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Methodical instructions

June 20, 2024

Methodical instruction for students

of the V course medical faculty

Lesson N 2 (practical – 6 hours)

Theme 1. Cholera. Infectious diseases of viral etiology with fecal-oral mechanism of transmission.

Theme 2. Intestinal infectious diseases with the dominant involvement of colon: shigellosis, amebiasis. Yersiniosis. Protozoal intestinal invasions: lambliosis, balantidiasis.

Aim: to study clinical and laboratory manifestation, diagnostics, treatment and prophylaxis of Cholera, shigellosis, amebiasis, iersiniosis, lambliosis, balantidiasis.

Theme 1. Cholera. Infectious diseases of viral etiology with fecal-oral mechanism of transmission.

Professional orientation of students: Cholera is an acute anthroponous infectious disease with fecal-oral mechanism of transmission. Cholera is characterized by dehydration due to loss of the fluid with watery diarrhea and vomiting. Cholera is concerned to the group of the diseases, which are submitted to “international medical-sanitary roles”.

1. Self study for class:

Theme N 1 (practical class).

Clinical manifestation of cholera.
Diagnosis of cholera.
Treatment of cholera.
Complications of cholera.
Prophylactic measures against cholera

2. Objective tests and real life situations

1. Etiology of cholera is:

1) Vibrio cholerae classic;

2) Vibrio cholerae El Tor;

3) Campylobacter pylori;

4) Balantidium colli;

5) Clostridium botulinum.

2. How long is the incubation period:

1) 1 to 3 days;

2) 1 to 7 days;

3) 2 weeks;

4) 1 month;

5) 3 month.

3. Which of these symptoms are present in cholera?

1) profuse watery diarrhea, vomiting, muscular cramps, dehydratation;

2) algor, high temperature, muscular pain;

3) high temperature, dry cough;

4) headache, dysconsciousness;

5) abdominal pain, high temperature, cough.

4. Cholera is transmitted by:

1) by ingestion of contaminated water;

2) by ingestion of seafood and other foods;

3) by air;

4) contacts;

5) transplacentally.

5. What inoculum material should be taken to diagnose the vibrio cholerae:

1) stool;

2) urine;

3) blood;

4) medular;

5) vomiting mass.

6. Patient C., 29 years referred to the infectious department. She complained of profuse watery diarrhea, vomiting, muscular cramps, and weakness. What is the provisional diagnosis?

7. Patient L, 40 years referred to the doctor with provisional diagnosis – cholera.

What methods will confirm the diagnosis?

3. Right answers to the self-assessment

1– 1, 2.

2– 1.

3- 1.

4 – 1, 2.

5 – 1.

6.-Cholera.

7.-Direct rectal swabs of fresh stool and their identification through agglutination with specific antiserum.

Theme 2. Intestinal infectious diseases with the dominant involvement of colon: shigellosis, amebiasis. Yersiniosis. Protozoal intestinal invasions: lambliosis, balantidiasis.

Acute enteric infections are one of the topical issues of health care in all countries. According to WHO, during the latest decades, incidence rate of diseases caused by Yersinia Enterobacteriactae (pseudotuberculosis and enteric yersiniosis) has raised. They are observed everywhere, both in developed and in developing countries. In the structure of enteric infections registered in developed countries yersinioses are in 3-4 place after shigellosis and salmonellosis. A number of causes stimulates propagation of these diseases: homoiothermal animals are sensitive to Yersinia Enterobacteriactae including domestic animals, birds and humans; urbanization, development of large cattle farms, extension of public catering enterprise network, expansion in the number of synanthropic rodents; rather high resistivity of pathogens to environmental factors, preservation and accumulation of (Yersinia Enterobacteriactae) at low temperatures, high occurrence of dysbacteriosis in animals and humans due to uncontrolled administration of antibiotics causes penetration and preservation of pathogenic and opportunistic flora in intestines; absence of specific safety arrangements, fecal-oral route, high sensitivity of humans to this disease.

Clinical urgency of yersinioses is associated with the absence of alarm to this pathology, probability of development of severe generalized forms, complexity of diagnostics due to polymorphism of clinical presentations and specific conditions of isolation of the etiologic agent, low level of diagnostics of sporadic cases and mild forms of the disease, risk of development of surgical implications such as enterorrhagia, enterobrosia, peritonitis, appendicitis, and complications of allergic and autoimmune genesis.

Method of implementation of practical work

Using the algorithm of communicative skills during practical work:

1. To prepare to communication with a patient and examination (mask, clean warm hands, cutoff nails, if necessary ‑ gloves, spatula, needed instruments).

2. Greeting and identification (name, level of competence), get the agreement of patient.

3. At the receiving of agreement of patient to set confidential mutual relations (a friendly face, respect and concern, soft talk during conversation).

4. To collect complaints, anamnesis of illness and epidemiologic anamnesis, to explain to the patient the reason of finding out of separate questions (contact with an infectious patient, home and wild animals, use of poor quality meal and others like that).

5. To explain the results of questioning.

6. To explain to the patient, what examination will be done and its reasonability, to get an agreement.

7. To notify about the possibility of the occurrence of unpleasant feelings during examination.

8. To conduct the examination of patient (to estimate the general state, consciousness status, position of patient in the bed, state of skin and mucus, physical examination), demonstrating practical skills.

9. To explain the results of examination understandably for patient.

10. To finish a conversation, thank for communication, wish favourable flow of illness and rapid convalescence.

Learning goals and objectives (with indication of the achievement level being planned):

The students must be familiar with (to study):

· To have general knowledge about the place of in the structure of infectious diseases, disease incidence in different regions of Ukraine and in the world, about the mechanism and factors of introduction of infection, main clinical representations, to get current information about incidence of complications and bacteria carrying.

· To study the history of scientific investigations of diseases caused by Yersinia; to have general knowledge about scientific contribution in this field made by native scientists; to get acquainted with current methods for diagnostication of these diseases.

Students should know:

1. etiology of pseudotuberculosis and enteric yersiniosis.

2.main pathogenic factors of Yersinia Enterobacteriactae.

3. epidemiology of pseudotuberculosis and enteric yersiniosis: transmission mechanism, routes and main transmission factors, sources of infection.

4. main stages of pathogenesis of pseudotuberculosis and enteric yersiniosis.

5. clinical classification of pseudotuberculosis and enteric yersiniosis.

6. main clinical representations of typical forms of pseudotuberculosis and enteric yersiniosis.

7. pathogenesis of main clinical symptoms.

8. intestinal and extraintestinal implications of pseudotuberculosis and enteric yersiniosis.

9. pathogenesis, origin time and clinical representations and clinical implications of pseudotuberculosis and enteric yersiniosis.

Laboratory diagnostics of pseudotuberculosis and enteric yersiniosis.

10. clinical approach to treatment of pseudotuberculosis and enteric yersiniosis.

11. disease management of patients with surgical implications.

12. preventive measures for pseudotuberculosis and enteric yersiniosis

13. rules for discharging and health assessments of convalescent patients

Students should be able:

1. Adhere to the rules of the work at the bedside.

2. To file information on medical history and to evaluate epidemiologic data.

3. To examine a patient and determine main symptoms and syndromes of pseudotuberculosis and enteric yersiniosis, to substantiate clinical diagnosis for early hospitalization of the patient.

4. To define the variant of pseudotuberculosis and enteric yersiniosis course, in particular, the generalized forms, on the basis of clinical symptoms.

5. To define in time probable implications of pseudotuberculosis and enteric yersiniosis and emergency conditions on the basis of clinical examination.

6. To prepare clinical documentation upon the provisional diagnosis of pseudotuberculosis and enteric yersiniosis (emergency report to regional epidemiologic department).

7. To prepare a plan for laboratory and additional examination of the patient with pseudotuberculosis, enteric yersiniosis.

8. To give an interpretation for laboratory results.

9. To give correct evaluation for the results of specific diagnostic investigation depending on biological material and duration of examination.

10. To work out an individual treatment plan depending on the clinical form, clinical stage, existence of implications, severity, allergic anamnesis, co-morbidity .

11. To work out preventive measures in the center of infection.

12. To provide recommendations on regimen, diet, examination and supervision during convalescence.

Materials for self-control

Questions for self-control

1. Source and reservoir of infection in the case of pseudotuberculosis, enteric yersiniosis?

2. Transmission mechanism and routes of pseudotuberculosis, enteric yersiniosis.

3. Pathogenic factors of Y. enterocolitica and Y.pseudotuberculosis.

4. Stages of pathogenesis of pseudotuberculosis, enteric yersiniosis.

5. In which part of the intestine pathologic process in the patient is localized?

6. Clinical classification of pseudotuberculosis, enteric yersiniosis.

7. Reference clinical signs of pseudotuberculosis at the height of disease.

8. Characteristics of dyspeptic syndrome in the case of enteric yersiniosis.

9. Characteristics, origin time and eruption dynamics in the patient with pseudotuberculosis.

10. Pathogenesis and description of Padalka symptom.

11. To describe the Gloves and Socks syndrome.

12. Characteristics of the course of generalized forms of pseudotuberculosis, enteric yersiniosis.

13. Implications typical for pseudotuberculosis, enteric yersiniosis.

14. Extraintestinal implications of pseudotuberculosis, periods of their origin.

15. Haemogramma of the patient with pseudotuberculosis, enteric yersiniosis at the height of disease.

16. Plan of the patient examination with provisional diagnosis of pseudotuberculosis, enteric yersiniosis.

17. Methods for specific diagnostics of yersinioses.

18. Causal treatment of yersinioses. Indications for administration, doses, administration way, treatment duration.

19. Pathogenetic therapy of pseudotuberculosis, enteric yersiniosis.

20. Rules for discharging the patient with yersiniosis from the hospital.

Tests for self-control

Check correct answers:

1. Identify surgical implications of pseudotuberculosis:

А. Toxic shock syndrome

B. Enterobrosia

C. Peritonitis

D. Miocarditis

E. Appendicitis

2. In the typical course of pseudo tuberculosis exanthema is

А. Roselous

B. Maculosus

C. Vesicular

D. Is mainly localized on the neck.

E. Is mainly localized on the body and extremities.

2. For etiotropic treatment of yersinioses the following is used:

А. Penicillin

B. Erythromycin

C. Lincomycin

D. Chloramphenicol

E. Ciprofloxacin

Right answers

1. B C E

2. А B E

3. D E

Problems for self-assessment

Situational problem

Patient, 16 years old, male, admitted to department of surgery on the 9th day of disease. Acute attack with elevation of body temperature to 38.5^оС, faintness, imperceptible rhinitis. On the second day the papular eruption spread all over the body which lasted for 3 days and was regarded as allergy. He was treated at home. In 5 days periodical abdominal pain developed, sometimes severe (the patient took defense attitude). The patient was hospitalized with diagnosis surgical abdomen .

Physical examination: Body temperature – 38.8^оС. Pale, tender abdomen with palpation on the right side in the iliac region, negative peritoneal signs, liver and spleen enlarged. On the 10^th day appendectomy was carried out; hyperemia of intestine was observed; in the region of angle the mass of enlarged dense mesenteric lymphonodus was found. Their biopsy was fulfilled. Provisional diagnosis: tuberculous mesenteric adenitis, nonspecific lymphadenitis. Tuberculosis was excluded on basis of Pirquet’s reaction and Mantoux test; lymphogranulomatosis was also excluded.

1. Provisional diagnosis.

2. Examination plan.

3. Treatment plan.

Materials for classroom individual work

List of practical training tasks to be done during the practical class:

· To master the method for examination of patients with pseudotuberculosis, enteric yersiniosis.

· To carry out curation of the patient with pseudotuberculosis, enteric yersiniosis.

· To carry out differential diagnostics of pseudotuberculosis, enteric yersiniosis.

· To prepare a plan for laboratory investigation of the patient with pseudotuberculosis, enteric yersiniosis.

· To interpret the results of specific examination of the patient.

· To define implications of pseudotuberculosis, enteric yersiniosis.

· To prepare a plan for treating the patient with pseudotuberculosis, enteric yersiniosis.

· To define medical tactics in the case of arising of emergencies.

· To prepare clinical documentation upon the diagnosed “Yersiniosis”.

Professional algorithm for formation skills and experience in diagnostic of pseudotuberculosis and enteric yersiniosis

№	Tasks	Sequence of actions	Notices and warnings concerning self-control
1. 2.	To master the methods for clinical examination of patients with pseudotuberculosis, enteric yersiniosis. To carry out curation of the patient	I. Inquire into patient complaints. II. To clarify the anamnesis: 1. Anamnesis of disease 2. Life history 3. Epidemiological anamnesis IIІ. To carry out physical examination. 1. General examination: – systemic condition; – skin, oropharyngeal mucosa; 2. Digestive system: – examination of the tonge; – abdomen percussion; – abdomen palpation; – characteristics of excrements. 3. Heart-vascular system: – pulse; – blood pressure; -heart auscultation. 1. Musculoskeletal system. 5. Nervous system	Separation of the complaints which are characteristic for the following syndromes: – general intoxication – organic lesions To pay attention to acute onset of disease; time, sequence of development, dynamics of – fever; – headache; – eruption; – damaged oropharyngeal mucosa; – dysfunction of intestine; – biliousness; – arthralgia; – other symptoms To determine previous diseases. To determine the data on the mechanism of fecal-oral transmission mechanism; to pay attention to dietary habits; seasonality of disease. It should be remembered that: occurrence, intensity, symptom dynamics and severity of course of disease depend on the age of the patient, accompanying pathology To pay attention to: -apathy, adynamia, restraint of the patient; – body temperature; – dermahemia; – biliousness; -occurrence, time of development, localization, characteristics of eruption; – damaged oropharyngeal mucosa; To pay attention to: – “ raspberry tongue”; – peculiarities of pain syndrome; – Banti’s syndrome; – Padalka positive syndrome; -intensity of diarrheal syndrome, characteristics of excrements; -symptoms of peritonitis (their existence indicates perforation of small intestine); To pay attention to: – relative bradycardia, in the case of water deprivation – tachycardia; – moderately decreased blood pressure; – moderately muffled heart sounds. To pay attention to: – arthralgia, – absence of symptoms of joint disease; In the case of severe course of disease – intensity of headache, probable development of meningitis, encephalomeningitis.

3.	To prescribe laboratory and additional investigations, to interpret the results.	1. General blood test. 2. Biochemical blood assay 3. General urinalysis. 4. Ultrasonic investigation of abdominal cavity organs 5. Bacterial inoculation of blood 6. Stool culture 7. Bacterial inoculation of urine 8. Bacterial inoculation of oropharyngeal lavage 8. Serologic methods: – agglutination test, -reaction of indirect hemagglutination	To pay attention to characteristic changes: leucocytosis, neutrocytosis, monocytosis, eosinophilia, enlarged erythrocyte sedimentation reaction. Moderate rise in transaminase activity, bilirubinemia due to direct fraction. Absence of significant changes in standard course. Banti’s syndrome. Is prescribed regardless of disease duration during the fever period; it is desirable to fulfill it as soon as possible. Is prescribed regardless of disease duration. It is desirable to fulfill it in the first days of disease. In the first days of disease. Are prescribed in paired blood serums at 10 days intervals; Diagnostic titer – 1:200. Diagnostic titer 1: 100

Shigellosis is one of the most widespread intestinal infections all over the world. In the countries of Africa, Latin America, Asia it is one of the principal reasons of children’s under 5 mortality. The tendency towards morbidity growth has been lately marked not only in these countries but also in the countries of East Europe, states of CIS, including Ukraine.

Fight against Shigella is difficult due to polymorphism of clinical manifestations, variety of agent transmission factors, high receptivity at short duration of innate and specific immunity after illness as well as owing to high adaptation ability of shigellea and their resistance to antimicrobial agents.

Shigellosis is found everywhere as concrete sporadic cases and epidemic outbreaks, thus it requires knowledge of this infection.

The problem of amoebiasis is of special significance in connection with contacts expansion with different countries, increase of tourist and business trips to the regions with hot climate. The real conditions are thus created for contamination in connection with the high morbidity level of native population. According to WHO findings (1988), amoebiasis is one of the major medical and social problems in the western and south-east regions of Africa, South-east Asia, China, Latin America, where the number of persons with dysenteric amebic invasion is 20-70%.

In the areas of temperate climate amoebiasis is registered as sporadic cases, however absence of doctors’ alertness to this disease and knowledge of this pathology leads to unreliability of statistical data about amoebiasis morbidity in these regions; especially as the number of dysenteric amoeba carriers in the case of careful inspection is 5-15% of inspected cases here. In our country the sporadic cases of amoeba dysentery are found mainly on a south. Amongst the countries of the CIS the most unfavorable are the states of Middle Asia and Transcaucasia, where carriers are found among 15-35% of habitants.

The objectives of the studies:

A student must have general knowledge (familiarize):

· to have general knowledge: about shigellosis, amoebiasis place in the structure of infectious diseases, history of study, scientific contribution of native and foreign scientists to the history of scientific researches in this field.

· to familiarize: statistical data concerning shigellosis, amoebiasis prevalence, complications frequency, bacteria carrying in Ukraine and in the world nowadays.

A student must know:

· shigellosis, amoebiasis etiology, factors of agent pathogenicity;

· epidemiology of shigellosis, amoebiasis, peculiarities of modern epidemiological process;

· pathogenesis;

· classification of shigellosis, amoebiasis clinical forms;

· peculiarities of shigellosis clinical course, depending on clinical form and agent;

· clinical main manifestations of amebic dysentery and extraintestinal amoebiasis dishape;

· shigellosis complications and their onset terms;

· amebic dysentery and extraintestinal amoebiasis complications;

· shigellosis, amoebiasis laboratory diagnostic;

· principles of treatment;

· therapeutic approach in case of emergency states;

· principles of prophylaxis;

· rules of discharging from the hospital;

· rules of the dispensary system.

A student must be able:

· to keep the basic sanitary antiepidemic rules working with shigellosis, amoebiasis patient;

· to take the medical history with the estimation of epidemiological data (consumption of food products without thermal handling, contact with shigellosis patient or bacteria carrier, stay in endemic to amoebiasis regions;

· to examine patient and find out main symptoms and syndromes of shigellosis, amoebiasis, to make the substantiation of presumptive diagnosis;

· to recognize the presence of specific complications;

· to carry out differential diagnostics of shigellosis, amoebiasis with diseases which have similar clinical manifestations;

· to draw up medical documents as far as the formulation of presumptive diagnosis “shigellosis”, “amoebiasis” is concerned (an urgent report to the sanitary epidemiological station (SES));

· to work out a plan of laboratory and additional examination of patient;

· to interpret the results of laboratory examination, including specific methods of diagnostics;

· to work out an individual plan of treatment taking into account epidemiological data, clinical form of illness, severity of clinical process, presence of complications, allergy in anamnesis, concomitant pathology;

· to render the first aid in the case of ITSh, hypovolemic shock;

· to work out a plan of antiepidemic and preventive measures in the nidus of infection;

· to give recommendations concerning the regimen, diet, examination, supervision to convalescents.

Materials for methodical providing of studies:

Questions to be answered:

Shigellosis

1. How can you characterize the modern state of shigellosis morbidity in Ukraine and in the world?

2. What main serological groups of shigellae do you know? Describe their morphological features.

3. Specify agent’s stability to the action of environment factors.

4. Describe the source of infection; name the mechanism and main ways of getting infection.

5. What are the stages of shigellosis pathologic process?

6. What is the clinical classification of shigellosis?

7. What are the peculiarities of shigellosis clinical course depending on clinical form and agent?

8. What are the possible complications of shigellosis?

9. Plan of shigellosis patient’s examination.

10. Methods of shigellosis specific diagnostics . Interpretation of examination findings.

11. What are the main diagnostic signs of shigellosis?

12. Carry out differential diagnostic of shigellosis with salmonellosis, food toxic infections, cholera, protozoa colitis, escherichiosis, acute surgical diseases of abdominal organs, tumors.

13. What are the principles of shigellosis patients’ therapy?

14. What are the terms and rules of convalescent discharging from the hospital?

15. Shigellosis prevention.

16. What are the terms of dispensary supervision?

Amoebiasis

1. How can you characterize the modern state of amoebiasis morbidity in Ukraine and in the world?

2. What forms of Entamoeba histolytica existence in human organism do you know? Describe them.

3. Specify the agent’s stability to the action of environment factors.

4. Describe the source of infection; name the mechanism and the main ways of getting infection.

5. What is the clinical classification of amoebiasis ?

6. What are the stages of amoebiasis pathologic process?

7. What are the peculiarities of amebic dysentery and extra-intestinal amoebiasis clinical course?

8. What are the possible complications of amoebiasis?

9. Plan of amoebiasis patient’s examination.

10. What are the methods of amoebiasis specific diagnostics?

11. What are the main diagnostic signs of amoebiasis?

12. Carry out differential diagnostic of amoebiasis with shigellosis, protozoa colitis, helminthiasis, nonspecific ulcerative colitis, acute surgical diseases of abdominal organs, tumors.

13. What are the principles of amoebiasis patients’ therapy?

14. Give the characteristics of etiotropic drugs.

15. What are the rules of convalescent discharging from the hospital?

16. Prevention of amoebiasis (specific, non-specific).

17. Terms of dispensary supervision.

Tests: choose the right variant

Shigellosis

1. What is the main transmission way of Flexner’s shigellosis?

A. By contact

B. Air-borne

C. Water-borne

D. Sexual

E. By food

2. Which type of Shigellae cause the most severe shigellosis form:

A. Sonnei’s sh.

B. Grigoriev-Shigy’s sh.

C. Flexner’s sh.

D. Large-Sack’s sh.

E. Shtutcer-Shmitc’s sh.

3. Rules of discharging from the hospital for shigellosis patient, which do not belong to the decreed group:

A. Not before 3 days after stool and temperature normalization

B. Apparent clinical recovery

C. Presence of 3 negative results of stool bacteriological analysis, carried out after antibacterial therapy termination

D. Presence of 1 negative result of stool bacteriological analysis, carried out in 2 days after antibacterial therapy termination

E. Not before week after stool and temperature normalization

4. What clinical variant of shigellosis corresponds to such symptoms: colicky cramp-like pain in lower abdomen, tenesmus, frequent scanty stool with mucus and blood streaks

A. Colitis

B. Gastroenterocolitis

C. Gastroenteric

D. Enteric

E. Enterocolitis

5. Measures for contact persons in the nidus of shigellosis infection:

A. Supervision for 7 days

B. Single bacteriological examination of the decreed contingents with their discharge from work on the term of supervision

C. Supervision for 5 days

D. Single bacteriological examination of the decreed contingents without their discharge from work

E. Supervision isn’t conducted

6. What antibacterial drugs are used for shigellosis treatment?

A. Nifuroxazid

B. Doxycyclin

C. Ampicillin

D. Intetrix

E. Furazolidone

7. Serological methods of shigellosis diagnostics are:

A. Indirect hemagglutination reaction

B. Tsuverkalov’ test

C. Rectoromanoscopy

D. Passive hemagglutination reaction

E. Hemagglutination reaction

8. Pain syndrome at shigellosis is accompanied by :

A. Nervous – muscular intestinal apparatus lesions

B. Central nervous system damage

C. Intestinal atony

D. Intestinal destruction process

E. Intestinal spasm

9. Mucosa of distal colon at acute shigellosis of moderate severity is completely restored morphologically and functionally in:

A. 2-3 months

B. A week

C. 6 months and more

D. A month

E. 2-3 weeks

10. Which of shigellosis agents produce exotoxin:

A. Sonnei’s sh.

B. Flexner’s sh.

C. Grigoriev-Shigy’s sh.

D. Large-Sack’s sh.

E. All shigellosis agents

Keys:

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

Amoebiasis

1. Hemogram of chronic intestinal amoebiasis patients is characterized by:

A. Anemia, eosinophilia, monocytosis, lymphocytosis, increase of ESR

B. Normal hemogram

C. Heterophilic leukocytosis, increase of ESR

D. Leukopenia, eosinophilia, anemia

E. Lymphocytosis, monocytosis

2. Coprocytogram at intestinal amoebiasis reveals:

A. Considerable amount of vitriform mucus, erythrocytes, eosinophils, Charco-Leyden crystals

B. Grouped erythrocytes are located as columns, there are leucocytes within eyesight

C. Erythrocytes are within all eyesight, small amount of mucus

D. Increased amount of neutral fat, undigested muscular fibres, starched corns.

E. Within the limits of norm

3. The followings drugs belong to tissue amebocytes

A. Chloroquine

B. Metronidazole

C. Yatren

D. Emetine

E. Dehydroemetine

4. The source of amoebiasis is :

A. Intestinal amoebiasis patient

B. Healthy carriers

C. Cattle

D. Extra-intestinal amoebiasis patients

E. Nonspecific ulcerative colitis patients

5. Which methods are the most informative for extra-intestinal amoebiasis diagnostic?

A. US

B. Total blood count

C. CT (computer-tomography) scan

D. Rectoromanoscopy

E. Radiography

6. What forms of dysenteric amoeba existence are there in the human organism?

A. Large vegetative form

B. Cysts

C. Small vegetative form

D. Average vegetative form

E. All mentioned above

7. Disease onset at amoebiasis is:

A. Gradual

B. Acute

C. Subacute

D. Acute with abrupt clinical manifestations

E. Latent

8. Complications of intestinal amoebiosis are:

A. Pericolitis

B. Intestinal perforation

C. Subdiaphragmatic (subphrenic) abscess

D. Infectious toxic shock

E. Intestinal bleeding

9. Material for parasitoscopy in case of intestinal amoebiasis is:

A. Blood

B. Urine

C. Stool

D. Pus from the surface of ulcers, taken away at rectoromanoscopy

E. Cerebrospinal fluid

10. Endoscopy of colon at chronic amoebiasis reveals the followings changes:

A. There are ulcers 10-20 mm in diameter on the unchanged mucosa; these ulcers have edematic, deepened edges, surrounded by hyperemic area and are located more often on folds, the bottom is covered with pus and necrotic mass

B. Different diameter ulcers, cysts, polyps, amebomas

C. Diffuse edema, hyperemia of mucosa, intestine spasm, hemorrhages, there are fibrinous stratifications on the ulcers’ surface

D. Vascular picture impoverishment, single ulcers, «velvety» mucosa, contact and spontaneous hemorrhages

E. No changes

Keys:

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

Self-control tasks

Task 1

Patient A., 22 years old, a student, was admitted to isolation hospital on the 3rd day of illness with complaints of weakness, colicky cramp-like abdominal pain, frequent and liquid stool with mucus and blood. The disease onset was marked by the increase of body temperature, headache, tenesmus, frequent stool. He lives at the separate flat with modern conveniences. All family members are healthy. A week ago the patient came back from the village, where similar disease cases were registered. The patient’s state is of moderate severity, body temperature is 37.5 ºC. Skin is pale, tongue is moist, coated with white film. Heart sounds are dull. The abdomen is moderately tympanitic (swollen), painful in colon area. Sigmoid colon is spastic, acute painful. Stool is liquid with mucus and blood streaks (10 times per day).