Практикум по педиатрии. Practicum in Pediatrics. Учебное пособие для студентов 5-го курса
.pdfBiochemical test of urine: protein – 4.2/l/day (norm – 0.2 g), phosphorus – 21 mmol/day (normal – 19-21), oxalates – 204 mg/day (norm – 17 mg).
Questions:
1.Put diagnosis and justify it.
2.Investigation plan.
3.What might contribute to the development of the disease in this case?
4.Prognosis of this disease.
5.Which syndromes can appear with the progression of CKD in children?
6.Which electrolyte changes are characteristic for different stages of CKD?
7.Which symptoms would indicate the beginning of the 5 (terminal) stage of CKD?
8.Assign the diet and treatment.
Diagnostic keys
1.Infection of the urinary tract (acute cystitis).
2.Secondary (obstructive?) pyelonephritis due to anomalies of the kidneys, acute course.
3.Secondary chronic pyelonephritis due to oxa- late-calcium crystalluria (primary), the period of exacerbation, Chronic kidney disease (CKD) 1.
4.Secondary pyelonephritis, chronic, active stage. Vesicoureteral reflux on the right. Reflux nephropathy. Anemia (hypoerythropoietic). Symptomatic arterial hypertension. CKD 2-3.
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5.Acute nephritic syndrome, kidney injury, acute period (acute post-streptococcal glomerulonephritis with acute nephritic syndrome with renal dysfunction).
6.Acute nephritic syndrome, renal injury (acute renal failure), acute phase.
7.Progressive nephritic syndrome (debut). Decom-
pensated metabolic acidosis. Kidney damage with a significant reduction in glomerular filtration.
8.Nephrotic syndrome without renal dysfunction.
9.Berger's disease, IgA-nephropathy. Mesangioproliferative type of glomerular changes.
10. Chronic glomerulonephritis, mixed form, the active phase. Moderate reduction in glomerular Filtration. Secondary oxaluria. Normochromic anemia.
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DESCRIPTION AND PROGRAM OF COURSE
“PEDIATRICS”
1. Course description
Course objective: obtaining professional knowledge of the basics of Pediatrics and main skills.
To gain this objective in the process of studying, the following tasks should be solved:
1.To teach students to work with the main and additional sources of information in pediatrics, and develop the ability to analyze and apply this knowledge in practice to determine the diagnosis and treatment.
2.To familiarize students with modern concepts of etiology, pathogenesis, epidemiology, clinical and laboratory diagnostic tools, diagnostic criteria, treatment and prevention of diseases in children.
3.To develop the students’ skills on the investigations of patients, differential diagnosis, formulation of preliminary diagnosis, diagnostic and therapeutic concepts, the interpretation of additional methods of investigation.
Innovative character of the course:
1.Use the latest scientific achievements in pediat-
rics.
2.Inclusion of approaches to diagnosis and treatment of diseases in children based on the principles of evidence-based medicine.
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3.Implementation of the Integrated Management of Childhood diseases WHO.
4.Interactive form of training – the clinical case studies, based on the medical records of individual patients (case-method).
Contents of the course. Class work (108 hours). Topics of lectures (12 hours):
1.Fetal hypoxia. Berth asphyxia.
2.Pathology of premature newborns.
3.Congenital infection.
4.Development retardation. Hypotrophy.
5.Cardiac failure.
6.Joints diseases.
7.Atopic diseases.
8.Chronic diarrhea.
Topics of lessons (96 hours):
1.Fetal hypoxia. Birth asphyxia. Birth injuries. Perinatal damages of nervous system.
2.Hypotrophy. Protein-energy malnutrition. Failure to thrive. Intrauterine growth retardation. Pyloric stenosis. Malabsorption. Paratrophy.
3.Vitamin deficiencies. Hypervitaminosis. Rickets and rickets-like diseases (tubulopathy). Hemorrhagic disease of the newborn.
4.Anemia. Neonatal jaundice.
5.Perinatal infection. Congenital infection. Localized purulent-septic diseases of newborn. Neonatal sepsis.
6.Respiratory diseases. Respiratory distress syndrome of newborn. Bronchopulmonary dysplasia. Pneumonia. Bronchiolitis.
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7.Diseases of the gastrointestinal tract. Gastroesophageal reflux disease. Peptic ulcer disease. Chronic gastritis and gastroduodenatis. Diseases of gall bladder and bile ducts. Irritable bowel syndrome.
8.Myocarditis. Cardiomyopathy.
9.Congenital heart disease. Infective endocarditis.
10.Rheumatic fever. Arthritis. Diseases of joints.
11.Atopic diseases. Atopic dermatitis. Allergic rhinitis. Bronchial asthma. Acute urticaria. Anaphylactic shock.
12.Kidney and urinary tract diseases.
Out of lesson work (36 hours):
1.Independent preparation for seminars, study the main and additional sources of information.
2.Writing medical records (course work).
3.Preparation of a report and presentation of the chosen topic.
4.Preparation of a report and presentation of the clinical case of the patient.
Description of the system of knowledge control. Control of knowledge should be carried out by point-rating system.
The following points are assessed:
1.Attending lectures (1 lecture – 1 point);
2.Attendance and work in class (discussion of case studies, participation in clinical analysis of patients – 4 points for 1 lesson);
3.Writing medical records (maximum mark – 15 points);
4.Two control tests for disease cycle (the maximum mark for each test – 15 points);
5.Preparation of a report and presentation on the chosen topic and/or clinical analysis of one patient (maximum mark – 5 points).
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Extra points are awarded for attendance of the student’ scientific circle and/or electives in pediatrics (the highest possible mark – 5 points).
Information about the authors:
Alexeeva Olga Vladimirovna – MD, Assistant Professor of the Department of Pediatrics.
Artamonova Valeria Anatolievna – MD, Assistant Professor of the Department of Pediatrics.
Bistrova Olga Vitalievna – Assistant Lecturer of the Department of Pediatrics.
Brilkova Tatyana Vladimirovna – MD, Assistant Lecturer of the Department of Pediatrics.
Illarionova Tatyana Yurievna – Assistant Lecturer of the Department of Pediatrics.
Kantemirova Marina Grigorievna – MD, Assistant Professor of the Department of Pediatrics.
Khaled Mustafa – post-gradute student of Department of Pediatrics.
Korovina Olga Alexandrovna – Assistant Lecturer of the Department of Pediatrics.
Krsheminskaya Irina Vladimirovna – Assistant Lecturer of the Department of Pediatrics.
Kuzmenko Larisa Grigorievna – MD, PhD, DSc, Professor of Department of Pediatrics.
Nazarova Tatyana Ivanovna – MD, Assistant Professor of the Department of Pediatrics.
Ovsyannikov Dmitriy Yurevich – MD, PhD, DSc, Head of Department of Pediatrics.
Petruk Natalia Ivanovna – MD, Assistant Professor of the Department of Pediatrics.
Pushko Lyubov Vitalyevna – MD, Assistant Professor of the Department of Pediatrics.
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2. Program of course
Module structure of the discipline.
Content of education
Module 1. Deseases of Newborns and Infants.
1.1.Fetal hypoxia. Birth asphyxia. Etiology. Pathogenesis. Diagnostic criteria. Classification. Apgar score. Clnical picture. Perinatal damages of nervous system of hypoxic-ischemic genesis (cerebral ischemia, intraventricular hemorrhage). Sarnat’s classification of hypoxic-ischemic encephalopathy. Damages of internal organs in birth asphyxia (myocardial ischemia, shock, pulmonary hypertension, meconium aspiration, necrotising enterocolitis, ischemic nefropathy, hypoglycemia, hyponatriemia, hypocalcaemia). Management. Neonatal resuscitation. Prognosis. Sequence of hypoxic perinatal damages of nervous system (cerebral palsy).
1.2.Birth injury. Etiology. Pathogenesis. Birth injury of skin, subcutaneous fat, muskuloskeleton system, internal organs, central (brain, spinal cord) and peripheral nervous system. Types of intracranial hemorrhage. Diagnostics. Treatment. Prevention. Prognosis. Sequent of traumatic perinatal damages of nervous system.
1.3.Pathology of premature infants. Respiratory distress syndrome of newborn. Apnoe. Bronchopulmonary dysplasia. Patent ductus arteriosus. Particulars of brain injury. Retinopathy of prematurity. Anemia (early and late). Etiology. Pathogenesis. Frequency. Clinical picture. Treatment. Prevention.
1.4.Neonatal jaundice and hyperbilirubinemia.
Meabolism of bilirubin in newborn. Unconjugated hy-
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perbilirubinemia (haemolytic disease of the newborn and other haemolytic anemia, conjugated hyperbilirubinemia) and complications (kernicterus). Conjugated hyperbilirubinemia. Persistent neonatal jaundice. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics. Treatment. Prevention. Prognosis.
1.5.Localized purulent-septic diseases of newborn. Neonatal sepsis. Clinical forms: localized infections (skin and subcutaneous fat infections, omphalitis, osteomyelitis, arthritis, conjunctivitis) and neonatal sepsis. Risk factors. Etiology. Epidemiology. Pathogenesis. Classification. Clinical picture. Diagnostics. Treatment. Prevention. Prognosis.
1.6.Congenital infection. Toxoplasmosis. Cytomegalovirus. Rubella. Syphilis. Herpes simplex virus. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis.
1.7.Hypotrophy. Protein-energy malnutrition. Marasmus. Kwashorkor. Failure to thrive. Intrauterine growth retardation. Paratrophy. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis. Sequent.
1.8.Anemia. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis. Sequence.
1.9.Vitamin deficiencies. Hypervitaminosis. Rickets and rickets-like diseases (tubulopathy). Spasmophilia. Hemorrhagic disease of the newborn. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis. Sequence.
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Module 2. Respiratory diseases.
2.1.Bronchiolitis. Etiology. Risk factors. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis. Sequence.
2.2.Pneumonia. Etiology. Pathogenesis. Classification. Diagnostic criteria. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis.
2.3.Allergic rhinitis. Bronchial asthma. Etiology. Risk factors. Pathogenesis. Classification. Diagnostic criteria. Clinical picture. Status astmaticus. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis. GINA. ARIA.
Module 3. Cardiac diseases.
3.1.Congenital heart disease. Ventricular septal defect. Open ductus arteriosus. Fallot's tetralogy. Atrial septal defect. Coarctation of the aorta. Transposition of the great arteries. Etiology. Epidemiology. Pathogenesis. Classification. Clinical picture. Diagnostics. Treatment. Prognosis.
3.2.Infective endocarditis. Etiology. Risk factors. Pathogenesis. Classification. Diagnostic criteria. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis.
3.3.Myocarditis. Cardiomyopathy. Etiology. Pathogenesis. Classification. Diagnostic criteria. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis.
3.4.Cardiac failure. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment.
3.5. Rheumatic fever. Arthritis. Diseases of joints. Etiology. Pathogenesis. Classification. Diag-
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nostic criteria. Clinical picture. Diagnostics and differential diagnosis. Reactive arthritis. Juvenile rheumatoid arthritis. Perthes disease. Treatment. Prevention. Prognosis.
Module 4. Diseases of the gastrointestinal tract.
4.1.Pyloric stenosis and pylorospasm. Etiology. Pathogenesis. Clinical picture. Diagnostics and differential diagnosis. Treatment.
4.2.Gastroesophageal reflux disease. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment.
4.3.Peptic ulcer disease. Chronic gastritis and gastroduodenatis. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention.
4.4.Diseases of gall bladder and bile ducts.
Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention.
4.5.Chronic diarrhea. Malabsorption. Chronic enterocolitis. Lactase intolerance. Coeliac disease. Cystic fibrosis. Inflammatory bowel disease. Irritable bowel syndrome. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention. Prognosis.
Module 5. Kidney and urinary tract diseases.
5.1.Urinary tract infection. Pyelonephritis. Cystitis. Etiology. Pathogenesis. Classification. Clinical picture. Diagnostics and differential diagnosis. Treatment. Prevention.
5.2.Glomerulopathy. Glomerulonephritis. Etiology. Pathogenesis. Classification. Clinical picture. Syndromes. Nephritic syndrome. Nephrotic synd-
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