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ЗмістII. Learning Objectives.
Specific Objectives – To gain knowledge of and develop skills in
F Appendix 1 Hemorrhagic diatheses low Chart of "Hemorrhagic Diatheses”
History of burdened heredity and triggering factors
I. Importance of the Subject.
The definition of “a hemorrhagic diathesis” comprises a group of various diseases and syndromes whose distinctive feature is an increased bleeding. It can be caused by different pathogenetic mechanisms. The first group deals with the diseases related to changes in the number and functions of thrombocytes (thrombocytopenia and thrombocytopathy). The second group comprises diseases the bleeding of which is caused by blood coagulation disorders as a result of a hereditary or acquired deficiency of procoagulants or increased content of anticoagulants (hemophilia, dysprothrombinemia, hypo- and afibrinogenemia). The third group comprises diseases the bleeding of which is caused by damage to the vascular wall (Schonlein-Henoch disease, Rendu-Osler disease, etc.). From the above, it may be deduced that there is a clinical diversity of hemorrhagic diathesis manifestations. Only knowledge of pathogenesis of a certain disease allows to select the only correct way of patient management.
The patients affected by a hemorrhagic diathesis are met with in the medical practice of a hematologist, a therapeutist, a pediatrician, a surgeon, a traumatologist, a gynecologist, a dentist and doctors of other specialties.
If the importance of the subject is clear, then the students shall proceed to learning the Practice objectives.
Key objective: To develop skills in making a differential diagnosis of different types of bleeding and diseases accompanied by a hemorrhagic syndrome, planning a patient management and providing the first aid in emergency cases.
The information necessary for reviewing and revising the basic knowledge and skills can be found in the following references:
Initial Test Questions.
Q1. During Konchalovsky-Rumpel-Leede cuff test modified by Borchgrevik, the following results were obtained for a 23-year-old patient: the petechia number in an outlined circle was 53.
Which of the following can be the correct result of this test in the patient?
Q2. A blood count of a 38-year-old woman presents the following evidence: erythrocytes 4,05×1012, Hb is 138 g/l, thrombocytes-120х109, leukocytes 4.1х109, 5 band neutrophils, 55 segmented neutrophils, 35 lymphocytes, 4 monocytes and ESR is 10 mm/h.
Which of the following is a correct name for the changes?
Q3. During an examination of the skin of a 45-year-old patient, small dotted and spotted painless hemorrhages were revealed that, according to the patient occured spontaneously.
Which of the following types of bleeding is present in the patient?
Q4. A physical examination of a 40-year-old patient revealed hematoma of the right knee joint. Taking a case history revealed that the patient's uncle had been suffering from hemophilia B.
Which of the following parts of the hemostasis system was affected in the patient?
Q5. The results of a laboratory investigation of a 25-year-old patient having a record of coagulopathy, in his case history showed the following: bleeding time was 8 min, and venous blood coagulation time was 10 min.
Which of the following is a correct explanation?
III. Theory Topics on the Subject
To reach the learning objectives it is essential to master the following theory issues:
The information necessary for mastering the theory issues may be found in the following references:
Then, proceed to answering some test questions and checking your answer for question 5 by the key.
Q1. A severe nasal bleeding started in a 32-year-old patient affected by hemophilia A. Which of the following drugs was prescribed to this patient?
Q2. A 20-year-old patient was delivered to the hematology department complaining of a hemorrhagic rash on the skin of his lower and upper extremities. A physical examination detected symmetrical hemorrhagic papulae in places with urticaria and single central necroses covered with crust. If pressed upon with a microscope slide, they do not disappear. Which of the following is a preliminary diagnosis?
Q3. A 34-year-old patient affected by Rendu-Osler disease often experiences nausea, and then vomiting of the color of coffee grounds. Fiberoptic gastroduadenoscopy detected multiple bleeding telangiectasias. Which of the following is a correct patient management?
Q4. An 18-year-old patient was delivered to an ENT department by ambulance due to an incessant nasal bleeding that started after an injury. Introduction of dicynon, application of a hemostatic sponge and nasal packing were to no avail. In case of rhinoscopy, the otolaryngologist noticed multiple telangiectasias on the mucous membrane in the nasal cavity. Which of the following diseases can be assumed?
Q5. A 32-year-old patient affected by idiopathic thrombocytopenic purpura developed uterine bleeding.
Which of the following methods of the emergency medical aid must be administered to the patient?
Teaching Guidelines for Practice Activities on "Hemorrhagic diathesis".
At the beginning of the class, the instructor gives a test to check and correct the pre-practice level of knowledge. Then, the students start to see patients under the instructor’s supervision after which the students give an analysis of the practice patients and the instructor checks the mastering of the practice topics. A final test is provided to strengthen the knowledge gained. At the end of the class, the instructor sums up the students' self-learning activity.
Complaints of spots occurred on the mucous membrane and on the skin of petechiae; gingival, nasal and gastrointestinal hemorrhges; occurence of hematomas, presence of vascular "stars» and rash along the vessels.
Objective examination showed: discovery of elements of the hemorrhagic rash at different stages of development, hemarthroses, vascular "spiders", "little spiders", papular symmetric skin rash along the vessels and signs of hemorrha-ges of various degrees of manifestation.
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