МЕТHODOLOGICAL INSTRUCTION

МЕТHODOLOGICAL INSTRUCTION

FOR THE V-th YEAR STUDENTS

foreign students faculty

 

LESSON № 6 (6 hours)

 

Theme 6: Аllergic diseases. Immunopathology of the аllergy. Other allergic (non-atopic) diseases: types,immunopathogenesis, immunodiagnostic, immunotherapy. Differential diagnosis of the pseudoallergy and allergy.

 

Aim: to form the complete picture of the allergic, pseudoallergic and paraallergic reactions; to focus onthe most important points of allergic diseases clinical features, diagnostics, treatment and prevention.

 

Professional motivation: Allergic reactions and allergic diseases are the most frequent types of theimmunopathology. Every fourth resident of the USA has at least one medical record about allergicreaction. Very often even benign reactions induce hard immediate and delayed complications.

 

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 allergy.

 

WORK 2: Curation of the patient with pseudoallergy, paraallergy.

 

Work 3. The student estimates results of laboratory and instrumental investigations, makes a differential diagnosis and formulates the clinical diagnosis, based on the diagnostic criteria of the disease. The student prescribes appropriate treatment and defines individual management program for patient.

 

 

Individual Students Program

1. Classification of the hypersensitivity reactions (Gell & Coombs).

2. Immunology of the type I hypersensitivity reaction.

3. Immunology of the type II hypersensitivity reaction.

4. Immunology of the type III hypersensitivity reaction.

5. Immunology of the type IV hypersensitivity reaction.

6. Clinical manifestations of allergy.

7. Asthma. Clinical manifestations, treatment.

8. Treatment of allergic disorders.

 

Seminar discussion of theoretical issues:

1. The role of genetic factors and the environment in the immunopathogenesis of allergy. Modern ideasabout the allergy and atopy. The Atopy as a systemic disease.

2. Types and main stage of immunological reaction. Aspects of allergic diagnosis. Screening methods inassessing allergies. Eliminative and provocative tests in allergy. Types of skin tests.

3. Principles of treatment of allergic diseases. Specific immunotherapy: indications and contraindications.

4. Features immunopathogenesis of asthma, hay fever, allergic rhinitis, urticaria, and others.

5. Drug allergies: causes, immunopathogenesis, clinic and prevention.

6. Non atopic disease: types, immunopathogenesis, immunodiagnosis, clinical manifestations anddifferential diagnosis.

7. Cell – mediated allergic disease (serum sickness, Arthus phenomenon, allergic alveolitis, etc.).:Immunopathogenesis, clinic, immune-diagnostics, immunotherapy.

8. Principles of therapy and immunomodulative allergy treatment.

 

Test evaluation and situational tasks:

1. A patient with rheumatic fever develops a sore throat from which beta-hemolytic streptococci arecultured. The patient is started on treatment with penicillin, and the sore throat resolves within severaldays. However, 7 days after initiation of penicillin therapy the patient develops a fever of 103 °F, ageneralized rash, and proteinuria. This MOST probably resulted from

A. recurrence of the rheumatic fever

B. a different infectious disease

C. an IgE response to penicillin

D. an IgG-IgM response to penicillin

E. a delayed hypersensitivity reaction to penicillin

2. True statements regarding immune-complex disease include which of the following?

A. Normally, most immune complexes are removed by the reticuloendothelial system

B. Symptoms of the disease are very specific

C. Renal manifestation are not frequent

D. Skin rash is the first symptom

E. Treatment is unknown

3. Right statements regarding immune-complex disease include which of thefollowing?

A. Signs and symptoms stem from the deposition of immune complexes in tissues other than those of thereticuloendothelial system

B. Symptoms of the disease are very specific

C. Renal manifestation are not frequent

D. Skin rash is the first symptom

E. Treatment is unknown

4. Regarding immune-complex disease true statements include which of the following?

A. Persistence of immune complexes in the circulation seems to be a requirement for the development ofrenal manifestations

B. Symptoms of the disease are very specific

C. Renal manifestation are not frequent

D. Skin rash is the first symptom

E. Treatment is unknown

5. True statements regarding immune-complex disease include which of the following?

A. Renal lesions depend on antigen-antibody combinations in which antigen is in slight excess

B. Symptoms of the disease are very specific

C. Renal manifestation are not frequent

D. Skin rash is the first symptom

E. Treatment is unknown

6. True statements regarding immune-complex disease include which of the following?

A. The rash of cutaneous necrotizing vasculitis may be an example of immune-complex disease

B. Symptoms of the disease are very specific

C. Renal manifestation are not frequent

D. Skin rash is the first symptom

E. Treatment is unknown

7. Which of the following statements about IgM is true?

A. It is a reagenic antibody

B. It is important in the first few days of the primary immune response

C. It increases in serum concentration after IgG has reached its peak serum concentration

D. It is the smallest of the immunoglobulin molecules

E. It is involved in the allergic reaction

8. A 27-year-old woman is evaluated because she had a spontaneous abortion 6 weeks after becomingpregnant for the first time. Laboratory studies reveal the presence of anticardiolipin antibodies. Levels ofIgG and IgA are normal. The IgM level is low-positive. Sensitive partial thromboplastin time and

modified Russell viper venom time are normal. Which of the following would be appropriatemanagement during this patient’s next pregnancy?

A. Warfarin

B. Heparin, prophylactic dose

C. Heparin, therapeutic dose

D. Aspirin, 80 mg/d

E. No treatment

9. A 32-year-old woman is evaluated because of a 5-year history of Raynauds phenomenon and thickenedskin over the fingers. Two years ago, she developed small patches (1 to 2 mm in diameter) of calcinosison the distal fingers and dorsum of one hand, which have persisted. She reports mild dyspnea when sheclimbs stairs. She takes a proton pump inhibitor for reflux esophagitis. Physical examination revealssclerodactyly, with one digital tip ulcer, minimal calcinosis, and two telangiectasias on her face, withoutlimitation of oral opening. Lung and heart examination are normal. Chest radiograph reveals no infiltratesor interstitial fibrosis in the lungs and a normal heart size. Results of routine laboratory tests are normal,including renal function. Echocardiogram suggests mild right ventricular diastolic dysfunction. Thediffusing capacity for carbon monoxide (DLCO) is 44% of normal. Within the next 5 years, she is at highrisk for developing which of the following?

A. Fine, dry crackles indicative of pulmonary fibrosis

B. Renovascular hypertension with hyperreninemia

C. Sclerodermatous changes on the forearms and face

D. Pulmonary hypertension

E. Esophageal varices

10. A 55-year-old woman who has had rheumatoid arthritis for 10 years is evaluated because of severepain in the left shoulder that developed over the course of the previous day. In recent months, her diseasehas been poorly controlled on a regimen of methotrexate, hydroxychloroquine, and low-dose prednisone.She has approximately 90 minutes of morning stiffness. On physical examination, her temperature is36.8 °C (98.2 °F), her pulse rate is 82/min, and her blood pressure is 110/70 mm Hg. She has moderatetenderness of the small joints of her hands and of both wrists. Her left shoulder is warm and very tender;she can move it only slightly before being limited by pain. What is the best next step in this patient’smanagement?

A. Orthopedic consultation for possible shoulder arthroplasty

B. Aspiration of the shoulder to exclude septic arthritis

C. Radiography of the shoulder

D. MRI contrast arthrography of the shoulder

E. Physical therapy for the shoulder

 

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): will be controlled with the tests and questions by the tutor.

 

Students should know:

1. Classification of the hypersensitivity reactions (Gell @ Coombs).

2. Immunology of the type I hypersensitivity reaction.

3. Immunology of the type II hypersensitivity reaction.

4. Immunology of the type III hypersensitivity reaction.

5. Immunology of the type IV hypersensitivity reaction.

6. Clinical manifestations of allergy.

7. Asthma. Clinical manifestations, treatment.

8. Medicines and schemes for treatment of allergic disorders.

 

Students should be able to:

1. Diagnose allergic reactions and diseases.

2. Choose the treatment for patient with allergic reactions and diseases.

3. Choose the complex of immediate treatment for patient with anaphylaxis.

 

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

 

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 : Аllergic diseases. Immunopathology of the аllergy

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