„Approved”
on methodical conference
department of internal medicine, physiotherapy
endocrinology and infectious diseases
„____” ____________ 200 р.
Protocol № _____
Chief of Dept., professor __________ О.І. Fediv
METHODOLOGICAL INSTRUCTIONS
to a fifth year student of the Faculty of Medicine
on independent preparation for practical training
Topic: Differential Diagnosis of Respiratory Tract
Infections, Concluding Lesson
Subject:
Major:
Educational degree
and qualification level:
Year of study:
Hours:
Prepared by assistant professor
Infectious Diseases
Medicine
Specialist
5
2
Sydorchuk A.S.
1. Topic: Differential Diagnosis of Respiratory Tract Infections, Concluding Lesson
2. Lesson duration: 2 hours
Aims of the lesson:
3. Students are to know:
• etiology, pathogenesis and pathologic morphology of diphtheria;
• etiology, pathogenesis and pathologic morphology of inluenza;
• etiology, pathogenesis and pathologic morphology of meningococcal infection;
• etiology, pathogenesis and pathologic morphology of measles;
• etiology, pathogenesis and pathologic morphology of scarlet fever;
• etiology, pathogenesis and pathologic morphology of adenovirus infection;
• epidemiology of diphtheria;
• epidemiology of inluenza;
• epidemiology of meningococcal infection;
• epidemiology of measles;
• epidemiology of scarlet fever;
• epidemiology of adenovirus infection;
• epidemiology of varicella, mumps;
• classification of respiratory tract infections;
• symptoms and development of diphtheria;
• symptoms and development of inluenza;
• symptoms and development of meningococcal infection;
• symptoms and development of measles;
• symptoms and development of scarlet fever;
• symptoms and development of adenovirus infection;
• diagnostic possibilities of additional methods of respiratory tract infections examination
(bacteriological, virologic, biological, serology examination and allergy examination);
• prognosis at different respiratory tract infection forms;
• peculiarities of treatment and prophylaxis of respiratory tract infections;
• antiepidemic measures against respiratory tract infections.
3.2. Students are to be able:
• to question a patient in order to obtain information on complaints and disease history;
• to question a patient in order to obtain information on epidemiologic anamnesis;
• to make a provisional diagnosis of respiratory tract infection based on symptoms, development
and epidemiologic information;
• to make a differential diagnosis including distinguishing between different intestinal infections;
• to prepare a plan of patient examination;
• to make sampling and inoculation of material for bacteriological or virologic examination;
• to evaluate results of serologic reactions and allergic tests;
• to prepare a plan of basic sanitary at onset of respiratory tract infections;
• to perform prophylaxis of respiratory tract infections.
3.3. Students are to acquire the following skills:
• to draw up an urgent notification;
• to take blood samples for inoculation into nutrient media;
• to take samples of vomit, feces for bacteriological test and ELISA
• to estimate liquid volume for desintoxication;
• to perform emergency aid at croup;
• to master Bezredka method of serum introduction;
• to perform allergy tests using appropriate allergen.
4. Advices to the student:
At preparation of this theme to pay a regard to its actuality taking into account propensity of
flu to epidemic and pandemic distribution, frequency of other ARVI, different frequency of specific
and heterospecific complications and from here – and necessity of early etiologic diagnostics of
these diseases.
To pay attention on difficulty of clinical differentiation of acute respiratory diseases,
necessity of acceptance into consideration of epidemiology information and drawings on additional
(foremost laboratory express methods) research.
During the leadthrough of differential diagnosis of diseases which are accompanied the
syndrome of defeat of respiratory tracts. At the inspection of patient it is important to define a
presence, character and intensity of inflammation in the different parts of respiratory tract,
overwhelming localization of pathological changes (pharyngitis, laryngitis, tracheitis, bronchitis, is
isolated or in their different combinations).
During differentiation of flu with other ARVI to remember, that to the flu peculiar acute
onset after a short latent period (a few hours – 2-3 days), from the expressed phenomen of general
intoxication (fever, headache with repressing localization in frontal-temporal areas, area of
superciliary arcs, pain at motions of eyeballs, dull ache in a body, joints, myalgias, brokenness,
adynamia) and by simultaneous appearance of signs of defeat respiratory tracts without an exsudate
component (dryness in a nose and difficulty of the nasal breathing, dry cough which becomes
black-breaking quickly, with pain after a breastbone). Hyperemia and puffiness of person, injection
of sclerae vessels, hyperemia of mucus soft palate, handles, tonsils with a cyanochroic tint,
grittiness of soft palate (Morozkin’s symptom), shivering (humidity of skin), tachycardia, low
blood pressure, absence of rash on a skin and hepatolienalic syndrome is enhanceable. And an
exsudate component joins only from the 2nd-3rd day of illness: excretion from a nose serosal, and
then has seromucous character; a cough becomes moist, less black-breaking. A temperature is
normalized in 3-5 days, but a general weakness, adynamia is saved long time.
For adenovirus diseases characteristic combinations of cathar of respiratory tracts are with
the expressed exsudate component, phenomen of tonsillitis and defeat of eyes (to the conjunctivitis,
keratoconjunctivitis), lymphadenopathy, quite often liver and spleen at relatively to the gradual
beginning of illness and moderate or the mild expressed features of general intoxication.
A parainfluenza for adults looks enough like a flu, however expressed the signs of
intoxication are far weaker, the symptoms of laryngitis come forward on the first plan, above all
things with the change of voice timbre at the insignificant catarrhal changes of mucus other parts of
respirator tract. To the parainfluenza peculiar beginning of outbreaks of disease among children,
outbreaks in child's collectives, absence of epidemic distribution (relatively low contagiosity of
illness).
For measles the next symptoms are typical: the acute onset, considerable increase of
temperature, catarrhal changes of mucus membranes of respiratory tracts is peculiar with the
expressed phenomen of conjunctivitis, presence on mucus of internal surface of lips and opposite
the cheek-teeth of significant symptom (already from the 2th day of illness) – spots of Bel'skogoFilatova-Koplika, appearance on the 4-5th day of illness and stage-by-stage distribution on the skin
of macular and papular rash.
During differentiation with other, not respiratory diseases (paratyphoid A and B, the spotted
fever, Q-fever and others like that) are take into account both clinical and epidemiology features
each of diseases which are differentiated, and also results of additional (laboratory) methods
researches which are utillized in diagnostics of similar diseases.
5. Test questions:
1. What are the pathogens to diphtheria?
2. What are the pathogens to cause influenza?
3. What are the pathogens to cause adenovirus infection?
4. What are the pathogens to cause meningococcal infection?
5. What are the pathogens to cause measles?
6. What are the pathogens to cause mumps?
7. What are the pathogens to cause SARS?
8. What are the principal pathogenic links of diphtheria?
9. What are the principal pathogenic links of meningococcal infection?
10. What are the principal pathogenic links of influenza?
11. What are the principal pathogenic links of adenovirus infection?
12. What are the principal pathogenic links of measles?
13. What are the principal pathogenic links of mumps?
14. What are the principal pathogenic links of scarlet fever?
15. Mechanism and ways of respiratory tract infection transmission.
16. Classification of diphtheria.
17. Classification of meningococcal infection.
18. Classification of adenovirus infection.
19. Classification of influenza.
20. Characteristic symptoms of different forms of diphtheria.
21. Characteristic symptoms of different forms of meningococcal infection.
22. Characteristic symptoms of different forms of adenovirus infection.
23. Characteristic symptoms of different forms of influenza.
24. Characteristic symptoms of different forms of measles.
25. Characteristic symptoms of different forms of mumps.
26. Characteristic symptoms of different forms of scarlet fever.
27. Criteria for making diagnosis of diphtheria.
28. Criteria for making diagnosis of meningococcal infection.
29. Criteria for making diagnosis of adenovirus infection.
30. Criteria for making diagnosis of influenza.
31. Criteria for making diagnosis of measles.
32. Criteria for making diagnosis of mumps.
33. Criteria for making diagnosis of scarlet fever.
34. Bacteriological test at different respiratory tract infections.
35. What are the specific methods used for diagnosis of different respiratory tract infections?
36. Making of differential diagnosis including distinguishing between different respiratory tract
infections.
37. Etiologic and pathogenic treatment of respiratory tract infections.
38. Veterinary and sanitary as well as sanitary and hygienic measures for prophylaxis of respiratory
tract infections.
39. Specific immunization against controllable respiratory tract infections. Schedule.
40. Emergency aid at respiratory infections complications (toxic shock, croup, acute suprarenal
failure, brain oedema, lungs oedema).
6. Literature:
А. Basic:
Infectious disiseases /Edited by: prof. E. Nikitin, prof. M. Andreychyn.-Ternopil «Ukrmedknyga»,
2004.-364 p.
B. Adding:
1. The Merck Manual of Diagnosis and Therapy.-Merck Sharp, 1987.-2696 p.
2. Reese R.E. A Practical Approach to Infectious Diseases-Boston-Toronto: Little,
Brown&Company, 1986.-782 p.
3. Ellner P.D., Neu H.C. Understanding Infectious Diseases – Mosby Year Book, 1992.- 343 p.