Methodical working out for students a theme: «Rheumatic diseases» icon

Methodical working out for students a theme: «Rheumatic diseases»




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Methodical working out for students a theme: «Rheumatic diseases».

Theme urgency: rheumatic diseases: systemic lupus erythematosus, systemic scleroderma, rheumatoid arthritis, polyarteritis nodosa, dermatomyositis.

Rheumatic diseases often meet, have a heavy current, make difficulty of differential diagnostics among themselves, and also with other illnesses. They are connected by similarity pathogenesis, some displays. The knowledge of their morphology is necessary for understanding of an essence of arising processes which explain their semiology, representation about possible complications will help their prevention. The abilities received on employment and the diagnostic habits necessary to practical doctors almost of all specialities, they also will help at mastering of corresponding sections on chair of therapy, surgery and others.

The purpose: to be able to define morphological features of rheumatic diseases.

Specific goals Purpose of initial level

To be able

1. To represent pathogenesis and morphological signs of the systemic lupus erythematosus, its possible complications.

2. To represent pathogenesis, to define morphological features of systemic scleroderma, possible complications.

3. To represent pathogenesis of rheumatoid arthritis, to define its morphological features, possible complications.

4. To represent pathogenesis of nodular periarteritis, to define its morphological features, possible complications.

5. To present pathogenesis of dermatomyositis its morphological and major complications.


1. To distinguish a normal structure of kidneys, hearts (Normal Anatomy), structure of a connecting tissue (Histology), glicans which are a part of a connecting tissue (Biochemistry).

2. To distinguish a normal structure of a skin, a gullet (Normal Anatomy, Histology).

3. To distinguish a normal structure of joints, cartilage tissue (Normal Anatomy, Histology).

4. To distinguish a normal structure of arteries of different caliber (Histology).

That you could find out, whether initial level of your knowledge-abilities necessary answers, we suggest executing a number of tasks.

Tasks for self-examination of initial level of knowledge-abilities.

Task № 1.

At opening of a corpse of the young woman who has died of complications systemic lupus erythematosus, found small centers of an inflammation in endocardium and on surface blood clots in area of trabecular muscles of left ventricle. As is called as such endocarditis on localization:

1. Parietal.

2. Chordal.

3. Valvulary’s.

4. Papillary’s.

5. All answers are true.

Task № 2.

During rheumatic diseases in a connecting tissue collect free glicosaminoglicans, that is connected with damage of the basic substance of a connecting tissue, destruction proteinglicans. What form of glicosaminoglicans can is in the inflammation centre at rheumatic diseases?

1. Chondroithinsulfatis.

2. Gialuronic acid.

3. Heparansulfatis.

4. All listed.

Task № 3.

In a histological preparation a picture of body with presence multilayered flat epithelium with cornescense, connecting tissue under it with glands of a different structure and appointment, outside of a connecting tissue fatty tela. That fit for body:

1. Skin.

2. Gullet.

3. Uterus neck.

4. Clear.

5. Bladder.

Task № 4.

In a histological preparation a tissue which consists of cells and intercellular matrix. Last homogeneous, with a blue shade at coloring gematoxillin and eosin. Roundish cells are grouped on 2-3 in capsules which are surrounded of matrix. What is a tissue?

1. Fibrous connecting tissue.

2. Cartilage tissue.

3. Bone tissue.

4. Fatty tissue.

5. Mucous tissue.

Task № 5.

In a histological cut of body many vessels of a different structure and are defined the sizes. One of vessels with pathology signs: has a considerable thickness of a wall with presence of internal and external elastic membranes, presence smoothly muscular and elastic tissue on the average a layer, a small gleam concerning a thickness of a vessel. Most possibly it is:

1. Capillary.

2. Arteriole.

3. Venula.

4. Artery.

5. Vienna.

Standards of answers: 1-1, 2-4, 3-1, 4-2, 5-4.

The information necessary for replenishment of necessary knowledge-abilities can be found in following references:

1. Prives M.G., Lysenko N.I., Bushkovich V. I. Human anatomy. "Hypocrate".-2001.-P. 385-397

2. Afanasev J.I., Yurin N.A. Histology, cytology and embryology - М "Medicine".-1990.-p. 335, 337, 338-339


The basic theoretical questions on which basis performance of target kinds of activity is possible:

1. An etiology and pathogenesis of systemic lupus erythematosus, general morphology of process (nuclear pathology, signs of disorganization of a connecting tissue, cellular reactions).

2. Morphological changes in heart, vessels, kidneys, skin, lungs, gastro enteric path, nervous system at patient’s vs. systemic lupus erythematosus; possible complications.

3. An etiology, pathogenesis, general morphology of systemic scleroderma.

4. Morphological changes in skin, heart and vessels, easy, kidneys, gullet at patients vs. systemic scleroderma; possible complications.

5. An etiology, pathogenesis, general morphology of rheumatoid arthritis (disorganization of a connecting tissue, cellular reactions, rheumatic knots).

6. Dynamics of morphological changes in joints, visceral defeats, possible complications.

7. An etiology, pathogenesis, morphology, complications periarteritis nodosa.

8. Morphology of dermathomiositis causes of death.

The literature for mastering of knowledge-abilities.

1. Strukov A.I., Serov V.V., Pathological anatomy/Kharkov, "Fact".-1999.-p.

2. Chair lecture behind a theme «Rheumatic diseases».

3. The count of logic structure (exhibit №1).

The additional literature.

1. Shlopov V.G. Basis of pathological anatomy of a human/ Kiev. - 1999.-p.

2. Serov V.V., Yarygin AD, V.S. Pathological anatomy. The atlas / М "Medicine".-1986.-p.

After studying of the references set forth above for self-examination of the acquired material on this theme it is offered to carry out following target tasks.

Task № 1.

At the young woman who have died of an uremia, on opening in heart it is found warty endocarditis with defeat parietal endocarditis near to the basis mitral valve, at histological research in kidneys glomerulonephritis with a sharp thickening of walls of capillaries glomeruli, centers of fibrinoid necrosis with cardiorhexis in them, proliferation of epithelium capsules of glomeruli, defeat tubule, strome. In vessels also fibrinoid necrosis, lymphoplasmocytar inflammation. For what of rheumatic diseases this most typical?

1. Rheumatism.

2. Systemic lupus erythematosus.

3. Systemic scleroderma.

4. Rheumatoid arthritis.

5. Periartheriitis nodosa.

Task № 2.

At the patient with suspicion on system disease of a connecting tissue spent biopsy of skin and a skeletal muscle. At histological research in muscles of changes it is not found. In a skin epidermis it is sharp fine, with smoothed epidermal-dermal border, considerable sclerosis of teat and mesh layers of derma, weak lymphogistiocytar inflammation near small vessels, the insignificant centers basophile connecting tissue. Disease what in this case the most probable?

1. Rheumatism.

2. Systemic lupus erythematosus.

3. Systemic scleroderma.

4. Rheumatoid arthritis.

5. Periartheriitis nodosa.

Task № 3.

The sick woman of 52 years in a zone of a knee joint had a knot about 5 sm in diameter, firm. There was a suspicion on a tumor, is taken bioptate. Histological research has found out fibrinoid necrosis with congestion around lymphocytes, plasmocytes, histocytes, and separate huge cells. In vessels - fibrinoid, cellular inflammation. Such structure the knot can meet at patients:

1. Rheumatism.

2. Systemic lupus erythematosus.

3. Systemic scleroderma.

4. Rheumatoid arthritis.

5. Periartheriitis nodosa.

Task № 4.

The man of 48 years with virus hepatitis in and a myocardium heart attack in the anamnesis had signs of a sharp peritonitis. During operation it is found hemorrhage heart attack of a thin gut its resection is made. Histological research has confirmed the diagnosis of a heart attack of a gut and small in vessels of average caliber is found fibrinoid necrosis with a thrombosis, sharp lymphocytes inflammation, plasmocytes, and histiocytes. Disease what most probable in this case has led to development of a heart attack of intestines?

1. Rheumatism.

2. Systemic lupus erythematosus.

3. Systemic scleroderma.

4. Rheumatoid arthritis.

5. Periartheriitis nodosa.

Task № 5.

The woman of 20 years within last year marks puffiness of eyelids, hyperemia of face skin, skin itch, erithematosis rash on a trunk skin; then pains in muscles have joined weakness of muscles of finiteness’s. Within last month disturbs disfagy: choke and pains at swallowing. The death has come from joined aspiration pneumonia. Histological in a skin an atrophy of epidermis and skin appendages, sclerosis of derma, local fucoids swelling and gyalinosis of derma in skeletal muscles and muscles drinks are revealed a dystrophy and necrosis muscular cells, atrophy of separate muscular tissue, local proliferation of cells perimisium, small lymphogistiocytar inflammation between muscular cells and round small vessels. What rheumatic disease is revealed at the sick?

1. DM

2. SSD

3. SLE

4. PN

5. RA

Task № 6.

At opening of a corpse of the woman of 54 years which were suffering arthritis rheumatoid and lost at the phenomena of nephritic insufficiency it is revealed: kidneys are increased in sizes, weight 350gm., dense, on a cut have "grease" shine, ochroleucous color. At microscopic research it is defined homogeneous pink weights in some capillary loops glomeruli, in walls arteriole and arteries, in basal membrane of tubule and in stroma. What development of process in kidneys has become complicated arthritis rheumatoid?

1. Amyloidosis of kidneys

2. Quickly progressing glomerulonephritis

3. Sharp pyelonephritis

4. Membranous glomerulonephritis

5. Tuberculosis of kidneys.

Task № 7.

The man of 35 years has been operated on an occasion of a sharp appendicitis. In the anamnesis heart attacks of kidneys, a myocardium heart attack. At histological research of appendixes shoot sharp narrowing of a gleam of some small arteries, segmentary fibrinoid necrosis centre and perivasculation lymphogistiocytar inflammation is revealed. What disease the patient suffered?

1. Hypertensive illness

2. Atherosclerosis

3. Rheumatism

4. Systemic lupus erythematosus

5. Periartheriitis nodosa.

Task № 8.

The patient of 26 years, with the big maintenance antinuclear antibodies to two-spiral DNA, is made biopsy of kidneys at which the thickening of capillary membranes glomerulies is revealed - becoming «wire loops», adjournment fibrinoids in loops of glomerulis. What process has developed in kidneys?

1. Post infectious glomerulonephritis

2. Lupus nephritis

3. Quickly progressing glomerulonephritis

4. Membranous glomerulonephritis

5. Amyloidosis of kidneys.

Task № 9.

The woman of 35 years has addressed with pains in small joints of brushes of hands and feet, sharp general weakness and a short wind. Objectively the doctor has revealed symmetry of defeat of small joints, restriction of mobility of knee joints, signs latent myocarditis, and Rologicheski-interstitial pneumonia and soldering in a pleural cavity. In blood were defined immunological infringements (presence rheumatologic factor).

It is possible to think of what rheumatic disease at this patient?

1. AR

2. SS

3. SLE

4. Rheumatism

5. PN

Methodical instructions for work of students on practical employment on a theme «Rheumatic diseases».

In the employment beginning under standards of answers check correctness of the decision of homework. Then by the test control your preparation for employment will be checked up. Independently you should make the description macro-and micro preparations. On a micro photo and micro preparations study «Lupus nephrite», «Fibrinoid necrosis vessels and a kidney heart attack», «Rheumatic knot», describe them, using algorithm of microscopic diagnostics of rheumatic diseases.

Technological card of employment

Microscopic diagnostics of rheumatic diseases.

Presence of the centers mucoids and fibrinoids changes of a connecting tissue, walls of vessels

Considerable lymfoplasmocytar inflammation walls of vessels, connecting tissue

Sign of a nuclear pathology, cariolysis, cariorrhexys, and hematoxillines little bodies. Features of lupus nephrite. Endocarditis Libman-Sacks.


Changes in joints and a surrounding connecting tissue: 1. Exudes sinoviitis. 2. Productive sinoviitis, destruction of a cartilage. 3. Fibroses-bone ankilosis. Rheumatic knots.Vaskulit, Glomerulonephritis, amyloidosis.


Changes in vessels of different caliber, thrombosis, development of heart attacks, hemorrhages. Chronic mesangial extracapillar glomerulonephritis. Presence of hems after heart attacks atrophies of bodies.


Weak lympho-plasmocytar inflammation considerable fibrosis. Changes in skin: 1. Hypostasis, cellular inflammation. 2. An atrophy of teat, skin appendages, sclerosis. 3. Sclerosis and gyalinosis of derma, fatty tela, vessels. Sclerodermal heart, lungs, changes of vessels of kidneys, membranous glomerulonephritis, gullet narrowing.


1. Dystrophy and necrosis of skeletal muscles. 2. Atrophy of separate muscular cells. 3. Local proliferation of peremisyum. 4. Inflammation in skin (rash, skin itch) sclerosis of derma, vasculitis, swallowing infringements.


Systemic lupus erythematosus

Rheumatoid arthritis

Periarteritis nodosa

Systemic scleroderma

Dermatomyositis







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