METHODICAL INSTRUCTION FOR STUDENTS OF THE 4 COURSE
MEDICAL FACULTY
LESSON № 11 (PRACTICAL – 6 HOURS)
Theme:
1. Syringomyelia
2. Neurosyphilis. Cerebral meningeal syphilis. Cerebrovascular syphilis. Syphilitic Gumma. Dementia Paralytica. Syphilis of Spinal Cord. Tabes dorsalis. Clinical characteristic, diagnosis and treatment
3. Neurological symptoms of AIDS
Aim: Students should be able independently to diagnose syringomyelia, neurosyphilis, to prescribe treatment. To make preventive measures. To fulfill medical labor examination. Students should be able to find out symptoms of ALS. Students should be able by themselves to examine neurological patient, to make the topical and clinical diagnosis, to prescribe adequate treatment, and to record the patient’s Case report.
Professional orientation of students: Syringomyelia results in rapid disability of patients in young and mature age. Neurological symptoms of AIDS is very common at any age. Syringomyelia and neurosyphilis is characterized by severe changes of central nervous system. That’s why in time diagnosis syringomyelia, neurosyphilis and neurological symptoms of AIDS has very important meaning for the effective treatment of such patients. General examination of a patient and filling in the patient’s Medical Card is done by all the doctors (independently from specialty) according to determined set. Careful history, subjective and objective clinical symptoms of a disease is the base for correct topical and clinical diagnosis and adequate treatment scheme for each patient. To form proper clinical thinking and deontology.
Methodology of Practical Class (9:00-12:00).
Algorithm of students’ communication with patients with pathology in subject (communication skills):
Complaints and anamnesis taking in patients
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with patient, try to gain his/her confidence
5. Correct inquest, listening to the patient’s explanation.
6. Conversation accomplishment.
Physical methods of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Find a contact with a patient, try to gain his/her confidence
5. Explain to the patient the nessessity of the examination and its aim, get his/her informed consent
6. Explain to the patient examination details, its safety and possible sensations
7. Prepare for the examination (clean, warm hands, ets.)
8. Explain to the patient results of his/her tests correctly and accesibly
9. Conversation accomplishment.
Informing about the results of examination
1. Friendly facial expression and smile.
2. Gentle tone of speech.
3. Greeting and introducing
4. Interpretation of test results
5. Calm a patient in the case of precense of pathological changes, inform about the following actions
6. Assure in positive changes and favourable prognosis at implementation of all of the medical recommendations
7. Conversation accomplishment
Work 1. Syringomyelia.
1. To inspect a sick (anamnesis, somatic-neurologic status).
2. To make the clinical diagnosis.
Step II. Aim: To prescribe the treatment.
Work 2. Neurosyphilis. Cerebral meningeal syphilis. Cerebrovascular syphilis. Syphilitic Gumma. Dementia Paralytica. Syphilis of Spinal Cord. Tabes dorsalis. Clinical characteristic, diagnosis and treatment. Poliomyelitis. AIDS.
Step I. Aim: To put clinical diagnosis. For this purpose it is necessary:
1. To determine the clinical form of the neurosyphilis according to algorithm of differential diagnosis (look to references).
2. To analyze specific serological tests (VDRL, RPR, ART, FTA-ABS, MHA-TP, and TPI).
3. To consider the specific AIDS tests.
4. To find out clinical stages of poliomyelitis according to algorithm of differential diagnosis (look to references).
5. To localized pathological focus.
6. To formulate clinical diagnosis, for example:
a) Tabes dorsalis, algae stage with paroxysmal visceral episodes.
b) Poliomyelitis, residual stage, with deep flaccid palsy of the right foot.
Step II. Aim: To prescribe the treatment.
Neurosyphilis is a treatable disease; progression may be stopped in all cases, and most patients will show improvement.
1. Aqueous penicillin G 2 to 4 million units IV q4h for 10 days, followed by penicillin G Benzanthine 2.4 million units IM weekly, for three doses.
2. Amoxicillin 3 g/day
3. For penicillin allergy, chloramphenicol 2 g/day for 15 to 30 days.
4. Patients with neurosyphilis must be followed with periodic serologic testing and repeat CSF exam for 3 years.
Step III. Aid: to study preventive measures.
Work 3. Neurological symptoms of AIDS
2. To inspect a sick (anamnesis, somatic-neurologic status).
2. To make the clinical diagnosis.
Step II. Aim: To prescribe the treatment.
Step III. Aid: to study preventive measures.
Individual Students Program.
You should be prepared for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:
Theme 1. Syringomyelia.
To learn the syringomyelia:
a) features of status dysrhaphycus;
b) characteristic of vegetative and sensory lesion;
c) clinical forms of syringomyelia;
d) symptoms of syringomyelia;
e) treatment of syringomyelia.
Theme 2. Neurosyphilis. Cerebral meningeal syphilis. Cerebrovascular syphilis. Syphilitic Gumma. Dementia Paralytica. Syphilis of Spinal Cord. Tabes dorsalis. Clinical characteristic, diagnosis and treatment. Poliomyelitis. AIDS.
1. To study neurosyphilis:
a) Etiology and pathogenesis;
b) Clinical presentation of symptomatic of early forms of neurosyphilis;
c) Clinical picture of late forms of neurosyphilis;
d) Specific serological tests for neurosyphilis (VDRL, RPR, ART, FTA-ABS, MHA-TP, TPI) and there results;
e) Specific treatment for mesodermal and parenchymatous neurosyphilis.
Theme 3. Neurological symptoms of AIDS
1.Clinical picture of AIDS:
a) Pathogenesis, pathomorphology and clinical presentation of AIDS neurological complication;
b) Stages of AIDS (latent, pre-AIDS, AIDS with wide clinical symptomatic;
c) Clinical presentation of neurological symptomatic of AIDS (AIDS-dementia, subacute encephalomyelitis, aseptic meningitis, meningoencephalitis, myelopathy, neuropathy);
2. Preventive measures.
Seminar discussion of theoretical issues (12:30-14.00).
Test evaluation and situational tasks.
Tests:
1. What clinical forms of neurosyphilis are?
2. Clinical classification of early meningeal-vascular syphilis.
3. Clinical classification of late parenchymatous syphilis.
4. To name the specific serologic tests for syphilis.
5. To name clinic symptoms of syphilitic meningoencephalitis.
6. What is characteristic feature of vascular syphilis?
7. What stages of Tabes dorsalis do you know?
8. Specific treatment of early (mesodermal) neurosyphilis. Prescribe aqueous penicillin G.
9. Specific treatment of late (parenchymatous) neurosyphilis. Prescribe Amoxicillin.
10. Clinical picture of neurological symptoms of AIDS.
11. Clinical picture of optic fundus in tabes dorsalis.
12. Name the clinical signs of chronic syphilitic meningitis.
13. Clinical forms of neurosyphilis.
14. Differential signs of syphilitic and vertebral radiculopathy.
15. The signs of neuralgic stage of tabes dorsalis.
16. The signs of ataxic stage of tabes dorsalis
17. The signs of “upper tabes”.
18. The signs of “lower tabes”.
19. What motor neuron is damaged at amyotrophic syphilis?
20. What motor neuron is damaged at spastic spinal palsy?
21. Clinical features of hypertension syndrome.
22. Name the drugs which cure hypertension syndrome.
23. Clinical features of status dysrhaphycus.
24. Clinical forms of syringomyelia.
25. Clinical symptoms of syringomyelia.
Real-life situations to be solved:
1. What symptoms belong to myelitis of thoracic part of spinal cord?
2. How neurosyphilis is classified now?
3. What stages of tabes dorsalis do you know?
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.
Student should know:
1. Etiology and pathogenesis of demyelination diseases
2. Clinical features of demyelination diseases
3. Clinical forms of demyelination diseases
4. Differential diagnosis of MS and ADEM
5. Clinical feature of neurosyphilis.
4. Clinical signs of neurological symptoms of AIDS.
5. Clinical features of status dysrhaphycus.
6. Clinical forms of Syringomyelia
7. Clinical symptoms of Syringomyelia
Student should be able to:
1. Examine the patients with demyelination diseases
2. Administer additional methods examination
3. Administer treatment of demyelination diseases
4. Determine prophylaxis of MS, ADEM, ALS, AM and their complications.
5. Make a correct topical diagnosis
6. Make a correct clinical diagnosis
7. Prescribe treatment
Correct answers of test evaluations and situational tasks:
1. Pelvic disorders, lower spastic paraplegia, conductive disorders of sensibility and trophic disorders.
2. Early (mesodermal) and late (parenchymatous).
3. Neuralgic, ataxic, pseudoparalitic.
Independent work of students (14:15-15:00).
References:
А – Basic:
1. WEB-site of tdmu
2. Basic Neurology Second Edition. John Gilroy, M.D.- McGraw-Hill international editions, medical series, 1990.
3. Methodological instructions for general clinical examination of a neurology patient and filling in the patient’s Case Report.
4. Clinical examinations in neurology – Mayo clinic and Mayo foundation.- 4-th edition.- W.B. Saunders Compani, Philadelphia, London, Toronto.- 1976 y.
В – Additional:
5. Neurology for the house officer.- 3th edition.-Howard L. Weiner, MD and Lawrence P. Levitt, MD,- Williams &Wilkins.- Baltimore.- London.- 1980 y.
6. Van Allen’s Pictorial Manual of Neurologic Tests.- Robert L.Rodnitzky.- Third edition.-Year Book Medical Publishers, inc. Chicago London Boca Raton.- 1981y.
7. Neurology in lectures. Textbook. Edited by the head of Neurology Department – prof. S.І. Shkrobot. – 2005.
Methodical instruction has been worked out by: dotsent N.R. Sokhor
Methodical instruction was discussed and adopted at the Department sitting
29.05.2013 . Minute № 9
Methodical instruction was adopted and reviewed at the Department sitting
__________201 . Minute № ___
