Standards of answers:

1. Polyuria, polydipsia, hyperglycemia, glycosuria

2. Congenital hypothyros

3. Hyperthyros.

Hardwares and material providing of training:

1) Tables:

“Indexes of sexual development of children”

“Endocrine glands and their hormones”

2) Charts:

Symptoms of diabetes mellitus

Syndrome of hypofunction of thyroid gland

Reasons of low height in children

3) Set of test tasks of entrance control (10 examples).

4) Set situation clinical tasks (10 examples).

5) Mtetodical developments:

“Anatomic and physiologic features of the endocrine system in children”

“Indexes of arterial pressure in children of different age”.

“Method of examination of the endocrine system”

“Syndromes in pediatrics”

Information sources.

А) Basic:

1. Kapitan T. Propedeutics of children’s diseases and nursing of the child. – Vinnitsa, 2006. – P. 619-632

B) Additional:

1. Мазурин А.В., Воронцов И.М. Пропедевтика детских болезней.- M: Медицина, 2001. – С.622-670.

2. Пропедевтика детских болезней / под ред. А.А.Баранова. – М.: Медицина, 1998. – С.304-314.

Program of self-preparation of students to the theme:

1. To study basic and additional information sources according to the theme of training.

2. To be able to conduct the method of examination of the endocrine system in children: inspection, estimation of physical and sexual development, palpation of thyroid gland.

3. To be able to take a care of children with the defeat of the endocrine system.

4. To pay attention and learn the basic pathological syndromes of defeats of endocrine system in children.

Semantic module 11. Immune system and system of blood in children.

Concrete aims:

• To collect anamnesis and expose information which specify on the changes from the side of the immune system and system of blood in children.

• To conduct the objective examination of the immune system and system of blood taking into account age features.

• To select the clinical signs of the immunodeficiency, anemia, to establish leading syndromes.

• To interpret the results of laboratory-instrumental methods of examination.

Theme 14. Anatomic and physiologic features of the immune system, examination method, semiotics of defeats.

Theme 15. Anatomic and physiologic features of the system of blood, examination method, semiotics of defeats.

Theme of practical training: Features of the system of blood in children of different age groups. Methods of clinic-laboratory examination of children with the defeat of the system of blood. Clinic -hematological semiotics of basic syndromes (anemic, hemolytic, hemorrhagic and other) and diseases of the system of blood in children. Laboratory methods of examination of the functional state of organs and systems of children's organism. Rule and technician of taking of material for examination. Methods of diagnostics of immunodeficiency in children.

Place: educational room in the somatic department.

Professional orientation of students: Growth of pathology of blood in children is marked in recent years, especially defeats of peripheral blood and limph system. The system of blood of child has the row of morphological and functional features, without taking into account which examination results and put clinical diagnosis cannot be correctly evaluated.

Base level of knowledge and abilities:

№	Discipline	To know
1. 2. 3. 4.	Anatomy Normal physiology Histology Pathological physiology	Development of the system of blood in fetus and in different periods of childhood. Description of elements of blood in children. Knowledge of physiology changes in the system of blood in children. Histological features of the system of blood. Basic principles of functioning of the system of blood in children.

Plan of conducting of training.

№	Elements of practical training (each)	Time (minutes)
1. 2. 3. 4. 6.	Test control and his analysis Demonstration of method of clinical examination of patient with pathology of the system of blood in children. Independent work of students with healthy and sick children. Inspection of patients. Registration of protocols of inspection of patient with estimation of the state of the system of blood and immune system in children that substantiation clinical syndrome. Round of children, which students worked with. Analysis of patients. Signing of protocols. Results and final estimation of knowledge and abilities of students and task for independent preparation to a next training.	15 min. 30 min. 50 min. 50 min. 15 min. Total:160 min.

List of theoretical questions:

1) Anatomic and physiologic features of the system of blood at the children of a different age and their clinical value.

2) Method of clinical examination of patient with pathology of the system of blood:

а) questioning

б) features of inspection: position in a bed, color of skin and visible mucous; estimation of appendages of skin, discover of deformation of bones and joints; forms of abdomen;

в) palpation of peripheral lymph nodes;

г) palpation of spleen;

д) palpation of liver;

є) define of fluctuation in joints;

ж) percussion of bones.

3) Semiotics of defeats of the system of blood:

а) anemic syndrome;

б) symptoms of leucosis;

в) symptoms of hemorrhagic vasculitis;

г) symptoms of thrombocytopenic purpura;

д) symptoms of hemophilia.

4) Rule and technique of taking of material for examinations

5) Methods of diagnostics of immunodeficiency in children

6) Estimation of results of laboratory examinations.

Method of conducting of practical training:

1. After verification of presents and announcement of theme of training with pointing on its actuality teacher conducts the writing entrance control of knowledge.

2. Analysis of the executed tests and consideration of errors.

3. In the ward of department a teacher demonstrates the method of clinical examination of patient with pathology of the system of blood.

4. A teacher distributes patients for independent work, assigns.

   № п/п	Task	Pointing of teacher to the students	Note
   1.	To collect anamnesis at a patient with pathology of system of blood	Algorithm of collection of anamnesis 1.Anamnesis of diseases: beginning of disease; first clinical symptoms; whether treatment was conducted, by what preparations; dynamics of disease; complaints of patient at the moment of examination 2. Anamnesis of life: current of pregnancy in mother; current of delivery; state of health of child in period of new-born and breast age; morbidity of child; presence of allergic reactions; heredity of patient.	It is necessary to put questions which are up to the system of blood It is necessary to expose the factors of risk of development of disease of the system of blood
   2.	To conduct the objective examination of the system of blood	Algorithm of practical work of student Inspection of patient: position in a bed, physical development of patient; presence of discolorations of skin, dryness; presence of changes of visible mucous shells; changes in a state of appendages of skin; presence of deformations and other changes of joints. Palpation of peripheral lymph nodes. Palpation of spleen. Palpation of liver. Percussion with the purpose of define of pain at percussion of bones. Analysis of results of laboratory methods of examination of the system of blood.	To conduct the examination of patient taking into account age features
   3.	To do a conclusion about the state of the system of blood and immune system at a child. To define the syndrome of defeat	To define the pathological changes (symptoms) in a state of the system of blood. To make the report of pathological symptoms. To make a conclusion about a syndrome	To give estimation of the exposed changes taking into account age features

5. Students design protocol of examination of patient with estimation of the state of the system of blood and immune system, a pathological syndrome is grounded.

6. A teacher conducts the analysis of patients with the analysis of substantiation pathological clinical syndrome. Signature of protocols.

7. A teacher works out the resume of training, gives estimation of knowledge and abilities of students. Assigns for independent preparation for a next training.

Forms and methods of self-control

Test tasks

1. Basic organ of hemopoesis after birth is:

1. spleen

2. liver

3. lymph nodes

4. marrow*

5. reticular formation

2. Basic organ of hemopoesis in the intrauterine period

1. spleen

2. reticular formation

3. liver*

4. marrow

5. lymph nodes

3. Indexes of red blood in new-born children at first hours after birth:

1. Hb – 120 g/l, Er.-4,0 Т/l

2. Hb – 180 – 240 g/l, Er. - 5,6-7,5 Т/l*

3. Hb – 110 g/l, Er.-3,0 Т/l

4. Hb – 80 g/l, Er.-2,7 Т/l

5. Hb – 260 g/l, Er.-9,1 Т/l

4. Amount of leucocytes in the peripheral blood in children of the first 5 days of life

1. 15-20 G/l*

2. 5-6 G/l

3. 8-10 G/l

4. 30-40 G/l

5. 3-4 G/l

5. Leukocyte formula of new-born children in age 5-6 days

1. neutrophils – 60, lymphocytes – 30 %

2. neutrophils – 26, lymphocytes – 60 %

3. neutrophils – 44, lymphocytes – 45 % *

4. neutrophils – 36, lymphocytes – 51 %

5. neutrophils -30, lymphocytes – 60%

Clinical situation tasks

1. A child 5 years became ill sharply, in the morning mother revealed the purple-dark blue spots of different sizes (from 0,5 to 3 cm in a diameter) on a trunk and extremities, nasal bleeding appeared. The temperature of body was normal. In the peripheral blood Er.- 3,3T/l, Hb –118 g/l, CI –0,8, Tromb.- 30 000 /l.

Define clinic-hematological syndrome.

2. In 2 year child the pallor of skin and mucous is marked, dystrophy of nails, hairs, anorexia, infringement of taste. In a peripheral blood: Er.-2,8 T/l, Нв. –84 g/l, CI - 0,56, Leuc. – 6,2 G/l, Tromb.– 220 000/l,

Define clinic-hematological syndrome.

3. 4 years old child has lemon color of skin, weakness, bad appetite, liver goes out from a costal arc on 3 cm., spleen – on 5 cm. In a peripheral blood: Er. – 2,7 T/l, Нв. – 82 g/l, CI – 1,1, Leuc. – 6,0 G/l, ESR – 6 mm

Define clinic-hematological syndrome.

Answers :

Task 1.

Hemorrhagic syndrome

Task 2.

Anemic syndrome

Task 3.

Hemolytic syndrome (hemolytic anemia)

Hardwares and materials of providing of training.

1. Tables:

“Intrauterine stages of hemopoesis”

“Physiology crosses of white blood in children”

“Peripheral lymph nodes”

2. Charts:

“Indexes of red blood in children of different age”

“Indexes of white blood in children of different age”

Set of test tasks of initial control

2. Methodical developments :

“Method of examination of the system of blood in children”