Tests and assignments for self assessment

Multiple choices. Choose the correct answer/statement:

1. Pathogenesis of Meningococcemia:

A. Entering of Meningococci through lymphatic vessels in different organs and tissues

B. Penetration of Meningococci in the mucus membraine of nasopharynx

C. Entering of Meningococci with the blood flow in different organs and tissues

D. Penetration of Meningococci over the blood-brain barrier

E. Penetration of Meningococci in the mucus membraine of respiratory tract

2. What tissues are most sensible to action of Meningococcal endotoxin?

A. Heart

B. Endothelium of blood vessels

C. Suprarenal glands

D. Brain

E. Cerebellum

3. Indicate antibacterial medicine for treatment of Meningococcal nasopharyngitis.

A. Semisynthetic penicillines

B. Genthamycin or ofloxacin

C. Macrolides or azythromycin

D. Rifampicin or macrolides

E. Sumamed or genthamycin

4. The hemorrhagic rashes appear at Meningococcemia.

A. On the second day of the disease

B. In 2-3 days after the beginning of disease

C. During first two days of disease

D. On 3-4 day of disease

E. In 4-6 hours after the beginning of disease

5. Indicate the typical pose of child at meningococcal meningitis.

A. Position on side with the tilted head and knees resulted to the abdomen

B. Position on the back with the knees resulted to the abdomen

C. Position on a stomach with the legs resulted to the abdomen

D. Position on side with the back incurved outside

E. Knee-elbow position

6. Indicate the features of CSF at meningococcal meningitis.

A. CSF has opalescence, pleocytosis within the limits of a few dozens, protein is increased, chlorides are reduced, sugar is increased

B. CSF is turbid, pleocytosis within the limits of a few thousands, protein is increased, sugar and chlorides are reduced

C. CSF is turbid, pleocytosis within the limits of a few thousands, protein is reduced, sugar and chlorides are increased

D. CSF is transparent, pleocytosis within the limits of a few units, protein is promoted, sugar and chlorides are reduced

E. CSF is turbid, pleocytosis within the limits of a few dozens, protein and sugar is reduced, chlorides are promoted

7. What antibiotic is applied in case of toxic shock in Meningococcal meningitis?

A. Ampicillin thryhidratis

B. Benzylpenicillin

C. Ciprofloxacin

D. Chloramphenicol

E. Cefotaxim

8. What is the main investigation for laboratory confirmation of Meningococcal infection?

A. Biochemical analysis of CSF

B. Immunological tests

C. Express methods

D. Latex agglutination of blood

E. Selection of agent from nasopharynx, blood, CSF

9. What dose of prednisolone is entered at Meningococcemia without the sings of infectious-toxic shock?

A. 25mg/kg

B. 20mg/kg

C. lOmg/kg

D. 15mg/kg

E.5mg/kg

10. Indicate typical signs of meningitis at children of the first year of life.

A. Nuchal rigidity, positive Musset, Kernig's signs

B. Positive Brudzinsky, Kernig's and Lesage signs

C. Bulging and tension of large fontanel, positive hanging (Lesage) signs

D. Positive Musset, Kernig's and Lesage signs

E. Nuchal rigidity, positive Musset, and Lesage signs

Algorithm of practical students' work

Complaints and anamnesis taking in newborns and infants

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with the parents of sick child.

5. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).

Complaints and anamnesis taking in toddlers and preschoolers (children aged from 1 to 6 years)

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. By means of game playing find a contact with a child.

5. Tactful and calm conversation with the parents of sick child.

6. Explanation of future steps concerning the child (hospitalization, some methods of examination, etc.).

Complaints and anamnesis taking in school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Tactful and calm conversation with sick child his/her parents.

5. Explanation of further steps to child and his/her parents (hospitalization, some methods of examination, etc.).

1. To collect complaints:

• crying, anxiety, headache, insomnia, cramps, nausea, vomiting,

• fever,

• rashes,

• cough, cold.

2. To collect anamnesis of the disease, epidemiological anamnesis:

• beginning the disease from the catarrhal phenomena, fever, toxic, meningeal syndromes, •joining of rashes in a few hours,

• contact with a patient who has meningococcal infection. Carrier in surrounding. • Conversation accomplishment.

3. To inspect a patient:

Physical methods of examination of newborns and infants

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Prepare for examination (clean and warm hands, warm phonendoscope, etc.).

Physical methods of examination of toddlers and preschoolers

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain his/her confidence.

6. Prepare for examination(clean and warm hands, warm phonendoscope, etc.).

Physical methods of examination of school age children

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to the parents what examination should be performed and obtain there informed consent.

5. Find a contact with a child; try to gain his/her confidence.

6. Prepare for examination (clean and warm hands, warm phonendoscope, use the screen if necessary etc.).

A. Examination:

• excitation or languor, tonic-clonic cramps; presence of specific pose (tilted head, resulted to the trunk extremities), bulging large fontanel, hyperacusia, blepharospasm, diaper symptom;

• maculous-papulous than hemorrhagic irregular rashes with necrosis in a center on buttocks, thighs, shins, other areas;

• throat hyperemia, lymphoid follicles hyperplasia on back pharyngeal wall; mucus nasal secretions

B. Palpation:

• bulging, tension of large fontanel,

• sensitive hyperesthesia,

• positive Kernig's, Brudzinsky's, Lesage's symptoms, nuchal rigidity,

• depression of tendon and skin reflexes,

• reactive pain phenomena.

C. Auscultation: tachycardia, deafness of heart tones. Conversation accomplishment.

Informing about the results of examination

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a child and his/her parents what examinations should be performed and obtain their informed consent.

5. Involve adolescent and his/her relatives in to the conversation (compare present examination results with previous ones, clarify whether your expectations are clear for them or not).

6. Conversation accomplishment.

4. To estimate the results of additional researches:

• Complete blood test: leucocytosis with neutrophilia and left shift, increased ESR

• Cerebrospinal fluid (CSF) examination: polymorphonuclear pleocytosis, protein

enlargement, high pressure of CSF, glucose and chlorides are low decreased or normal.

• Bacteriological investigation of nasopharyngeal mucus, blood, CSF; Bacterioscopy of

blood (thick drop) and CSF.

• Serological test: IHAR, immunological methods.

• Explaining the results of examination to child's parents.

• Conversation accomplishment.

5. To substantiate the diagnosis.

Planning and prediction of conservative treatment results

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to child's parents the necessity of further treatment directions correctly and accessibly.

5. Discuss with parents and their child the peculiarities of drug intake, duration of usage, side effects and find out whether they understand your explanations.

6. Conversation accomplishment.

7. To prescribe the treatment: regime, diet, antibiotics, detoxication, corticosteroids, diuretics, anticonvulsive medicine, NSAlDs, symptomatic treatment.

Informing about treatment prognosis

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Correct and clear explanation of expected results of treatment.

5. Discuss with the parents and their child the importance of continuous treatment, following the treatment scheme; make sure that your explanations are properly understood.

6. Conversation accomplishment.

Step

1. The child, of 2 years, with meningococcal infection, is examined by the group of students together with a physician. Typical rash is present on skin of the whole body, especially on the buttocks, lower limbs. Name, which sign is not present at meningococcal rash:

A. Hemorrhagic nature

B. The elements are mildly increased on the level of the skin

C. The necrosis in the centre

D. Disappears at pressure

E. In scraper is possible to find meningococci

3. To the boy, 4 years old, was put the diagnosis of meningococcal infection (generalized form). The child is treated in infectious department. What generalized form is the most often one?

A. Meningitis

B. Meningococcemia

C. Combined form (Meningococcemia + meningitis)

D. Meningoencephalitis

E. Encephalitis

4. The child, 4 years old, is ill with meningococcal infection (meningococcemia), complicated by infectious-toxic shock. Choose the antibacterial medicine, which is reasonable to use for etiotrope therapy:

A. Penicillin

B. Erythromycin

C. Genthamycin

D. Karbenicillin

E. Chloramphenicol

Real situation to be solved:

1. A boy of 1 year old was hospitalized in infections department with upper respiratory tract infection.

Objectively: severe condition, body temperature is 39.5 °C, boy is exited, and tremor is present. The disease has begun 4 hours before. Skin is pale, without rashes. Conjunctiva and pharynx are hyperemied. Heart beats are rhythmic, 176 per minute. Breathing is puerile, 62 per minute. Abdomen is soft, painless. In 2 hours after hospitalization hemorrhagic "star-like" papules have appeared on buttocks, legs.

1. Name the diagnosis.

2. What laboratory test prove the diagnosis?

2. In entrance department of the infectious hospital to the 5 years old child physician put
diagnosis of meningococcal infection, generalized combined form (meningococcemia, meningitis).

1. Account a dose of penicillin; write the recipe for a course of treatment.

2. When the child could be discharged from the hospital?

Answers for the self- control:

Tests: 1. C; 2. B; 3. D; 4. E; 5. A; 6. B; 7. D; 8. E; 9. E; 10. C.

Step: l.D: 2. C;3.E.

Real - life situation 1:

1. Meningococcal infection, generalized form, typical meningococcemia.

2. Nasopharynx, blood culturing of N. meningitidis.

Real - life situation 2:

1.20 kgx3 000,000 IU per day every 4 hours (for 6 times) = 1000,000 IU 6 times daily.

Rp.: BenzylpenicilliniNatrii 1,000,000 IU.

D. t. d. N 30

S. dissolve the contents of the phlacon in 5 ml of 0,25 % Novocain, put intramuscularly 5 ml

of dissolved penicillin 6 times a day (every 4 hours).

3. Clinically healthy, with normal CSF analyses; with one documented negative nasopharyngeal culture which perform in 3 days after antibiotic therapy.

Aids and material tools: Charts "Meningococcal infection", photo, video.

Result level

Students must know:

1. Etiology, epidemiology, pathogenesis of meningococcal infection.

2. Clinical diagnostic features of meningococcal infection.

3. Laboratory examination of patients with meningococcal infection.

4. Differential diagnosis of meningococcal infection.

5. Main treatment of meningococcal infection.

6. Prophylaxis of meningococcal infection. Students should be able to:

1. Separate anamnesis data, which told us about meningococcal infection.

2. Find diagnostic criteria of meningococcal infection, while examining the patient.

3. To perform differential diagnosis among diseases, which have the similar clinical features.

4. To learn the main tendentions of the meningococcal infection treatment.

5. To perform prophylaxis of meningococcal infection.

Дата добавления: 2015-10-29