Vinnytsya National Pirogov Memorial Medical University
Department of Children Infectious Diseases
“Approved”
at sub-faculty meeting

“__”_____2012, protocol №_____
Head of Department
prof. _______I.I. Nezgoda
Study Guide for Practical Work of Students
Topic: “Measles (Morbilli), Rubella, Varicella (Chicken-pox), Herpes
Zoster”
Course V
English-speaking Students’
Medical Faculty
Duration of the class-180min.
Composed by assistant O.V. Bodnariuk
Vynnytsa
2012
I. The theme actuality.
Measles is one of the most contagious diseases in children. In 1999, more than one
million children died from measles. With the inauguration of the Measles Initiative in 2001,
there have been dramatic decreases in childhood deaths globally. From 1 million deaths annually
in 1999, fewer than 450,000 in 2004 and decreasing rapidly with more nationwide vaccination
campaigns completed in 2005 and 2006.
Rubella is usually a mild illness. However it can cause serious harm to an unborn baby if
a woman gets it during early pregnancy. For this reason it is strongly recommended that all
children are immunised against rubella.
Chickenpox is an acute infectious disease, characterized by vesicular eruption with
transparent liquid on skin and mucous membranes.
Herpes zoster is an infectious disease, characterized by rash in the form of vesicles
grouped closely and neuralgias in certain skin areas, innervated by separate sensitive nerve.
ІІ.
Primary aims of the study
A student should know:
1. Etiology of measles, rubella, varicella, Herpes zoster.
2. Epidemiology (source of infection, ways of transmission, age-old receptivity and
morbidity) measles, rubella, varicella, Herpes zoster.
3. Pathogenesis of disease, pathomorphologic changes in the skin and staggered organs
measles, rubella, varicella, Herpes zoster.
4. Classification of clinical forms of measles, rubella, varicella, Herpes zoster.
5. Clinic of typical form of measles, rubella, varicella, Herpes zoster.
6. Clinical manifestations of measles, rubella, varicella, Herpes zoster.
7. Complications of measles, rubella, varicella, Herpes zoster.
8. Methods of laboratory research of measles, rubella, varicella, Herpes zoster.
9. Principles of therapy of measles, rubella, varicella, Herpes zoster.
10. Measures of prophylaxis of measles, rubella, varicella, Herpes zoster.
A student should be able:
1. To follow the basic rules of work with patient a bed sick with measles, rubella, varicella,
Herpes zoster.
2. To take anamnesis with the estimation of epidemiology information (taking into account
seasonality, origin of febricities, polymorphism of clinical signs of illness).
3. To examine a patient and reveal the basic clinical signs of illness.
4. To represent information of anamnesis and objective inspection in a hospital chart and
formulate the preliminary diagnosis.
5. To write a plan of examination.
6. To write a clinical diagnosis (form of disease, type, severity, course of disease).
7. To prescribe the treatment taking into account age, severity of illness.
8. To write out a prescription.
9. To organize disease measures in the hearth of infection (to find out the source of
infection, fill an urgent report in SES, to set a quarantine, to define the circle of contact
persons).
10. To write epicrisis with the estimation of development of illness, results of inspection,
efficiency of treatment, prognosis, by recommendations for a subsequent supervision or
treatment depending on the form of measles, rubella, varicella, Herpes zoster.
III. Educational aims of the study
- forming the deontological presentations, skills of conduct with the patients
2
- to develop deontological presentations, be able to carry out deontology approach to the
patient
- to develop the presentations of influence of ecological and socio-economic factors on the
state of health
- to develop sense of responsibility for a time illness and loyalty of professional actions
- to be able to set psychological contact with a patient and his family.
IV. Control materials for the preliminary and final stages of the lesson
Tests and tasks
1. A 9-year-old boy has been ill for 2 days. Now he has fever up to 37,5°С, maculae, papules,
vesicles on his skin, skin of the head. Vesicles are round, situated on an unindurated base,
surrounded by erythematous corona.
What is your diagnosis?
A. Smallpox
B. Scarlet fever
C. Herpetic infection
D. Streptodermia
E. Varicella
2. A 7-year-old girl was in contact with a patient with herpes zoster. Fever up to 39,3°С,
polymorphic rash (maculae, papules, crusts, vesicles) on her skin and mucous membranes of oral
cavity have occurred on the 7th day of illness.
What is your diagnosis?
A. Smallpox
B. Herpes simplex
C. Herpes zoster
D. Varicella
E. Streptoderma
3. A 4-year-old girl has severe form of varicella.
What medication should be administered except one?
A. Acyclovir
B. Specific immunoglobulin
C. Recombinant interferon
D. Inductor of endogenous interferon
E. Steroid hormones
4. An 8-year-old boy is not ill with varicella. He had been in touch with the child, who had
varicellas.
He can fall ill within:
A. 28 days
B. 17 days
C. 21 days
D. 14 days
E. 11-21 days
5. A 9 -year-old boy has fever, polymorphic rash - maculae, papules, vesicles and crusts on his
face, skin of the head, trunk, limb and extremities. Severe headache, vomiting, ataxia, slow down
and discoordination of motion have occured on the 10th day of illness.
3
What the complication occurred?
A. Encephalitis
B. Serous meningitis
C. Neyrotoxycosis
D. Encephalitis reaction
E. Meningo- encephalitis
TASK 1
A child of 4 years old ill last night when the temperature rose to 37.8°С. Next morning at the
temperature of 37.5°С there was rash on the skin of the trunk, head and extremities in the form
of fine spots and papule of 0.2 х 0.3 cm in size. There were small vesicles with transparent
content in the centre of separated papules.
The general condition is satisfactory. There are no catarrhal signs. The internal organs are
without changes.
The child attends a kindergarten, there are no infectious diseases registered there.
The grandmother of the child has been ill for 10 days, she has a headache, temperature
37.5°С, there are vesicles eruptions on the face under the eye on the risht past of the cheek,
above the eyebrow, and on the forehead, local hyperemia and edema of the skin is marked here.
1. Make the clinical diagnosis?
2. What diseases should the child’s disease be differentiated with?
3. Administer the treatment of the child.
TASK 2
A 5 -year-old girl has fever, vesicular rash and crusts on her face, skin of the head, trunk
and extremities. Severe headache, vomiting, ataxia, sloingw down and discoordination of motion
occurred on the 8th day of illness.
1. Make the clinical diagnosis?
2. What the complication occur?
3. Administer the treatment of the child?
1. A 5-year-old boy has been ill for 5 days. The disease had abrupt ouset with fever up to 38,1 C,
cough, conjunctivitis, edema of eyelids. Maculopapular rash appeared on his face, neck and behind his
ears on the 5th day of the disease. The next day the rash spread to his trunk.
What is your diagnosis?
A. Adenoviral infection
B. Measles
C. Rubella
D. Infectious mononucleosis
E. Scarlet fever
2. A 7-year-old boy has been ill for 2 days. He complains of cough, coryza, headache, fever up to
38C. There are conjunctival hyperemia, epiphora, enanthema on the mucosa of the soft and in part of
the hard palate, whitish papulae looking like poppy-seed, surrounded by a narrow band of hyperemia
opposite of the molar teeth.
What is your diagnosis?
A. Measles
B. Rubella
C. Scarlet fever
D. Enteroviral infection
E. Adenoviral infection
3. A 2-year-old boy is not vaccinated against measles. He had been in touch with the child who had
4
catarrhal period of measles and took immunoglobulin.
He can fall ill within such period as:
A. 28 days
B. 17 days
C. 21 days
D. 14 days
E. 7 days
4. A 5-year-old child has low-grade fever, enanthema, enlarged post-auricular cervical and
suboccipital lymph nodes, pale red small macular rash, which localizes mainly on the extensor
surface of the extremities, back and buttocks. What is your diagnosis?
A. Infectious mononucleosis
B. Measles
C. Scarlet fever
D. Rubella
E. Enteroviral infection
5. A 2-year-old child full ill acutely: ever and rash appeared. Now it has slight malaise, coryza
and cough, enanthema on its soft palate. There is pale red small macular rash on its back and
buttocks. Post-auricular cervical and subboccipitall lymph nodes are the size of a large pea, hard
and slightly tender on palpation. What is your diagnosis?
A. Rubella
B. Measles
C. Scarlet fever
D. Infections mononucleosis
E. Entero viral infection
Task 1
A child of 1.5 years old has been ill for 3 days: temperature 38.5°С, rough "barking" cough,
rhinitis, conjunctivitis, photophobia, fine spotty enanthema on the palate, fine white spots on the
mucous membrane of the cheeks.
1. The prospective clinical diagnosis.
2. What diseases should exclude (the differential diagnosis)?
Today on the 4-th day of the disease the condition worsened, the temperature rose up to
39.5°C, at the height of fever there was an attack of short-term spasms and expressed dyspnea.
There was rash on the face. Parents called in an ambulance.
Objectively: temperature 39.8°С, the child is languid, lethargic. He experienced frequent
rough cough. The pharynx is brightly hyperemic, there are fine white spots on either side of the
mucous membrane of the cheeks. Plentiful pink spotty-papulous rash is seen on the face, behind
the ears and on the neck, elements of rash merge. The eyelids are swollen, there is conjunctivitis.
Respiration is 60/min. Wings of the nose are strained, there is intercostal retraction. Percussion
above the lungs on the right reveales shortening of percussion sound in the lower part. On
auscultation breath is sharply weakened in the lower part on the right. Heart sounds are a little bit
muffled, there is tachycardia. Other pathology is not revealed.
3. Make the detailed clinical diagnosis.
4. Administer necessary scope of examination of the patient for confirmation of the diagnosis
5. The plan of treatment of the patient.
Task 2
A child of 3.5 years old attends a kindergarten. Within 3 days rise in the temperature to
38.0-39.0°С was marked, he became restless, there was a dry cough, eyes and eyelids reddened,
5
lacrimation and photophobia were marked. On the 3-rd day his mother noticed fine whitish
points of semolina grain in size on the child’s gums. The mother presented these complaints to
the local physician.
Objectively: the child is languid, the eyelids are hyperemic, conjunctivas are hyperemic and
edematous. Integuments are pale, clean, there is no rash. The pharynx is brightly hyperemic, the
mucosa is friable, there is spotty enanthema on the palate. There is a coating in the form of fine
whitish points of semolina grains in size on the mucous membrane of the cheeks and gums
which do not merge and can’t be removed with the spatula. Breath is rigid above the lungs, there
are single conducting dry rвles. Activity of the heart is rhythmical. Other pathology is not
revealed.
1. Make the preliminary diagnosis, prove it.
2. Where should the patient be treated?
In a day the child had rash on the face, behind the ears in the form of fine pink spots which
became larger within a day, they merged here and there against the background of continuous
catarrhal signs. The face became swollen. Next day rash extended to the trunk and then to the
extremities. Elements of rash are brightly pink, of irrgular shape, confluent here and there, large,
of 0.5 cm, protrude above the skin surface. The skin between the rash elements is of usual
colour.
3. Will the initial diagnosis change? If yes, how will it be formulated?
4. The plan of examination of the patient.
5. The plan of treatment.
Task 3
5 year old girl attends a kindergarten, where 16 days ago there was a case of German
measles. The child was vaccinated according to schedule. The patient got sick with an increase
in body temperature up to 37,2°С and stuffiness in nose. At survey the status satisfactory. The
scleara are slightly injecting bilateraly. In the pharynx - soft hyperemia of the tonsils and
arches, the mucous membranes are clear. Small-spotted rash of pink colour is on the unchanged
skin, not inclined to confluence all over the trunk, more intensive on the back and extensor
surfaces of the extremities. Retrocervical and occipital limphatic nodes in size up to1,2 cm,
plural elastic consistency, aren’t unified among themselves, small-amount of pain noted.
Questions:
1 In which picture do you see the rash, which is described in the task.
2. What changes on the part of blood are typical for this disease?
а) Er- 4,3х1012/l; Нв – 123 g/l; Lе – 3,0х109/l; younger – 0%, e – 3%, stab – 5%,
segments – 23%, limp – 62%, mon – 7%; plasmatic cells – 16:100; ESR – 6 mm/t.
б) Er. – 4,5х1012/л; Нв – 125 г/л; ю –0%, э – 2%, stab – 21%, segments – 25%, limp –
44%, mon – 8%; plasmatic cells – 1:100; ESR – 5 mm/h.
3 Put a diagnosis based on the clinical features, characteristics of rash and laboratory
data.
VII. Literature
Basic literature:
№
Author(s)
Mikhailova A.M.,
Minkov I.P., Savchuk
A.I.
2. Robert M. Kliegman
1.
Name of source
(textbook, manual, monograph,
etc.)
City,
Publishing
house
Year of
edition,
vol.,
issue
Number
of
pages
Infection diseases in children.
Odessa
2003
219
Nelson Textbook of Pediatrics
6
NY,
2007
3121
et al.
5. Duker - Krugman's
SAUNDE
RS
Infectious disease.
Harcourt
Publishers
limited
Infectious diseases The clinician
WebMD
guide to Diagnosis, Treatment and Corporatio
Prevention.
n
Infectious Diseases of Children.
Mosby
6. Gary R. Fleisher,
Stephen Ludwig
Textbook of Pediatric Emergency
Medicine.
3. Jonathan Cohan
4. David C Dale
Lippincott
Williams
& Wilkins
18th
Edition
2004
2nd
edition
2004
edition
11th
edition
6th
edition
2010
2136
310
1574
2052
The additional literature:
№
The author(s)
1. Bogadelnikov I. V.
The name of a source
(The Text book, The Manual, the
Monography and etc.)
City,
Publishing
house
The differential diagnosis of the
major infectious diseases at children.
Simferopol.
"Boris"
7
Year
Publish
A
ing
numb
houses
er of
that
pages.
produce
d it.
1999
528