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Sumy state university medical institute




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Task 4


Man 30 years entered infectious department. Disease began acutely with the increase of temperature to 37 0С, watery stool without pathological admixtures with frequency to 10-15 times a day, nausea, vomiting, expressed intoxication. According to a patient, the day before ate unwashed fruit, what became reason of disease. From data of coprogram in an excrement much undigested cellulose, grains of starch and undigested muscular fibres.

1 Formulate diagnosis.

  1. What diseases is it necessary to provide differential diagnostics with?


^ Standards of answers to the tasks

Task 1

1 Epidemic pleurodynia.

2 Appendicitis, pleuropneumonia, banal miositis, radiculitis.


Task 2

1 Food toxicoinfection (clinically), gastritic form, easy degree of severity.

2 Dysentery, salmonellosis, cholera, escherichiosis, enterovirus diarrhoea.

Task 3

1 Salmonellosis (clinically, epidemiologically), noncommunicative form, gastroenteritic variant, intermedius severity.

2 Cholera, FTI, escherichiosis, dysentery.

Task 4

  1. Rotavirus infection.

2 Cholera, dysentery, escherichiosis, intestinal Iersiniosis.


4 Materials for audience free work

4.1 List of educational practical tasks which must be executed on practical class :

  • to capture the methods of inspection of patient with salmonellosis, FTI, enterovirus infection, rotavirus infection, poliomyelitis;

  • to provide curation of patient;

  • to provide differential diagnostics;

  • to work out a plan of laboratory inspection;

  • to interpret the results of specific inspection of patient;

  • to recognize complications;

  • to work out a plan of treatment of patient;

  • to define a medical tactic in the case of origin of the urgent conditions;

  • to draw medical documentation.


4.2 Professional algorithm in relation to forming of skills and abilities of diagnostics of diarrhoea syndrome of different etiology


п/п

Task

Sequence of implementation

Remarks, warnings in relation to self-control

1

2

3

4

1

To capture the methods of clinical inspection of patient

Complaints


Anamnesis of disease



To distinguish complaints and characteristic syndromes.

To pay attention on beginning, duration, sequence of origin of symptoms, their dynamics


1

2

3

4







Anamnesis of life


Epidemiological anamnesis

To determine the carried diseasees


To determine given, touching realization of fecal-oral mechanism of transmission : the use of off-grade foods of animal origin, patient: to specify, with whom used foods, causing a disease, where foods were bought and kept

2



To provide curation of patient



To provide an objective inspection


General examination


Digestive system


Cardiovascular system


Respiratory

system


General analysis of blood


Coprogram


Serum research


Bacteriological hemanalysis, vomitive masses, scourages of stomach, excrement

Express, dynamics of symptoms conditioned by duration and severity of course of disease

To pay attention on:

- color of skin covers;

- turgor;

- condition of mucous membranes


To pay attention on:

--mucous shell of cavity of mouth;

- flatulence;

- - diarrhoea;

- absence of peristaltic murmurs

To pay attention on:

- muffled tones;

- - tachycardia;

- expansion of borders of relative dullness of heart;

- systole murmur on an apex


To pay attention on:

- violation of breathing (apnoea) rhythm;

- increasing of frequency breathing

3

To prescribe laboratory and additional researches

To pay attention on:

-neutrophilic leukocytosis with change of leukocytar formula to the left; increase of ESR;


--to pay attention on presence in the excrement of blood, mucus, pus.

IEA, RA, RIHA, RA with autostamm, growth of titrus of antibodies.


Determination of causative agent



^ 5 Materials of after-class of independent work

Subjects of Research work

Features of course of diseases with a diarrhoea syndrome in modern terms.

Modern methods of specific diagnostics of diseases, which have course with diarrhoea syndrome.

^ IV TYPES OF VIOLATIONS OF AQUATIC-ELECTROLYTE BALANCE. DEHYDRATION SHOCK. CHOLERA. DIAGNOSTICS AND PRINCIPLES OF TREATMENT OF DEHYDRATION SHOCK


Duration - 2 hours.


Actuality of theme: dehydration shock is the urgent condition for infectious patients, often developing at the severe course of disease. Wrong diagnostic decisions result not only in ineffective and uneffective medical measures, but have a damage for life of patient. If it is earlier diagnosed at sick dehydration shock and realization of reanimation measures is before begun, the greater probability of success is in treatment.

Knowledge of the urgent conditions for infectious patients necessary for the doctors of all specialities, especially those, who works in multi-field and rural medical establishments. They often remain in private with problems which arise up for a patient suddenly. From speed of decision-making, life of man depends on the rightness of actions of doctor.

A cholera is acute intestinal infection, which is accompanied by the defeat of the enzyme system of intestinal epithelium and shows up as diarrhoea, vomiting, haemodynamic disorders which result in dehydration and acidosis.

Kherson, Mykolaiv, Odesa to the area are Endemic on a cholera in Ukraine. Choleraic vibrios are distinguished on territory of all Ukraine. The low-grade and atypic forms of disease predominate; there is possibility of forming of secondary endemic hearths. Annually in the world from 12 to 65 thousands people suffer from cholera.


2 Educational aims of class (with pointing of mastering level which is planned)

2.1 A student must know:

а- 2

  • etiology of cholera, factors of pathogenicity of causative agent;

  • epidemiology of cholera;

  • pathogenesis;

  • clinical displays of cholera with typical course;

  • clinical-epidemiological features of cholera;

  • pathogenesis, time of origin and clinical displays of complications of cholera;

  • laboratory diagnostics of cholera;

  • principles of treatment;

  • principles of prophylaxis;

  • tactic in the case of origin of the urgent conditions;

  • prognosis of cholera;

  • rules of discharge of reconvalescents from an in-patient department;

  • rules of the observation of reconvalescents.

  • clinical and laboratory diagnostics of aquatic-electrolyte violations at the different degrees of dehydration;

  • pathogenesis of dehydration shock;

  • differential diagnostics of dehydration shock with the shock conditions of other genesis;

  • principles of treatment, first aid to patient on the before-hospital stage.


2.2 A student must be able:

а- 3

  • to observe the basic rules of work at sick-bed;

  • to take the case history with the estimation of epidemiology data;

  • to inspect patient and determine basic symptoms and syndromes of cholera, ground clinical diagnosis for timely direction of patient in an in-patient department;

  • to provide differential diagnostics of cholera;

  • on the basis of clinical inspection in good time to recognize possible complications, urgent conditions;

  • to draw medical documentation in fact of establishment of preliminary diagnosis "cholera" (urgent notification is in SES);

  • to work out a plan of laboratory and additional inspection of patient;

  • to interpret the results of laboratory inspection;

  • to work out an individual plan of treatment the account of epidemiology data, severity of condition, presence of complications, allergist anamnesis, concomitant pathology;

  • to render the first aid on the before-hospital stage;

  • to work out a plan of antiepidemic and prophylactic measures in hearth of infection;

  • to give recommendations in relation to the regimen, diet, inspection, supervision in reconvalescence;

  • to provide differential diagnostics of dehydration shock.


3 Materials of before class free work

3.1 Base knowledge, abilities, skills, necessary for the study of theme (intersubject integration)

Discipline

To know

Able

1

2

3
^

Previous disciplines


Microbiology

Properties of Vibrio cholerae. Methods of specific diagnostics

To interpret the results of specific methods of diagnostics of cholera



1

2

3

Physiology

Parameters of physiological norm of organs and systems of man; indexes of inspection in a norm (CBC, urines, biochemistry of blood, parameters of AAC, electrolytes and other)

To estimate data of laboratory inspection

Physiopathology

Mechanism of violation of functions of organs and systems at the pathological conditions of different genesis

To interpret pathological changes on results a clinical and laboratory inspection

Immunology and

allergology


Basic concepts of object, role of the system of immunity in infectious process, influence on the term of elimination of causative agent from the organism of man

To estimate data of immunological research

Epidemiology

Epidemic process (source, mechanism of infection, ways of transmission) at cholera; prevalence of disease in Ukraine and in the world

To take the epidemiology history, provide antiepidemic and prophylactic measures in the hearth of infection

Propaedeutics of internal diseasees

Basic stages and methods of clinical inspection of patient

To take the history, provide the clinical inspection of patient, determine pathological



1

2

3







symptoms and syndromes. To analyse finding

Clinical pharmacology

Pharmakokinetics and

pharmacodynamics, side effects of facilities

to specific and nosotropic therapy

To prescribe treatment depending on the degree of severity of disease, individual features of patient. To write recipes

^ Subsequent disciplines

Domestic medicine



Pathogenesis, epidemiology, dynamics of clinical displays, possible complications of infectious diseases. Principles of prophylaxis and treatment

To provide differential diagnostics of diseasees of different genesis. To recognize an infectious disease, its complication; to interpret data of laboratory inspection. In good time to hospitalize a patient in an infectious in-patient department. To render the first aid in the case of necessity



1

2

3

Intrasubject integration

Infectious diseases

Features of infectious diseases. Principles of diagnostics, treatment, prophylaxis of infectious diseases. Pathogenesis, epidemiology, dynamics of clinical displays, laboratory diagnostics, possible complications of infectious diseases

To provide differential diagnostics of diseases of different genesis. To recognize an infectious disease, its complication; to interpret data of laboratory inspection. To prescribe treatment. To render the first aid on the before-hospital stage
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