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: “Diphtheria, Infectious mononucleosis, Mumps”.
Course III
English-speaking Students’
Pharmaceutical Faculty
Duration of the class-90 min
Composed by assistant O.V. Bodnariuk
Vinnytsya
2012
I. The theme urgency
Diphtheria is an acute infectious disease caused by Corynebacterium
diphtheria and characterized by the appearance of a fibrinous membrane on the site of
pathogen invasion, which can spread on to the tonsils, larynx and pharynx, leading to
symptoms of toxemia and toxic lesions of the cardiovascular system, nervous system,
adrenal glands and kidneys.
Infectious mononucleosis (Filatov’s disease) is an acute feverish viral disease,
being spread by air-droplet route. It is characterized by polyadenitis (especially
cervical one), acute membranous tonsillitis, enlarged liver and spleen, leukocytosis,
limphocytosis, presence of atypical lymphocytes. The pathogen of the disease is
Epstein-Barr virus (EBV), which contains DNA. EBV is isolated in other diseases:
such as Burkitt’s lymphoma and nasopharyngeal carcinoma.
Mumps remains endemic in many countries throughout the world, and mumps
vaccine is used in only 57% of countries that belong to the World Health
Organization, predominantly in countries with more developed economies. As in the
prevaccine era, most cases of mumps are still in children ages 5 to 14, but the
proportion of young adults who become infected has been rising slowly over the last
two decades. Mumps infections are uncommon in children younger than 1 year old.
Death due to mumps is rare; more than half of the fatalities occur in persons older
than 19 years.
ІІ. Primary aims of the study
A student must know:
1. Etiology and properties of the cause and causing factors of diphtheria.
2. Epidemiology (source of infection, ways of transmission, age-old receptivity
and morbidity).
3. Pathogenesis of disease, pathomorphologic changes in the staggered organs.
4. Classification of clinical forms of diphtheria.
5. Clinic of typical form of diphtheria.
6. Clinic of rare form of diphtheria.
7. Classification of toxic (severe) forms of diphtheria.
8. Clinic of toxic (severe) forms of diphtheria.
9. Complication of diphtheria.
10.Methods of laboratory research.
11.Principles of therapy of diphtheria.
12.Measures of prophylaxis of diphtheria.
13.Etiology of infectious mononucleosis and mumps.
14.Epidemiology infectious mononucleosis and mumps.
15.Characteristic of Epstein-Barr virus (EBV) and mumps.
16.Pathogenesis of disease, pathomorphologic changes in the staggered organs
and blood cells.
17.Classification of clinical forms of infectious mononucleosis and mumps.
18.Clinic of infectious mononucleosis and mumps.
19.Clinic of acute form Epstein-Barr viral infection and mumps.
20.Clinic of chronic form Epstein-Barr viral infection and mumps .
21.Other clinical forms of Epstein-Barr viral infection and mumps
22.Hematologic disorders are typical for infectious mononucleosis and mumps.
23.Methods of laboratory research.
24.Principles of therapy of infectious mononucleosis and mumps .
25.Antiviral treatment of Epstein-Barr viral infection and mumps.
A student must be able:
1. 1.To follow the basic rules of work with a patient sick with diphtheria.
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, conduct them bacteriological inspection).
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 diphtheria.
11.11.To follow the basic rules of work with patients sick with infectious
mononucleosis and mumps.
12.To take anamnesis with the estimation of epidemiology information (taking
into account seasonality, origin of febricities, polymorphism of clinical signs of
illness).
13.To examine patients and reveal the basic clinical signs of illness.
14.To represent information of anamnesis and objective inspection in a hospital
chart and formulate the preliminary diagnosis.
15.To write a plan of examination.
16.To write a clinical diagnosis (form of disease, type, severity, course of
disease).
17.To prescribe the treatment taking into account age, severity of illness.
18.To write out a prescription.
19.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).
20.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 infectious
mononucleosis and mumps.
III. Educational aims of the study
- forming the deontological presentations, skills of conduct with the patients
- 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 stage of the lesson
Tests and tasks
1. What virus is Infectious mononucleosis caused by?
A. human herpesvirus type 1
B. Varicella-Zoster virus
C. human herpesvirus type 4
2. The causative agent of Infectious mononucleosis belongs to:
A. Arbovirus
B. Togavirus
C. Enterovirus
D. Herpesvirus
3. What causative agent can cause mononucleosis-like syndrome at children?
A. Cytomegalovirus
B. Toxoplasma gondii
C. AIDS
D. all answers are right
4. The Epstein-Barra virus has tropism to:
A. T- lymphocytes
B. B- lymphocytes
C. neutrophils
D. all answers are right
5. The most early symptoms of Infectious mononucleosis are are:
A. increase in temperatures of body
B. Swelling of the neck lymph nodes
C. difficulty in nasal breathing
D. tonsillitis
E. all answers are right
6. What is not characteristic for Infectious mononucleosis?
A. tonsillitis
B. hepatomegaly
C. gastroenterocolitis
D. fever
7. What complication is characteristic for Infectious mononucleosis?
A. rupture spleen
B. glomerulonephritis
C. gastroenterocolitis
8. What diseases is Infectious mononucleosis necessary to differentiate with?
A. lymphogranulomatosis
B. mumps
C. AIDS
D. Adenoviral infection
E. all answers are right
9. The marker of Epstein-Barr infection is:
A. CMV IgM
B. HBsAg
C. HSV1/2 IgM
D. EBV Ig M
10. What is not applied for treatment of Infectious mononucleosis?
A. Penicillin G
B. Azithromycin
C. Cefotaxim
D. Prednizolon
11. The source of Mumps is:
A. Sick person
B. Birds
C. Rodents
12. The way of transmission of Mumps is:
A. fecal-oral
B. Contact
C. air-droplet
D. transmissible
13. The duration of incubation period of Mumps is:
A. a few hours
B. 11 – 21 days
C. 5 – 7 days
D. 3 – 5 days
14. What organ is not affected by Mumps?
A. salivary glands
B. liver
C. pancreas
D. Testicles
E. nervous system
15. What age group mostly suffers from Mumps?
A. younger 1year of age
B. 5 -10 years of age
C. 10 - 15 years of age
16. What glands are affected by Mumps more often?
A. Parotid
B. sublingual
C. Thyroid
D. Thymus
17. Where the causative agent of Mumps can be found?
A. saliva
B. blood
C. liquor
D. all answers are right
18. What laboratory method is used for confirmation of Mumps?
A. bacterioscopic
B. general blood test
C. Bacteriological
D. Serological
19. What etiotropic treatmant of Mumps do you know?
A. acyclovir
B. antibiotics
C. ribavirin
D. No specific antiviral agent for rubella
20. What treatment is used for Mumps orchitis?
A. . acyclovir
B. Ribavirin
C.Ozeltamivir
D. prednisolone
21. What an active specific prophylaxis of Mumps do you know?
A. vaccination
B. isolation
C. immunoglobulin
22. C.diphtheria belongs to:
А. Nesseria
B. Corinebacteria
C. Rickettsia
D. Listeria
23. Peculiarities of the C.diphtheria are:
А. Grampositive stabs, which produce exotoxins
B. Gramnegative stabs, which produce endotoxins
C Grampositive stabs, which produce endotoxins
D. Gramnegative stabs, which produce exotoxins
24. The mechanism of diphtheria transmission:
А. Transmissible
B. Contact
C. Paranteral
D. Vertical
25. Croupous fibrinogenous inflammation doesn’t spread on the surface of mucous membranes:
A. Bronchus
B. Tonsils
C. Trachea
D. Larynx
26. Diphtheritic fibrinogenous inflammation spreads on the surface of the mucous membranes:
А. Tonsils
B. Larynx
C. Trachea
D. Bronchus
27. The leading part (level) in the pathogenic mechanism of diphthiria is:
А. Bacteriemia
B. Toxaemia
C. Sensibilization
28. Where do fibrinogenous films of diphtheria localize form apper?
А. Bronchus
B. Larynx
C. Trachea
D. Fauces
29. Everything is typical for the localize form of diphtheria during the first hour, exept:
А. They look like net with grayish colour
B. They are taken easily off
C They are taken heavily off
D. They are quickly enlarged in side. If they are taken off they will appear again
30. Expressive intoxication during laryngeal diphtheria cann’t be, because:
А. High level diphtheritic antitoxin is in blood
B. Fibrinous film connects with mucous membranes superficially
C. Toxin removes with urine quickly
31. Which form of diphtheria is absent in the classification?
А.Diphtheria of the fauces
B. Diphtheria of upper respiratory tract
C. Diphtheria of the skin
D. Diphtheria of the CNC
32. The dose of ADS depends on:
А. The age of a child
B. The severity of the disease
C. The weight of a child
33. Point the date of vaccination against the diphtheria:
А. 6 mo,18 mo, 6 year
B. 3 mo, 4 mo,5 mo
C. 3 mo, 6 mo, 18 mo.
Task № 1
A thirteen-year child has an acute onset of the disease. Among the symptoms
temperature increases to 38,40 C; tonsillitis (photo №1); the lymphatic nodes
splenomegaly and mild hepatomegaly. The findings on the blood tests are as
leucocytes – 3,0x109\l, l – 40 %, at. m. – 10 % .
Questions:
1. What is your diagnosis?
2. Give the examination scheme.
3. Prescribe the treatment.
4. What antibiotic is not used at this disease? Why?
Task № 2
A thirteen-year child has an acute onset of the disease. Among the symptoms
temperature increases to 38,70C; tonsillitis (look at the photo); the lymphatic nodes
splenomegaly and mild hepatomegaly. The findings on the blood tests are as
leucocytes – 5,8x109\l, at. m. – 20 % .
Questions:
1. What is your diagnosis?
2. Give the examination scheme.
3. Prescribe the treatment.
4. What group does this disease belong to?
are: the
enlarge;
follows:
are: the
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follows:
Task №3
A fourteen-year child has temperature (38,3-38,9°С) during 3 days and painful swallowing.
Physical Examination: The child is sleepy and lethargic. The changes in the throat stipulate
the obstructing of the breath, the lymphatic nodes of the neck are enlarged, hepar +4 cm, spleen
+6 cm are protruding from the ribs.
The findings on the PCR are as follows: DNA EBV (+), on the IFA are: IgM EBV (+).
The blood test is: (Er – 4,1x1012\l, Hb – 130h\l, L – 4,8x109\l, b – 2%, s – 25%, l – 41%, m –
12%, at. l – 20%, ESR – 20mm\hr).
Questions:
1. What is your diagnosis?
2. What is the causative agent of this disease?
3. What diseases is it necessary to differ diagnostics with?
4. Prescribe the antibacterial drug for treatment tonsillitis.
Task № 4
A fourteen-year child has an acute onset of the disease. His complains are: high temperature
38,0°С, headache, the pain during opening mouth and mastication. Physical Examination:
edema is determined in the projection of the salivary gland on the right, auricle is lifted upward
(look at the photo), on palpation – moderate painful, the skin over the inflamed gland is
moderate tense and lustrous, customary colour. The mucous membrane of the oral cavity is dry,
the papilla of the efferent duct is hyperemic.
Questions:
1. What is your diagnosis?
2. What organs and systems are effected at this disease?
3.
4.
What diseases is it necessary to differ diagnostics with?
What do you know about active immunization?
Task № 5
A thirteen-year child has moderate painful throat, the temperature increases up to 38-38,7°С.
Throat examination - look at the photo. The submaxillary lymphatic nodes are enlarged. Edema
subcutaneous tissue is spreading to the middle of the neck. Myocarditis appeared of the child in
2 weeks in spite of the treatment.
Questions:
1. What is your diagnosis?
2. Which form of the disease should you think about?
3. What complications can appear at this disease?
4. What do you know about active immunization?
Task № 6
A nine-year child complains on the bad condition, the temperature increases up to 38-38,7°С,
painful swallowing during 3 last days. Physical Examination: the submaxillary lymphatic
nodes are enlarged on both sides. Throat examination - look at the photo. After taking the
fibrinous membranes off the glands’ surface, it is bleeding. Bacterioscopy of mucous swabs: Gr
(+) positive bacteriums in pairs with clavate thickening at the endings.
Questions:
1. What disease has the child?
2. The doctor’s tactics according to hospitalization
3. Prescribe the primary medicines for the disease.
4. What do you know about active immunization?
Task № 7
A ten-year child is ill for six days. The disease began with appearance of edema of saliva gland
region. The child had pain in the scrotum.
During the examination: double-sided orchitis. The edema of saliva gland region and orchitis
are decreased on the 4th day of the disease, but the general condition of the child is worse:
complaints on heavy headache, increased temperature to 39,2°С, vomiting, stiffness of the
occipital muscles develops, Kernig’s symptom positive.
Questions:
1. What disease has the child? Figure out the diagnosis according to the clinical form
classification.
2. The doctor’s tactics.
3. Calculate the dosage of penicillin, analginum, prednisolonum.
4. What do you know about active immunization?
V. Literature
1. Mikhailova A.M., Minkov I.P., Savchuk A.I. Infection diseases in children.Odessa, 2003.- 236 p.
2. Nelson Textbook of Pediatrics. / Edited by Richard E. Behrman, Robert,
M.Kliegman, Ann M. Arvin.; senior editor, Waldo E. Nelson. – 1996.
3. Kuznetsov S.V., Olchovskaya O.N., Tatarkina A.N. Selected lectures in
children’s infectious diseases.- Kharkiv, 2006.- 164 p.