МЕТHODOLOGICAL INSTRUCTION

МЕТHODOLOGICAL INSTRUCTION

FOR THE V-th YEAR STUDENTS

foreign students faculty

LESSON № 4 (6 hours)

 

Theme 4: The immunological aspects of autoimmune diseases. Immunology of tumors.  Curation 1.

 

Aim: to form the complete picture of the autoimmune disorders and diseases, their allergic, pseudoallergic clinical features, diagnostics, treatment and prevention. To learn immunological features of tumors.

 

Professional motivation: Autoimmune diseases are the heaviest type of the immunologic disorders with early complcations, invalidization and death. 10-15 % of human population suffers from autoimmune disorders. Only understanding of the autoimmunity pathogenesis is a key to correct diagnostics and treatment of the diseases. Early diagnostic of the tumors and understanding of their immunological

features can lead to the better prognosis.

 

Methodology of Practical Class

Introduction by the teacher, control the initial level of knowledge – 09.⁰⁰-09.³⁰

Individual students’ work with patients – 09.³⁰-12.⁰⁰

Break – 12.⁰⁰-12.³⁰

Seminar (discussion of theoretical questions, practical work with patients) – 12.³⁰-14.⁰⁰

Break – 14.⁰⁰-14.¹⁵

Individual work 14¹⁵-15⁰⁰ (students who didn`t pass the tests in Moodle system, complete the individual work).

 

Algorithm of students’ communication with patients with pathology in subject (communication skills):

During examination of the patient students have to use such communicative algorithm:

Complaints and anamnesis taking in patients

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Take complaints and anamnesis in a patient.

5. Explain to the patient results of his/her lab tests correctly and accessibly.

6. Explain to the patient your actions concerning him/her (the necessity of hospitalization, certain examinations and manipulations), which are planned in future.

7. Conversation accomplishment.

Objective examination:

Physical methods of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient, what examinations will be carried out and get his/her informed consent.

5. Find a contact with the patient and make an attempt to gain his/her trust.

6. Inform about the possibility of appearing of unpleasant feelings during the examination.

7. Prepare for the examination (clean warm hands, cut nails, warm phonendoscope, etc.).

8. Examination (demonstration of clinical skill).

9. Explain to the patient results of his/her lab tests correctly and accessibly.

10. Conversation accomplishment.

Estimation of laboratory and instrumental investigations

Informing about the results of examination of patients with internal diseases

1. Friendly facial expression and smile.

2. Gentle tone of speech.

3. Greeting and introducing.

4. Explain to a patient results of his/her lab tests correctly and clearly.

5. Involve the patient into the conversation (compare present examination results with previous ones, clarify whether your explanations are clearly understood).

Planning and prognosis the results of the conservative treatment

Friendly facial expression and smile.

1. Gentle tone of speech.

2. Greeting and introducing.

3. Correct and clear explanation of necessary treatment directions.

4. Discuss with a patient the peculiarities of taking medicines, duration of their usage, possible side effects; find out whether your explanations are clear for him/her or not.

5. Conversation accomplishment.

 

WORK 1: Curation of the patient with autoimmune disease.

 

WORK 2: Curation of the patient with the tumor.

 

WORK 3: Curation 1.

 

Individual Students Program

1. Immunopathogenesis of autoimmunity.

2. Immunopathogenesis of systemic lupus eythematosus.

3. Immunopathogenesis of rheumatoid arthritis.

4. Immunopathogenesis of psoriasis.

5. Clinical manifestations of systemic autoimmune diseases.

6. Clinical manifestations of organ-specific autoimmune diseases.

7. Immunediagnostics of autoimmune diseases.

8. The main principles of treatment of autoimmune diseases.

9. Physiologic “autoimmunity”.

10. Autoimmune components ion-autoimmune diseases.

11. Pathogenesis of oncological process.

12. Role of the immune system in oncological process.

13. Treatment of the tumors.

 

Seminar discussion of theoretical issues:

1. Definition of autoimmune reactions, autoimmune disease. Mechanisms of failure of immunological tolerance, the role of genetic factors.

2. Immunodiagnosis, immunopathogenesis. The role of immunological methods in the early diagnosisand verification of autoimmune diseases.

3. Current approaches to application immunomodulative new generation drugs in the

treatment of patients with autoimmune diseases.

4. Mechanisms of the immune system of the body “host” and “tumor”.

5. The Factors of immunological resistance of the tumor. The concept of tumor-associated antigens.

6. Immunosuppressive effects of tumors. Immune changes in cancer patients.

Immunodiagnosis, including differential according to the CD-phenotype of tumor cells. Current approaches to the immunotherapy of patients with cancer.

 

Test evaluation and situational tasks:

1. Anti-double stranded DNA is highly highly specific for:

A. Systemic sclerosis

B. SLE.

C. Polymyositis

D. Henoch’s schonlein purpura

E. Diffuse glomerulosclerosis

2. A 20 year old woman presents with bilateral conductive deafness, palpable purpura on the legs and hemoptysis. Radiograph of the chest shows a thin-walled cavity in left lower zone. Investigations reveal total leukocyte count 12000/mm3, red cell casts in the urine and serum creatinine 3mg/dL. What is the most probable diagnosis?

A. Henoch-Schonlein purpura

B. Polyarteritis nodosa

C. Wegener’s granulomatosis

D. Disseminated tuberculosis

E. Disseminated tuberculosis & Polyarteritis nodosa

3. In polyarteritis nodosa, aneurysms are seen in all, except:

A. Kidney

B. Lung

C. Liver

D. Pancreas

E. Liver & pancreas

4. Henoch Schonlein purpura is characterized by all except:

A. Thrombocytopenia

B. Glomerulonephritis

C. Arthralgia

D. Abdominal pain

E. Skin rash

5. One of the following is a characteristic of Henoch – Schonlein Purpura:

A. Blood in stool

B. Thrombocytopenia

C. Intracranial hemorrhage

D. Susceptibility to infection

E. Low ESR

6. All the following are features of Behcet’s syndrome except:

A. Recurrent aphthous stomatitis

B. Multi-system involvement

C. Seen only in the tropics

D. Common in youngsters

E. Recurrent aphthous stomatitis &Multi-system involvement

7. A 20 year old woman presents with bilateral conductive deafness, palpable purpura on the legs and hemoptysis. Radiograph of the chest shows a thin-walled cavity in left lower zone. Investigations reveal total leukocyte count 12000/mm3, red cell casts in the urine and serum creatinine 3 mg/dL. What is the most probable diagnosis?

A. Henoch-Schonlein purpura

B. Polyarteritis nodosa

C. Wegener’s granulomatosis

D. Disseminated tuberculosis

E. Behcet’s syndrome

8. A 35 year old lady complains dysphagia, Raynaud’s phenomenon, sclerodactyly. Investigations show antinuclear antibody. The likely diagnosis is:

A. Systemic lupus erythematosis

B. Systemic sclerosis

C. Mixed connective tissue disorder

D. Rheumatoid arthritis

E. Polymiositis

9. Vasanti, 28-year-old, presents with complaints of tightness of fingers. There is also history of dysphagia. Which of the following is the probable diagnosis:

A. Dermatomyositis

B. Scleroderma

C. Rheumatoid arthritis

D. Polyarteritis nodosa

E. Rheumatoid arthritis

10. All of the following may be associated with Sjogron syndrome, except:

A. Dry eyes

B. Dry mouth

C. Parotid gland enlargement

D. Systemic manifestations

E. Dry eyes & Dry mouth

 

Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks)

Students should know:

1. Immunopathogenesis of autoimmunity.

2. Immunopathogenesis of systemic lupus eythematosus.

3. Immunopathogenesis of rheumatoid arthritis.

4. Immunopathogenesis of psoriasis.

5. Clinical manifestations of systemic autoimmune diseases.

6. Clinical manifestations of organ-specific autoimmune diseases.

7. Immunediagnostics of autoimmune diseases.

8. The main principles of treatment of autoimmune diseases.

9. Physiologic “autoimmunity”.

10. Autoimmune components ion-autoimmune diseases.

11. Immunity of the tumors.

 

Students should be able to:

1. Diagnose systemic autoimmune diseases.

2. Diagnose autoimmune reactions.

3. Diagnose organ-specific autoimmune diseases.

4. Choose the treatment for patient with systemic autoimmune diseases.

5. Choose the treatment for patient with organ-specific autoimmune diseases.

6. Choose the treatment for patient with autoimmune reactions.

7. Carry out puls-therapy.

 

Correct answers of test evaluations and situational tasks: 1B, 2C, 3B, 4A, 5A, 6C, 7B, 8B, 9B, 10D

 

References.

А – Basic:

1.     Stephen Holgate. Martin Church. David Broide Fernando Martinez,  Allergy Hardbound, Published: November 2011.- 432 p.

2.  Mark Peakman. Diego Vergani. Basic and Clinical Immunology with STUDENT. – Imprint: Churchill Livingstone Published: – April 2009

3.     Roderick Nairn, Matthew Helbert.  Immunology for medical students /  Hardboun – 2012 –326 p.

4.     Web -sites:

a)     http://intranet.tdmu.edu.ua : The immunological aspects of autoimmune diseases. Immunology of tumors.

b)    http://emedicine.medscape.com/

B – Additional:

1. Linda Cox.  Allergen Immunotherapy, An Issue of Immunology and Allergy Clinics.- / Published: May 2011.-  Hardbound, – 312 p.

2. Dédée Murrell. Autoimmune Diseases of the Skin, An Issue of Immunology and Allergy Clinics. –  Imprint: Saunders.- Published: May 2012.

 

 

Methodical instruction has been worked out by assoc. prof.  Volodymyr Horodetskyy

Methodical instruction was discussed and adopted at the Department sitting: “01” October 2013, Minute №3