test ______________________________________________________________
______________________________________________________________________
______________________________________________________________________
Analysis of feces on worm ova _____________________________________________
______________________________________________________________________
Test on enterobiosis ______________________________________________________
______________________________________________________________________
Bacteriological
examination
_________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____
ECG: _________________________________________________________________
_______________________________________________________________________
_____________________________________________________________________
USD __________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
____
Endoscopies
examination
of
________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
X-ray
examination
________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___Prescribed treatment
______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_____
Dynamic of the main syndromes during treatment; the objective state of the patient at
the moment of his discharge from the hospital
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
______
Recommendations:
1. Diet № ______________________________________________________________
2. Regimen _____________________________________________________________
3. Medical measures _____________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___
_______________________________________________________________________
_
Literature
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
___________________________________________________
The curator (signature) __________________
Prepared by: assistant of professor Nataliya I. Balatska
The methodological instruction was discussed and confirmed at the session of the
department
Minutes No 1 August 29, 2006.