Additional methods of examination

Although clinical evaluation is essential, progress can also be assessed by monitoring certain parameters at the bedside.

Addition methods of examination include:

skin temperature- this reflects cutaneous blood flow and is therefore a useful indirect measurement of peripheral perfusion;

urinary flow - this is a sensitive measure of renal perfusion and can easily be monitored if a urinary catheter is in place;

oxygen saturation - this can be monitored easily using a finger or ear lobe probe. In general, oxygenation is satisfactory if the saturation is greater than 90 %;

ECG - a standard monitor will record rate and rhythm, ST-segment shift, which may be useful in patients with ischemic heart disease;

central venous pressure - using a catheter to measure the right atrial pressure is a useful means of assessing the circulating blood volume and therefore the appropriate rate of intravenous fluid replacement;

pulmonary artery wedge pressure - in most situations the central venous pressure is an adequate guide to the filling pressures of both sides of the heart.

Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir Publishers, 1990. - 647 p.

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic2. Rheumatism

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: Rheumatic disease of the heart: etiology, pathogenesis, classification, the clinical picture, and etiology factors. the Jones Criteria for Rheumatic Fever, Updated 199, additional methods of examination

Acute rheumatic fever

Rheumatic fever is a general infectious in which connective tissues, mainly of the cardiovascular system, are affected by inflammation; joints, serous membranes, internal organs, and the central nervous system are often. Rheumatism is a collagenous disease, i.e. a disease characterized by a systemic and progressive derangement of connective tissue.

Rheumatism was classified as an independent disease with typical affections not only of the points but also mainly have the heart in 1835 by a French clinicist Bouillaud and in 1836 by the Russian physician Sokolsky. Until that time rheumatism had been considered a disease of joints.