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.