METHODICAL INSTRUCTION
to practical classes on Pediatrics
for students of the 5-th course
Foreign Students Faculty
MODULE 2
LESSON № 1 (PRACTICAL – 6 HOURS)
Theme. Anemias in children. Etiology Pathogenesis. Classification. Clinic. Diagnostics. Differential diagnosis. Treatment. Emergency aid for bleeding. Prevention. Outlook.
Aim: Students have to get information about the diagnostic criteria of different types of anemias in children (particularly about iron-deficiency anemia, hemolytic anemia, B12– deficiency anemia) and principles of its treatment.
Professional Orientation of Students: Anemia is one of the most frequent diseases in children. There are different causes of anemia and different methods of anemia diagnostics and it is very important to get knowledge about these. Information about peculiarities of different anemia types will make differential diagnosis among various anemia’s types much more easier and will allow to prescribe correct treatment to patient.
1. Students’ independent study program:
1. Classification of anemias.
2. Etiology, pathogenesis, main clinical features of anemias
3. Laboratory data and instrumental findings in patients with anemia
4.diagnostic criteria of anemia.
5. Treatment of anemias.
6. Prophylaxis of anemias in children.
2. Examples of test tasks and situational tasks:
1. The boy, 8 years old, has pale skin, general weakness, and decreased appetite. In general blood test: Hb – 80 g/l, RBC 3,86×10 9/l , CI 0,7, WBC – 6×10 9/l, bands – 2%, eosynophiles – 5%, segments – 51%, lymph. – 32%, monocytes -10%, thromb. – 210х10 9/l ESR – 7 mm/hour. What disease is possible in tis case?
(А) Iron-deficiency anemia
(B) Hemolytic anemia
(C) Acute leukemia
(D) B12-deficiency anemia
(E) Thrombocytopenic purpura
2. What is the main source of iron?
(A) Vegetables
(B) Fruits
(C) Milk
(D) Meat
(E) Bread
3. What is the most important sign of hemolytic anemia:
(A) Hypochromic anemia.
(B) Neutropenia, thrombocytopenia, anemia
(C) Thrombocytopenia
(D) Anemia, reticulocytosis
(E) Hyperchromic anemia.
4. What is the most important sign of B12-deficiency anemia:
(A) Hyperchromic anemia.
(B) Hypochromic anemia.
(C)Thrombocytopenia
(D) Anemia, reticulocytosis
(E)Anemia, lymphopenia, monocytopenia.
5. The 13 years-old girl complains of decreased appetite, brittle nails, pale skin. Peripheral lymph nodes are normal size. Cardiac tones are rhythmical, there is mild systolic murmur on the apex. PS – 78 per minutes. The liver and spleen are not enlarged. Blood analyses: RBC 3.7 * 10 12/L, Hb 86 g/1, CI – 0,7, WBC – 6.4 * 10 9/L, e – 2 %,- 4 %, S –53%, lymp. – 38 %, mon. – 1 %. ESR – 8 mm/per hour.
1. Put the diagnosis.
2. What laboratory tests should be administered?
6. The 3 years-old boy was admitted to the hospital with purulent otitis signs. From the life history: from 1st mature pregnancy, has no illnesses before. Parents are healthy. During examination: skin is pallor with some jaundice; hypertrophia of tonsils, systolic murmur on the apex of the heart; liver is palpated 2 cm lower the costochondrial rib, spleen is palpated 3 cm lower the costochondrial rib. During otolaryngologycal examination: pus in the right external auditory passage, eardrum hyperemia. Blood analysis: HB – 110 g/l, er. – 3.8 * 1012 /l, L – 9.1 * 109 /l, e – 1%, S – 64%, l – 28%, m – 6%, reticulocytes – 4.6%, anisocytosis, poykilocytosis, ESR – 31 mm/hour. Osmotic fragility of erythrocytes min. 0.52%, NaCl, max. 0.32% NaCl. Coombs reaction +++. Prednisone was administered, 1 mg/kg/d orally, vitamin complex, otitis treatment.
1. Name the diagnosis.
2. What was the trigger of the disease?
3. Correct answers of test and situational tasks:
1 – A 3 – D
2 – D 4 – A
5 – 1. Iron-deficiency anemia moderate severity. 2. To check iron and iron-binding capacity of blood serum, to make blood smear.
6 – 1. Auto-immune idiopathic hemolytic anemia; 2. Purulent otitis.
4. Methodology of Practical Class (9.00-12.00)
Work 1. To examine the patient with anemia, to establish the provisional diagnosis and to prove the clinical diagnosis.
Anamneses should be taken with the usage of age proper models of communication:
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.).
7. Conversation accomplishment.
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 and his/her parents.
5. Explanation of the further steps to a child and his/her parents (hospitalization, some methods of examination, etc.).
6. Conversation accomplishment.
Physical examination should be performed with the usage of age proper models of communication:
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 their 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.).
7. Examination.
8. Explaining the results of examination to child’s parents.
9. Conversation accomplishment.
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 a child and his/her parents what examinations should be performed and obtain their informed consent.
5. Find a contact with the child, try to gain his/her confidence.
6. Prepare youself for examination (clean and warm hands, warm phonendoscope, use the screen if necessary, etc.).
7. Examination.
8. Explaining the results of examination to child’s parents.
9. Conversation accomplishment.
Work 2. To diagnose type of anemia and to make a differential diagnosis of anemias with other hematological problems.
Work 3. To prescribe proper treatment.
Talking with patient should be performed according age proper models of communication:
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 drugs intake, duration of usage, side effects and find out whether they understand your explanations.
6. Conversation accomplishment.
Informing about the 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.
5. Seminar discussion of theoretical questions and practical work (12.30-14.00).
6. Students’ self-work (14.15-15.00) for students who have not passed Moodle.
7. The student must know:
1. Classification of anemias in children.
2. Causes of anemias in children.
3. Clinical and laboratory features of different anemias types in children.
4. Differential diagnosis among various anemias types in children.
5. Principles of the different anemias treatment.
6. Principles of the anemia prophylaxis.
8. The student should be able to:
1. Examine a patient with anemia.
2. Establish a provisional and clinical diagnosis of anemia.
3. Make a differential diagnosis between anemias and other hematological problems.
4. Administer the adequate treatment of anemia.
5. Recommend preventive measures of anemia to patient.
9. References:
Basic:
- Nelson Textbook of Pediatrics, 19th Edition. – Expert Consult Premium Edition – Enhanced Online Features and Print / by Robert M. Kliegman, MD, Bonita M.D. Stanton, MD, Joseph St. Geme, Nina Schor, MD, PhD and Richard E. Behrman, MD. – 2011. – 2680 p.
- Hastings CA, Torkildson JC, Agrawal AK. Handbook of Pediatric Hematology and Oncology: Children’s Hospital and Research Center Oakland, second edition. Oxford, John Wiley & Sons, 2012. – 378p.
3. Doctor (student) – patient models of communication // KovalchukL.Ya, Mysula I.R., Lisnichuk N. Ye., Oleschuk O.M., Sakharova I.Ye. – TSMU, “ Ukrmedkniga”, 2009. – 39 p.
Additional:
- Pediatrics / Edited by O.V. Tiazhka, T.V. Pochinok, A.M. Antoshkina/ – Vinnytsa: Nova Knyha Publishers, 2011. – 584 p. Nelson’s textbook of Pediatrics.
- Manual of Pediatric Hematology and Oncology, Fifth Edition. Edited by: Philip Lanzkowsky. Academic Press. – 1027p.
Methodical Instruction has been worked out by As. Prof. Inna Ye. Sakharova
Methodical instruction was discussed and adopted at the Pediatrics № 2 Department sitting
17 of June, 2011. Minute № _18__
Methodical instruction was adopted and reviewed at the Department sitting
21 of December, 2012. Minute № _7__
Methodical instruction was adopted and reviewed at the Department sitting
26 of June, 2013. Minute № _16__
