Subject 13 - Acute rheumatic fever. Systemic lupus
erythematosus
(4 hours)
Part 1. Acute rheumatic fever.
(2 hours)
Place
Training Room, rheumatological department.
Purpose
To know:
 The definition of acute rheumatic fever and chronic rheumatic heart disease
 Etiology and pathogenesis. The role of streptococcal infection and immune responsiveness
in the development of acute rheumatic fever.
 Classification
 Clinical manifestations (carditis, polyarthritis, chorea, skin lesions).
 Laboratory and instrumental methods of diagnostics.
 Criteria for the diagnosis and differential diagnosis.
 Treatment with regard to the degree of activity, the role of antibiotic therapy.
 Complications
 Primary and secondary prevention
 Weather and performance.
Be able to:
Based on survey data of patients with acute rheumatic fever
 to formulate a clinical diagnosis
 to the differential diagnosis
 identify tactics survey
 treatment.
 identify and forecast performance
 recommend preventive measures
Professional orientation of students
Background Acute rheumatic fever is caused on the one hand is that it affects young patients
and is the cause of acquired heart disease leading to heart failure and invalidisation on the
other side of the infectious nature of the disease factor that enables effective treatment and
prevention of disease.
The basic level of knowledge and abilities
№
1.
2.
Discipline
Anatomy
Biochemistry
To know
Anatomical structure of the heart
and joints
Biochemical characterisation of
plasma and serum
To be able
To evaluate changes in protein
fractions, levels of hexoses,
seromukoids and sialic acids
3.
Pathophysiology
4.
Propedevtika
internal diseases
5.
Microbiology
Dysregulation of immune
responses, an imbalance of T-and
B- lymphocyte
Semiotics of heart valves and
joints disorders
Rate indicators of immunogram
and anti-streptokokk immunity
Evaluate the clinical and
laboratory data
Be able to evaluate the results of
Etiology of acute rheumatic fever
microbiological studies
Plan for practical lesson
№
Elements of practical employments
Time(minutes)
1. Verification of present's students
5
2. Entrance control and his analysis
10
patients for Supervision ( card or clinical tasks )
3. Distributing
*
5
patients or study of educational hospital chart
4. Review
*
20
5. Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
15
6. Exercises with clinical formulations for solving clinical situation tasks
10
7. Output control of knowledge and its evaluation
10
8. Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
The list of theoretical questions, which are considered in the classroom
1.
2.
The definition of acute rheumatic fever and chronic rheumatic heart disease
Etiology and pathogenesis. The role of streptococcal infection and immune
responsiveness in the development of acute rheumatic fever.
3. Classification
4. Clinical manifestations (carditis, polyarthritis, chorea, skin lesions).
5. Laboratory and instrumental methods of diagnostics.
6. Criteria for the diagnosis and differential diagnosis.
7. Treatment with regard to the degree of activity, the role of antibiotic therapy.
8. Complications
9. Primary and secondary prevention
10. Weather and performance.
Methods of practical classes
The first lesson the teacher carries out safety training (if any condition), which is celebrated in
the magazine signed by the student teacher.
After reviewing the present teacher carries out a written entrance control basic knowledge
(attached set of 15 tests by the number of students).
Then the teacher carries out the distribution of patients for students and determine their
problem.
№
Task
1.
Conduct
examination of
patients with
acute
rheumatic
fever or
chronic
rheumatic
fever. Evaluate
the results of
the survey
(laboratory and
instrumental).
Write a clinical
diagnosis, plan
of survey and
treatment of
patient (write a
recipes).
Instructions of teacher for students
During survey to reveal:
1. Signs of heart and joints disorders
2. Signs of inflammations
3. Potential causes of disease
Notes of teacher for
students
At substantiating the
clinical diagnosis of
attention paid to the
detection of clinical and
laboratory data specific to
acute rheumatic fever and
valvular heart disorders.
Teachers work according to the plan of organization studies, carries out at the end of initial
control knowledge. Set of materials for the initial control attached (situational and clinical
problem, X-rays, tests, etc.).
Teacher pidvode summarize lessons from evaluations of each student and announces the
theme of the next session.
Illustrative material
1. Tables and slides with classification of acute rheumatic fever
2. Educational history
3. Sets of radiographs, blood
4. Tests, case studies
Sources of information
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2.J.A.P. Da Silva, A.D. Woolf Rheumatology in Practice. – Springer-Verlag London Limited.
– 2010. – 533 р.
Individual Students Program
Explore:
 The definition of acute rheumatic fever and chronic rheumatic heart disease
 Etiology and pathogenesis. The role of streptococcal infection and immune
responsiveness in the development of acute rheumatic fever.
 Classification
 Clinical manifestations (carditis, polyarthritis, chorea, skin lesions).
 Laboratory and instrumental methods of diagnostics.
 Criteria for the diagnosis and differential diagnosis.
 Treatment with regard to the degree of activity, the role of antibiotic therapy.
 Complications
 Primary and secondary prevention
 Weather and performance.
Draw:
 The scheme of the methods of prevention of rheumatic fever or primary rheumatic disease
in patients with valvular heart disease
Be able to:
 to formulate a clinical diagnosis
 to the differential diagnosis
 identify tactics survey
 treatment
 identify and forecast performance
 recommend preventive measures and antiricedive treatment
Pay attention to the use of modern laboratory methods for estimate of inflammation and
instrumental examination to the diagnosis of valvular heart disease.
Subject 13 - Acute rheumatic fever. Systemic lupus
erythematosus
(4 hours)
Part 2. Systemic lupus erythematosus
(2 hours)
Place
Classroom , Department of Rheumatology .
Purpose
Students must know:
• etiology and pathogenesis of systemic connective tissue diseases.
• The main clinical manifestations of systemic lupus erythematosus.
• Methods of diagnosis and differential diagnosis of connective tissue diseases.
• Modern principles of treatment of these diseases.
Be able to:
• a preliminary diagnosis and determine the tactics of treatment in systemic connective tissue
diseases (systemic lupus erythematosus).
Professional orientation of students
A significant prevalence of systemic connective tissue diseases (systemic lupus erythematosus
(SLE)) requires the continuous improvement of methods of diagnosis and treatment. Timely
diagnosis of connective tissue diseases, the definition of activity and the nature of the pathological process. These diseases are most common in young patients, and is often the cause of
reducing the health and disability.
The basic level of knowledge and skills
№
Discipline
To know
1.
Anatomy
Anatomical structure of the
joints of the upper and lower
extremities
2.
Histology
The structure and function of
connective tissue
Indicators protein - carbohydrate
compounds in the blood
3.
Biochemistry
4.
Pathophysiology
5.
Propedevtik of internal
diseases
To able
Etiology and pathogenesis of
disorders of the connective tissue
Evaluate clinical and laboratory Semiotics of connective tissue
tests, to determine the range of desease in various organs and
motion in joints
systems (arthritis, dermatitis,
cardio, polyserositis, nephritis)
To evaluate clinical and laboratory findings
Schedule practical training
№
Elements of practical employments
1.
Verification of present's students
5
2.
Entrance control and his analysis
15
Time(minutes)
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks to
self- preparation for the next lesson
5
5.
Note: * - in the absence of the clinic patients for Supervision during practical part can be
made in the form of setting up and solving situational problems
List of theoretical questions, which are discussed in class
1 . As I understand the term "systemic connective tissue diseases."
2. What are the main violations immunogenesis in systemic connective tissue diseases.
3. The main types of pathological immune reactions in autoimmune diseases.
4 . Etiology, pathogenesis of SLE.
5 . Clinical manifestations of systemic diseases of connective tissue.
6. What are the laboratory findings in patients with SLE.
7. What are the diagnostic criteria for diagnosis of SLE.
8 . Modern principles of treatment of systemic connective tissue diseases, new drugs.
Method of leadthrough of practical employment *
On the first employment teacher hold instructing from accident (if there are such terms) which
registers in the magazine of teacher's signature of student prevention.
* Students answer in writing on the tests of base knowledges entrance control. Then a teacher
distributes students for kuration patients and determines them a task.
№
Task
Teasher's pointing to
students
Teacher's note for students
1.
Spend curation of patient
diagnosed with SLE ,
evaluate the results of
write clinical diagnosis ,
evaluation and treatment
plan ( with prescription )
1. Signs of SLE
2. The degree of activity of
SLE
3. Characteristic for SLE laboratory abnormalities
Pay special attention to the definition of the ctivity degree of SLE
A teacher works in obedience to the plan of organization of employment, in the end - initial
control of knowledges. Before completion of employment teacher announce his results with
the estimation of every student and declares the theme of next session.
Forms and methods of self-control
Explore:
• How to understand the term "systemic connective tissue diseases."
• What are the main violations immunogenesis in systemic connective tissue diseases.
• The main types of pathological immune reactions in autoimmune diseases.
• Etiology, pathogenesis of SLE.
• Clinical manifestations of systemic diseases of connective tissue.
• What are the laboratory findings are characteristic of SLE.
• What are the diagnostic criteria for diagnosis of SLE.
• Modern principles of treatment of systemic connective tissue diseases, new drugs.
Draw:
• Plan the pathogenesis of SLE.
To be able to:
• Based on the examination of patients with SLE to formulate a preliminary diagnosis and determine the treatment strategy.
Note the use of laboratory studies of the immune system, the importance of the principles of
treatment and supportive care.
Forms and methods of self-control
Test items
1 . For the treatment of the first attack of SLE II degree of activity You will use:
A. Aminoholinovi drugs.
B. Antibiotics.
C. glucocorticoids.
D. NSAIDs.
E. cytostatics.
2. The most reliable paraclinical criteria for systemic lupus erythematosus are:
A. Anemia.
B. Antinuclear antibodies.
C. With -reaktivny protein.
D. LE - cells.
E. Expedited ESR.
Cases
1 . The patient 28 years old complains of cough, dyspnea, pain in the small joints, low-grade
fever, weight loss, hair loss. Objectively: hyperemia, deformation of the proximal interphalangeal joints, heart sounds weak, systolic murmur over the top. In the analysis of the blood:
anemia, leukopenia, ESR 45 mm / h. In the urine - protein 1.65 g / l, erythrocytes 8-10 in
sight, hyaline cylinders 4-5 in sight. Add preliminary diagnosis. What clinical syndrome make
up clinic disease? Determine the tactics of treatment.
Illustrative material
1 . Tables and slides with classifications of disease pathogenesis, diagnostic criteria for SLE.
2. Teaching history.
3 . Set of analyzes, the results of instrumental studies
4 . Set of drugs that are used in the treatment of connective tissue diseases.
5. A set of case studies, a set of tests.