MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
Educational-
for teachers and students of Treatment Faculty

MINISTRY OF HEALTH OFTHE REPUBLIC OF UZBEKISTAN
CENTER OF DEVELOPMENT OF MEDICAL EDUCATION
TASHKENT MEDICAL ACADEMY
"A F F I R M E D"
Pro-rector of educational work
Professor Teshaev O.R.
E ducational-
for teachers and students of Treatment Faculty
"
at a DNC meeting of Therapeutic Faculty
Protocol № ___from_________2012
Chairman of DNC
Karimov M.Sh.___________

Exanthema
1. Place of the lessons, equipping
- The auditorium;
- Box office;
- Outpatient department;
- Department of droplet infection;
- Ray department;
- Emergency room;
- Laboratories (clinical, biochemical, bacteriological, immunological);
- TCO: Case patients with measles, rubella, scarlet fever, pseudotuberculosis, gypsum fiber board, meningokokktsemiey, infectious mononucleosis, etc. slaydoskop; TV-video, training, supervising the program, guidelines for self-e practical training in infectious diseases, the scenarios methods of work in small groups, case studies.
2. The duration of the study subjects
Number of hours - 6
3. Session Purpose
- Develop skills in an integrated approach to clinical diagnosis of infectious diseases with exanthema syndrome, management of laboratory studies in primary care. Education of rational therapy at home, personal preventive health examinations and rehabilitation of convalescents from infectious disease exanthema syndrome;
- Parsing the theme as a specific patient at the bedside, in laboratories and in the classroom, to bring interest to the profession, to stimulate self-education, as well as develop a sense of responsibility and compassion for the sick;
- For example, parsed thematic issues to develop scientific thinking and stimulate creative approach to solving non-standard clinical problems and the possibility of independent decisionmaking. Develop logical thinking and the ability to express their thoughts on the professional language.
Objectives
The student should know:
- Differential diagnosis of exanthema syndrome in common infectious diseases;
- Earlier rational laboratory diagnosis of infectious diseases with exanthema syndrome;
- Preparation of diagnostic search algorithm in the presence of exanthema in a patient;
The student should be able to:
- To conduct a professional examination and history taking the patient;
- Give the characteristic rash;
- To form a preliminary diagnosis on the basis of early and differential diagnosis;
- Appoint a targeted survey;
- Interpret data from laboratory and instrumental methods of examination;

- Own clinical decision-making logic (to form a definitive diagnosis, assess the severity of the patient's condition and prognosis);
- Diagnose the state of emergency and provide first medical aid at the prehospital phase;
- To decide if sending a patient for a consultation or hospitalization and appropriate hospital;
- To carry out rehabilitation of convalescents.
As a result of training the student should learn practical skills:
1st-order skills
- Examination of the patient;
- Take blood for serology;
- Take throat swab for bacteriological studies;
- Take a nose swab for bacteriological studies;
2nd-order skills
- Interpretation of laboratory data;
- Provide the necessary assistance for pre-hospital;
- To hold the primary anti-epidemic measures in the outbreak.
4. Motivation
Increase in the frequency of occurrence of childhood infections drip adult contingent, as well as the incidence of exanthema syndrome in infectious diseases physician determine the need for ownership of the SPM differential diagnostic tactics when it detects a patient with a rash.
5. Interdisciplinary communication
Teaching this topic is based on the knowledge bases of students metabolic biochemistry, microbiology, immunology, pathological anatomy, pathological physiology, and allergy.
Acquired during the course knowledge will be used during the passage of medicine, surgery, obstetrics, gynecology, hematology and other clinical disciplines.
6.The content of training
6.1.The theoretical part
Characteristics of the various elements of exanthema.
1. Roseola (roseola) - a speck of a pale-pink or red, round, invisible in the stretching of the skin.
2. Spot (macula) - has an irregular shape is the result of vasodilatation, pinkish-red.
3. Erythema (erythema) - vast areas of hyperemia, red color, appear in the vasodilatation of the skin).
4. Hemorrhage (hamorrhagiae) - hemorrhage into the skin as a result of increased vascular permeability. May be of various shapes and sizes.
5. Erosion (erosio) - a defect of the epidermis, which is formed after opening the cavity of the primary elements (vesicles, pustules, blisters).
6. Ulcer (ulcus) - deep skin defect, which captures the epidermis, dermis, and sometimes the underlying tissues. Ulcers develop as a result of the collapse of the primary elements in the deep infiltrative parts of the dermis - bumps, knots, at the opening of the deep pustules, and if anthrax - as a consequence of destruction serial child vesicles and pustules, which are formed on the edges of ulcers, so it kind of grows on the periphery . The shape and the edges of ulcers are of great importance for the differential diagnosis. The edges of the sores may be saped, steep, saucer, kallez, soft, etc. The bottom of the ulcer may be flat, smooth (chancre), like crater(syphiloma) on its surface can be expressed in granulation (cutaneous leishmaniasis), etc.

7. Papule (papula) - formed as a result of vasodilatation and the formation of cellular infiltrate in the upper layers of the dermis, rising above the level of the skin.
8. Tubercle (tuberculum) – cavityless element-inflammatory granuloma in the dermis, characterized by papules that are always clearly detectable in the skin infiltrate rather compact.
9. Node (nodus) - a limited seal formation with a diameter of 1 to 5 cm, extending into the skin.
10. Blister (urtica) – acavity limited swelling of the papillary layer of skin. Element quickly appears and disappears quickly, leaving no trace, accompanied by itching.
11. Bubble (vesicula) - small cavity formation containing serous, serous-hemorrhagic less fluid develops in the epidermis immediately under the horny layer, in the middle or at the border with the dermis.
12. Pustule (pustula) or abscess - festering vesicle.
13. Herpetic eruption (herpes) - a group of small closely spaced bubbles on the inflammatory erythematous base.
14. Scale (squama) - occurs at the site of a vanished rash due to rejection of horny plates of the epidermis. Depending on the size of flakes peeling can be pityriasis or plate.
15. Pigmentation (pigmentatio) - appears on the site of a vanished rash, resulting in increased formation of skin pigment.
16. Cork (crusta) - a product of condensation and drying of various other elements of the exudates rash (pustules, vesicles, erosions, ulcers).
17. Scar (cicatrix) - coarse-fibered connective tissue growth, replacing the deep skin defects.
The macula-papular rash.
Observed in the following diseases: measles, pseudotuberculosis (Far East Scarlatiniform fever, rubella, scarlet fever, rash Boston (enterovirus), an infectious erythema Rosenberg, an acute febrile phase of HIV infection, secondary syphilis, herpes pink, guttate psoriasis, urticaria, drug allergies.
Maculopapular rash and vesicular.
Observed at: chickenpox, herpes, shingles (herpes), impetigo, drug allergies.
Hemorrhagic rash.
When: drug allergy, meningokokktsemii, various vasculitis, hemorrhagic fevers.
Measles. In epid.anamnesis - contact with measles patients, the absence of vaccination, receipt of immunoglobulins, corticosteroids, transfusions of plasma, blood products, antibiotics.
Prodromal period of 3-5 days, characterized by catarrhal symptoms: conjunctivitis, rhinitis, cough, fever to 38 ° C, when viewed from the oral cavity and pharynx revealed diarrhea and flushing of the mouth, gums, patches Filatov, Koplik, measles enanthema.
At the height of the disease on a background of high temperature and marked catarrhal symptoms appear bright red, Makulo-papular rash on the background of the unchanged skin, prone to a merger, get enough sleep stages. First, behind the ears, on the first day on the face, on the second day on the trunk, on the third day of rash on the extremities. By the time the rash appears on the extremities, face, the face begins to fade, becoming brown shade elements - pigmentation, there is peeling.
The tactics of GPs with suspected measles. Establish a preliminary diagnosis to the patient: "Measles."

- Establish criteria to determine the severity and indications for hospitalization.
- Identify approaches to treating the patient at home.
- Identify and contact specific to prevention if necessary.
Scarlet fever.
The disease is characterized by sore throat, rash Punctate on the trunk and extremities, "raspberry tongue ', peeling of the skin. Characterized by acute onset of illness with no prodrom - increased body temperature, there is vomiting and sore throat. A few hours later a rash, which quickly spreads to the face, neck, trunk and extremities. Punctate rash on the skin hyperemic background with concentration in natural folds on the lateral surface of the trunk, the extensor surfaces of the upper and lower extremity symptoms Filatov (+). The rash disappears in
3 to 5 days, leaving no pigmentation, then there is peeling.
The tactics of GPs in scarlet fever. In making a diagnosis helps to clear congestion delimited throat, the presence of angina, crimson tongue, the discovery of plate peeling, lymphadenitis, from the blood neutrophilic leukocytosis with a shift to the left, a high ESR.
To establish the diagnosis according to the classification to determine the indications for hospitalization, and leaving home to assign treatment according to protocol.
Allergic rash due to food and medicines.
Acute onset, associated with receiving food or drug. Clinical signs are local and general. The rash is mainly Makulo-papular (like measles), itching, but may be mixed - the point, and others rozeole Patients complain of fatigue, muscle aches, headache, nausea, and vomiting. May be increased body temperature, increased limfanodus, puffiness face, conjunctivitis, rhinitis. The rash is usually unstable, characterized polymorphism. Measles rash may appear when using different drugs. Appearing on the body, rash, rarely on the face, often localized in the joints. The rash may be -annular, urticarial, hemorrhagic rash, etc. Phasing no catarrhal phenomena do not exist. In the exudative diathesis: an eruption may be the type of eczema, redness, dryness, irritation and flaking.
Herpes infection. Manifested lesions of many organs and tissues and is accompanied by bubble eruptions on the skin and mucous membranes. The appearance of lesions on the skin are sometimes preceded by hyperesthesia, itching, tingling, or pain and neuralgia in the whole region. On inflamed, hyperemic, and a few infiltrated area of skin appears a group of closely seated vesicles filled with clear content, which can be localized anywhere, but more often on the border of the skin and mucous membranes. Bubbles burst, crust over and heal in 7-10 days.
Children often secondarily infected blisters that makes conduct antibiotic therapy. Cold sores more often localized on the lips, around the mouth, nose wings, and sometimes spreads to the face and even on the trunk. On the site of the rash is noted itching and burning. The severity of fever and the common manifestations of intoxication due to primary disease. Treatment is usually symptomatic.
Chickenpox.
Prodromal period of mild and often goes unnoticed. Period characterized by the appearance of fine rash of red spots with sharp edges. A few hours later the stain turns into papules and then vesicles. Affected not only the skin, but oral mucosa, genitals, conjunctiva.
Varicella rash lasts 4-5 days, every new eruption accompanied a rise in temperature.
Characteristic of false polymorphism, seen and you can see the spot and papules and vesicles, and crusts at the same time. Unicameral vesicles are located superficially, after falling scabs scar is formed.
Herpes zoster.
In the history of a patient with herpes zoster, there are indications the deferred chicken pox. The whole cycle of changes takes 5-10 days. Usually the rash is unilateral.

After the onset of pain and to the development of herpetic eruption is 2-3 days. Regional lymph nodes are increased. The disease begins with fever and severe symptoms of intoxication. In this case there is a strong pain in the area where in the future should appear herpetic rash. After several days groups appear red papules, located in one or two adjacent segments. In their place was soon formed vesicles with contents transparently, quickly becomes cloudy. Bubble elements of herpes rash dry up to form crusts, after rejection, which often remain depigmented spots and a long time maintained pains in areas where there was a rash. The basic data for diagnosis are marked pain syndrome, the localization of characteristic rash.
A peculiar form of disease caused by varicella-zoster virus, characterized by the appearance of vesicular eruptions, closely seated on a course of individual sensory nerves.
Meningococcemia. An early sign of a fever, which has a 1-day reaches 39-40 ° C, is intermittent or permanent. Patients complain of fever, weakness, headache, and sometimes pain in the back, extremities, loss of appetite. On the 1st day of illness skin is pale, marked hyperesthesia, characterized by tachycardia, shortness of breath. In the late 1st - early 2nd day there is the main symptom of the illness - a rash. Elements of the rash may be roseolous, papular, but the most characteristic hemorrhagic rash of irregular shape of stars of various sizes. Often the rash is Punctate or in the form of large surface area of necrosis in a few square meters. See In more severe cases, gangrene develops the tips of fingers, feet, ears. As the rash appears not at the same time, it has a different color and brightness, ie, polymorphism observed peculiar rash. Most often, the rash occurs on the legs, buttocks, thighs, trunk and eyelids.
Rubella.
The increase in the occipital and back neck lymph nodes (1-2 cm, the nodes are soft, juicy and slightly painful on palpation), lymphadenitis - the first symptom of rubella appearance of the skin pale pink little macula or maculopapular rash on the normal background skin, sometimes accompanied by slight itching ; fading rash within 2-4 days without pigmentation and scaling. The diagnosis of rubella is confirmed by detection of rubella-specific antibodies in paired sera with HAI, taken at intervals of 10 days. The increase in antibody titer to
4 or more times confirms the diagnosis of rubella.
Pseudotuberculosis . The rash appears in the midst of disease at 3 to 4 days of illness against the backdrop of severe intoxication - as a "hood" (redness of face and neck with cyanotic tint), a symptom of "gloves" (delimited bluish-pink paint brushes), a symptom of "socks" ( delimited pink-bluish color of paint brushes). For typical pseudotuberculosis mesenteric adenitis and terminal ileitis, an enlarged liver and spleen, fever up to 7-10 days. The diagnosis of great importance abjection of the material the patient (feces, urine, blood) as well as serological diagnosis.
Boston (enterovirus) rash.
The source of infection - patients and virus carriers.
Particularly high susceptibility in children aged 3 to 10 years. The disease occurs with a high temperature to 39-40 ° C, with severe intoxication (headache, weakness, vomiting).
Characterized by hyperemia of face, upper half of body. The distinguishing feature - a rash resembling rubella, there is one stage, abundant, localized mainly on the trunk, limbs keeps 1-2 days. Itching, scaling, pigmentation does not. On the oral mucosa observed enanthema spotty, and sometimes vesicles. In addition, marked headache muscle aches, vomiting and sometimes abdominal pain and diarrhea. Diagnosis is very difficult. In recent years, developed methods for direct and indirect immunofluorescence.
Staphylococcal skin lesions. The source of infection - patients, carriers of pathogenic strains of sick animals. Patterns of transmission - contact, food, air-drop. Distinguished: localized and generalized forms.

For localized forms include diseases for which there is no metastatic foci of infection.
This is a different skin and subcutaneous tissue, occurring on the type of pyoderma, furunculosis, abscess, cellulitis lesions in the throat (sore throat), ear, respiratory, digestive, urinary tract infections. Any form of illness characterized by acute onset, high fever, severe symptoms of intoxication. In the KLA leukocytosis, neutrophilia, accelerated ESR.
Staphylococcal sepsis.
Generalized form of infection resulting from a sharp suppression of the humoral and cellular immunity, frequently develops in infants.
Characterized by symptoms of septic intoxication, presence of septic foci of infection, lesion of the blood and a progressive metabolic disorder.
Infectious erythema - an acute infectious disease characterized by the appearance of blotchy, maculopapular rash merging, accompanied by fever and intoxication.
Infectious erythema Rosenberg. Disease begins acutely with high fever, chills, aches throughout the body, joints and a rash on a 4-5-day illness - first, the individual elements of the face, then after a few hours or the next day on the trunk and extremities. Especially abundant rash on the sides of the trunk, extensor surfaces of the extremities, with concentration in the large joints, buttocks, thighs, forming a solid erythematous field.
The rash is blotchy maculopapular or pink or bright red. Rash fades gradually from the center and pale bluish, a 5-6dney disappears pigmentation does not happen. The patient's face hyperemic, overstuffed with an injection of sclera, dry tongue, throat congestion and a mild increase in the tonsils, often enanthema on the soft palate.
Infectious erythema Tshamera. The disease begins with mild fever, weakness, aches in the limbs sometimes just with the rash. The rash appears first on both cheeks as separate slightly protruding red spots, then patches grow and merge and form a solid red patches erysipelas type.
Erythema on his face like butterfly wings. Nasolabial triangle is pale, the rash may be on the forehead, chin, arms, legs, and very sparse on the trunk. Often the rash is merged at the elbows, buttocks, thighs, forming a solid erythematous field and has like measles view. The rash lasts 2-4 days and then begins to fade from the center.
The sudden rash (roseola infant). The infection usually occurs in children 6-18 months, begins with a sudden rise in temperature to 39-40 ° C, which lasts for 3-5 days, accompanied by rhinitis, an increase in cervical lymph nodes, and then abruptly drops to normal. The most pathognomonic sign - a rash during the decline, but more often several hours after normalization of temperature. The rash had only been on the skin of the trunk, a few hours later - at the neck, upper extremities, then the thighs and buttocks. The characteristic lesions are in the wrists and buttocks. At the same time can join intestinal disorders, whooping and meningeal symptoms. In the blood, characterized by the following changes: with a decrease in temperature, usually on the
3rd day, there is leucopenia with lymphocytosis and monocytosis.
Used in this lesson, new teaching technologies, "Who is bigger? Who is faster? ".
USING "Who will? Who is faster? ".
Length-15 minutes.
The purpose of training. Refine and consolidate the knowledge of practical applications.
Translate theoretical knowledge into practical skills and mental differential diagnosis of exanthema syndrome in infectious diseases at the prehospital stage.
The teacher asks for one minute each student a series of questions. As the answers are recorded correct answers. At the end of a minute series of questions given to the following student and recorded the number of correct answers, etc. The dialed number of points put up the final

assessment within one day of maximum points.
Options abstracts:
1. Describe in roseola? Roseola - a speck of a pale pink, red, purple-red or purple, with a diameter of 1-5 mm, not protruding above the skin. It is caused by vasodilation papillary layer of skin, skin stretching and disappear after the cessation of tension reappears.
2. Give a description of the stain? Spot - is an element of a rash similar to roseola, but the larger sizes (5-10 mm) are not above the level of skin color is the same as in roseola. It is caused by vasodilatation of the skin.
3. Give a description for papules? Papule - a more or less dense acavity element, towering above the skin. If it points to the formation of the inflammatory infiltrate in the papillary dermis, vasodilatation and limited swelling. When pressed on her pale papules, but its color completely disappears.
4. Describe in erythema? Erythema - a vast areas of hyperemia of the skin, purple-red or red. Erythema is formed by the merger of large spots (diameter 11-20 mm). Erythema is the result of vasodilatation and skin papillae papillar vascular plexus. Severe inflammation is absent.
5. Describe to bump? Tubercle - acavity education, arising as a result of the inflammatory infiltrate in the dermis of granulomatous structure. The bumps are elements slightly elevated above the level of the skin, but lying deep in the dermis, and when they are always determined by palpation of the infiltrate.
6. Give a description of a bubble? Bubble - a shallow cavity formation containing serous, sometimes serous-hemorrhagic fluid. Bubble develops in the epidermis immediately under the horny layer, in the middle or at the border with the dermis. It rises above the skin in the form of the element hemispherical shape with a diameter of 1.5 to 5 mm.
7. Give a description of hemorrhage on? Hemorrhage - bleeding in the skin as a result of diapedesis or destruction of vessels in the skin. Depending on the time of the appearance of color may be red, blue, red, purple, green, yellow. Hemorrhages are in the form of dots or spots of various sizes and shapes, do not disappear when pressed the skin.
8. The nature of the rash in measles? Spotted papular, red, copious background on unchanged, with a tendency to merge, staged appearance with head - body - legs, disappearing in the same manner.
9. The nature of the rash in rubella? roseola-papular, pours overnight, unchanged at the skin, the size of a pin head to the lentils over the skin does not rise, extensor surfaces do not merge.
10. The nature of the rash of scarlet fever? Punctate on hyperemic background, more on the flexor surfaces of the hands, the inner surfaces of the legs, abdomen, in the natural folds of the face, cheeks and forehead, pale nasolabial triangle.
11. The nature of rash pseudotuberculosis? Punctate, Punctate spots, papular, pruritus, on flexor surfaces of lateral parts of the body, the face is not striking.
12. The nature of rash meningokokktsemii? Hemorrhagic, on the sides of the body, buttocks, star-shaped, of various sizes and depths of necrosis, rises above the skin, persists 4-8 days.
13. The nature of the rash of typhoid fever? Rozeoleznaya, petechial, isolated on the abdomen and lower chest, does not rise above the skin, with pressure disappears and re-appears, persists 3-5 days.
14. The nature of the rash haemorrhagic fevers? Hemorrhagic, on the lateral surface of the body, chest, petechial hemorrhages on the mucous membranes, sclera, stored for 3-4 days, it

disappears after pigmentation.
15. On what day of the disease develop a rash with measles? At the 4-5-day illness.
16. On a day when the disease rubella rash? On the 1st day of illness.
17. On what day of the disease develop a rash of scarlet fever? At 1-2-day illness.
18. On what day of the disease develop a rash when pseudotuberculosis? At the 2-4-day illness.
19. On what day of the disease develop a rash at meningokokktsemii? On the 1st day of illness.
20. On what day of the rash illness of typhoid fever? At the 8-10-day illness.
21. On what day of the disease develop a rash during hemorrhagic fevers? At the 3-5-day illness.
22. Call infectious disease in which the 1-2-day fever rash appears? Scarlet fever, chickenpox, rubella, meningokokktsemiya.
23. Call at least one infectious disease in which 3-5 days of fever rash appears? Measles.
24. Call at least one infectious disease in which the later six-day fever exanthema appear?
Typhoid fever.
6.2. Analytical part
Situational problems
Problem number 1.
Patient A., was admitted to the clinic for a 4-day illness with complaints of fever, cough, runny nose, sneezing, eye abscess, loss of appetite. At the 4th day of disease developed a rash on his face. In the observation in the clinic noted landmark spread the rash. The rash was profuse, discharge, very worried about the "cut" in the eyes.
When you receive could see white patches on the small loosened hyperemic oral mucosa (such as semolina). The temperature remained high until 7 days of illness. Expressed intoxication - headache, vomiting, lethargy, weakness, insomnia, delirium. At the height of the disease marked by tachycardia, muffled heart sounds, the phenomenon of bronchitis, coated tongue, abdominal distension. Meningialnyh phenomena not. State of moderate severity.
1. What kind of disease you can think of?
2. On what day of the disease appear exanthema?
3. Characteristic rash is measles?
4. What distinguishes the measles rash of rubella?
5. What is different from measles rash scarlet fever?
6. What diseases is necessary to dif. Diagnosis
№ Replies
1. About Corey
2. At 4 to 5 days of illness appear exanthema.
3. Spotted papular, red, copious background on unchanged, with a tendency to merge with the staged appearance of the head - torso, legs, disappearing in the same order.
4. phasic, merging with each other, there is a 3-day sickness, more big

5. roseolous, appear simultaneously throughout the body, symptoms and Pasta Filatov is positive, the rash appears on the first day of disease, large-leaf peeling.
6. German measles, scarlet fever, drug allergies, yersiniosis, pseudotuberculosis.
Objective number 2.
Patient A., aged 10, was admitted to the clinic for a 3-day illness with complaints of fever, general weakness, poor sleep, headache, skin rash. On examination of the face, scalp, torso, limbs observed abundant vesicular rash with clear content, maculopapular rash and brown. Drying soil elements rash of dark brown color. There is fairly intense itching.
Several elements of the rash located on the gums. Pulse speeded, muffled heart sounds. State of moderate severity.
1. Place a provisional diagnosis?
2. What distinguishes the rash of varicella zoster?
3. What distinguishes the rash of chickenpox from smallpox?
4. Which diseases should be differentiated?
5. The nature of the rash in abortive forms of chicken pox?
6. Treatment.
№ Replies
1. Chickenpox.
2. Rash all over his body, polymorphic, and vesicular scalp.
3. Rash compartment, soft, polymorphic, centrifugal.
4. Smallpox, shingles, smallpox monkey, a herpes infection.
5. There is a spot and a papule, vesicle no.
6. Desintoxication, desensitizing, local gadgets
Objective number 3.
Patient M., aged 36, was admitted to the clinic for a 3-day illness with complaints of headache, insomnia, high temperature. Ill three days ago, wrote a cold, the temperature remained within normal limits. At the 2nd day of illness about 17 hours the patient appeared sharp headache, chills, temperature rose to 39,9 ° C, after a few hours from the onset of disease occurred repeated vomiting, vomiting the next day, repeated every 20-30 minutes.
Increased headache.
At the time of admission to hospital the patient's condition was serious, the temperature of 38,7 °
C, the consciousness is kept on the questions are answered with difficulty, occasionally moaning.
The face is pale. On the skin of the chest, abdomen, extremities abundant, polymorphic eruption star character with cyanotic tinge in the center of many elements of areas of necrosis. Pulse 92 beats per minute, soft, rhythmic. BP 90/60 mm. Hg. Art. Cardiac sounds are muffled. In the lungs, vesicular breathing. The abdomen is soft and painless. No neck stiffness. Symptoms
Brudzinskiy and Kernig negative.
1. Your preliminary diagnosis?

2. What laboratory data will help you in making a diagnosis?
3. Tactics doctor GPs.
4. Treatment of the patient.
№ Replies
1. Meningococcal disease, meningokokktsemiya.
2. Complete blood count, bacteriological tests, blood, throat swab, scraping of the rash.
3. Give direction. Call epidemiological. transportation for hospitalization for infectious hospital profile. Give extra notice to the SES.
4. Causal treatment - penicillin 200 000-300 000 IU. 1 kg of body weight; pathogenetic therapy - the struggle with toxemia. Steroids. Anticonvulsant therapy. Symptomatic therapy.
6.3. Practical part
Characteristic rash.
Purpose: Preliminary diagnosis of diseases associated with syndrome of exanthema.
Indications: Diseases accompanied by the appearance of rashes on the skin.
Necessary equipment: The couch, the light source, a mask.
Performed steps (stages):
№ The event number is not performed
(0 points)
Partially completed
(5 points)
Fully executed correctly (10 points)
1. The physician must be in the mask. Ask the patient to undress
0
2. Put the patient closer to the light (artificial or natural)
0
3. Inspect the color of the skin 0
5
5
10
10
5
5
10
10 4. Identify the elements of the rash (the macula, papule, etc.)
0
5. Determine the location of the rash 0
6. Determine the propensity to merge elements of an eruption
7. Find out phasing rash
0
0
5
5
5
10
10
10

8. Identify the elements of secondary rash
(pigmentation, lihenifikatsii, peeling, etc.)
9. Determine dermographism
10. Ask the patient to get dressed
Wash hands
Total
0
0
0
5
5
5
10
10
10
0 50 100
7. Control Questions
1. Give a description for roseola.
2. Give a description of the spot.
3. Give a description for papules.
4. Give a description for erythema.
5. Describe in tubercle.
6. Give a description of a bubble.
7. Describe to hemorrhage.
8. The nature of the rash with measles.
9. The nature of the rash in rubella.
10. The nature of the rash of scarlet fever.
11. The nature of rash pseudotuberculosis.
12. The nature of rash meningokokktsemii.
13. The nature of the rash of typhoid fever.
14. The nature of the rash haemorrhagic fevers.
15. On what day of the disease develop a rash with measles?
16. On a day when the disease rubella rash?
17. On what day of the disease develop a rash of scarlet fever?
18. On what day of the disease develop a rash when pseudotuberculosis?
19. On what day of the disease develop a rash at meningokokktsemii?
20. On what day of the rash illness of typhoid fever?
21. On what day of the disease develop a rash during hemorrhagic fevers?
8. The recommended literature
1. Tooth TM, Ivanov KS, Kazantsev AP, Foresters, AL Differential diagnosis of infectious diseases. Leningrad, 1991.
2. Vasil'ev VS, Komar VI, VM Tsyrkunov The practice of infectious diseases. Minsk, 1994.
3. Kazantsev AP, Zubic TM, Ivanov KS, Kazantsev, VA Differential diagnosis of infectious diseases. Moscow, 1999.
4. Emond, R., Rowland H., Uelsbi F. Infectious diseases. Color Atlas. Moscow, 1998.
5. Madzhidov VM Yukumli kasalliklar. Tashkent, 1992.
6. Makhmudov OS Bolalar yukumli kasalliklari. Tashkent, 1995.
7. Uchaikin VR Guidelines for Communicable Diseases in children. Moscow, 1999.
8. Shuvalov, HE Infectious diseases. Moscow, 1999.
9. Musabayev IK "Guidelines for intestinal infections." Tashkent, 1982.
10. Pokrovsky VI, Pak SG and so on "Infectious Diseases and Epidemiology." Moscow, 2003.
11. Yushchuk ND, Vengerov YY "Lectures on Infectious Diseases." Moscow, 1999.

12. Uchaikin VF "Guidelines for Infectious Diseases in Children". Moscow, 1998.
13. Internet Resources (www.medlinks.ru, www.cdc.gov, ...).