TERNOPIL STATE MEDICAL UNIVERSITY
NAMED after I.Y. GORBACHEVSKYI
DEPARTMENT OF PAEDIATRICS №2
Methodical instructions
to practical classes on propaedeutic pediatrics for 3-year students
of medical faculty
Module 2: Anatomo-physiological peculiarities, methods of investigation and semiotics diseases in children.
Lesson 4 (practical – 6 hours)
Themes: Methods of clinical neurological investigation of the child. Semiotics of the maiervous system disorders in children.(Hydrocephaly ,meningitis, encephalitis, child cerebral pulse). Peculiarities of lumber puncture in children and semiotics of its exchanges during pathology( Hydrocephaly ,meningitis, etc.). Nursing care of children with diseases of the nervous system.
Aim: To be able to estimate the state nervous systems at a child on the basis of knowledge of anatomic physiological features and evidential medicine, to find out pathological symptoms and syndromes which are often observed at children at the different diseases, be able to carry out the care of children with these illnesses.
Professional of motivation of students: The row of features of the nervous system at children is predetermined by motion and prognosis of basic pathologies of child’s organism. Knowledge of the stages of forming of this system helps a doctor to understand the features of development of the muscular system at a child and foresee the organ changes which can arise up at the pathogenesis.
The nervous system of child in the process of growth and development of organism is added to difficult transformations on which influence row of external and internal factors. The correct estimation of the state of the nervous system has the important value for timely diagnostics of different rejections from the side of this system, is the mortgage of rational examination and treatment sick.
The central and peripheral nervous system at children has a lot of morphological and functional features which need to be known to every doctor for the decision of a number of practical tasks. A pediatrician must be able to recognize the nervous diseases are most widespread at children. Knowledge of bases of neurology are needed for the exposure of diseases of cerebrum, peripheral nervous system, clarification of their etiology and giving urgent medical assistance.
Students’ independent study program:
Baseline of knowledge and practical skills:
1. To collect anamnesis. (care of the patients in pediatrics, propedeutic therapy).
2. To evaluate correctly clinical symptoms and results of laboratory and instrumental examinations (physiology, biochemistry).
3. To formulate a diagnosis on the basis of information of anamnesis, results of clinical, laboratory and instrumental methods of diagnostics and prescribe treatment (propedeutic therapy, pharmacology).
Methodology of Practical Class – from 09.00 till 12.00
Theme 1. (list of theoretical questions)
1. To learn the anatomo-physiological features of nervous system at children:
1) anatomic features;2 ) morphological features; 3) physiology features.
2. To collect complaints and anamnestic information at a sick child.
3To learn Anatomo-physiological features of the central and peripheral nervous system and sense-organs at children:
– reflexes new-born;
– sequence of development of pavlov reflexes at children;
– sense-organs child depending on age.
Theme 2
1. Features of medical care for children with pathology of muscular ?and bone systems.
2. Medical care of children with the defeat of muscular ?and bone systems
3. To learn the laboratory-instrumental methods of research in child’s neurology.
4. To learn the semiotics of defeat of the central and peripheral nervous system, basic clinical symptoms and changes of at:
– serose and festering meningitis;
-encefalites;
-tuberculose meningitis;
-hydrocefaly
-children paralysy;
-tumor of cerebrum
To learn the features of care of children with pathology of the nervous system:
– features;
– at violation of sensitiveness;
– During the attack of cramps.
1. Basic symptoms and syndromes of defeat of muscular ї ?and bone systems
2. Interpretation of basic diagnostic tests for determination of the state of muscular ї ?and bone systems
3. A spinal fluid is indexes in a norm and pathology.
1. Basic symptoms and syndromes of defeat of nervous systems. Interpretation of basic diagnostic tests for determination of the state of these systems
2. Examples of test tasks and situational tasks
Tests
Which of the following reflexes is a spinal automatism?
A. Sucking
B. Babkin’s reflx
C. Moro’s reflex
D. Extrusion
E. Sac’s eye
ANSWER C
The righting reflexes include all of the following except?
A. Paruclute reflex
B. Low landeu’s
C. Supporting
D. Upper landeu’s
E. Neck-righting
ANSWER C
When an infant is placed on the abdomen , he turns the head to the left or right side. What reflex is this ?
A. Moro’s reflex
B. Defence
C. Bauer’s
D. Karniga
E. Rooting
ANSWER B
An infant is supported with the feet touching a head surface , It is noticed that the lower extremities are crossed . This is pathology of what reflex
A. Perez
B. Grasp
C. Startle
D. Automatic stepping
E. Child pulse
ANSWER E
At what age should an infant searching to locate sounds
A. 4 months
B. 1 month
C. 7 months
D. 2 months
E. 5 months
ANSWER C
At what age Infants begin grasping objects with both hands . ?
A. 10 months
B. 2 months
C. 6 months
D. 3 months
E. 4 months
ANSWER E
What characteristic of Erb’s palsy ?
A. Meningitis
B. Damage of the upper cervical 5-6 roots of the brachial plexus
C. Seizures
D. Damage of the sacral plexus
E. Hydrocephalus
ANSWER D
A child walks with one hand held at ?
A. 14 months
B. 6 months
C. 12 months
D. 10 months
E. 9 months
ANSWER C
Which of the following reflex the infants blinks at sudden appearance of a light movements ?
A. Blinking reflex
B. Grap’s reflex
C. Robinzon’s reflex
D. Hold’s reflex
E. Babkin
ANSWER A
Which of the following reflex the infants blinks at sudden appearance of a light movements ?
A. Cornal reflex
B. Grap’s reflex
C. Robinzon’s reflex
D. Hold’s reflex
E. Babkin
ANSWER A
Situational tasks.
Task 1. To have appealed to the doctor with complaints about the large nesses of head at a child. To the child 4 months, burned with mass of 3600 , by length bodies 51 see, circumference of head 38 cm, thorax – 34 cm. Now a child has mass of body of 5960,0 , circumference of head 48 cm. A large fontanellaeis 6 to8 cm, little – 2 to2 cm, there is spasm of hands, symptom of Greffe. A child badly holds a head, say agy
Task: 1. To estimate development and common state of child.
2.What syndrome can be put ?
3.What auxiliary methods of research must be appointed ?
4.What changes from the side of spinal flour can take place in this case ?
Task 2. To the child 2 days, was borne with mass of 3800 ã. Began to cry at once, to the breasts enclosed through 6 hour, but sucks badly, yells periodically. At a review there is absence of motions in a right arm, extremity is unbended in all joints, resulted to the trunk. Tendon reflexes are not caused from a right side.
Task: 1.what pathology can be suspected at a child ?
2.What reason of this pathology ?
3.What treatment to appoint ?
3. Right answers on tests and situational tasks:
Standard of answers to task 1:
1. A child was born with megascopic circumference of head. In 4 mons has mental retardation, considerable increase of circumference of head (on 6 see), sizes of large and small fontanella t, eyeing symptoms, spasm of hands.
2. A hydrocefal syndrome is diagnosted.
3. USd of cerebrum, lumber punction, examination of eyeground, X-Ray of head.
4. High Pressure of neurolymph, diminishing of amount of albumen .
Standard of answers to task 2:
1. Maternity traumatic right damage of the humeral nervous interlacing. Overhead right side paralysis.
2. Mogitocias are in buttock .
3. Splint at physiology position of hand. , a massage, physical therapies procedures
4.
Theme 1 Methods of clinical neurological investigation of the child.
Work 1. Anatomic-physiological features of the central and peripheral nervous system and sense-organs at children:
-Congenital – reflexes new-born;
– sequence of development of Pavlov‘s reflexes at children;
Work 2. To collect anamnesis in chidren and their relatives examine the patient with nervous system disorders, to establish the provisional diagnosis and to prove the clinical diagnosis. To examine the state of nervous system according 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 (palpation of lymphatic nodes,auscultation of the heart,cor,palpation of liver and spleen ) 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
Theme 2 Method of research of basis nervous system
Work 1. Collect the anamnesis, directed on the exposure of changes from the side 0f nervous system at children Collect anamnesis at a child and relatives, to explore the state of the nervous system at a sick child.
Work 2. To appoint the complex of additional methods of inspection for finding out of the state of nervous system at a child.
– method of lead through and interpretation of basic diagnostic tests for determination of the state of nervous system of child
– interpretation laboratory and instrumental researches
Work 3. To estimate the state of the nervous system at the children of different age:
-Collection of anamnesis;
-To estimate motive functions;
-To estimate functions of sensible analyzers;
-To estimate vegetative nervous system;
-To estimate languages.
Theme 3 A care is of children with pathology of the nervous system
Work 1. To estimate information of objective examination .Peculiarities of Feature of estimation of the state of nervous system of child’s organism
Work 2. To draw conclusion about the state of nervous system at a child, to write protocol. To specify possible reasons of the found rejections. To provide to the child examination according to its age and found out the changes.
Work 3. Semiotics of defeat of the central and peripheral nervous system, basic clinical symptoms and changes of nervous system :
-serose and festering meningitis;
-encephalitis;
-tuberculoses meningitis;
-hydrocephaly
-children paralyze;
-tumor of cerebrum.
The features of medical care for children with the defeat of the nervous system.
5. A procedure of implementation of practical work: 9.00-12.00 a.m.
6. Seminar discussion of theoretical questions and practical work: 12.30-14.00 p. m.
7. Self activity is checked up by solving situational tasks from every theme and by answers to the tests of “Step” type, structural questions and others. (14.15 p.m. – 15.00 p.m. for this student who didn’t write moodle)
8. A student must know:
1. Anatomic features ?of the nervous system at children
2. Morphological features of the nervous system
3. Age-old features of development of anatomic structure of head and spinal cord.
4. Typical complaints at the nervous diseases.
5. Factors which could influence on development of nervous diseases.
6. Methods of research of the nervous system.
7. A care is of children with pathology of the nervous system.
8. Physiology features of the nervous system
9. Physiology stages of perfection ? nervous ?system
10. Features of research method
11. Semiotics of defeats ?of the nervous system
12. The features of care are of children with the diseases ?of the nervous ?system.
13. Age-old features of development of anatomic structure of head and spinal cord.
14. Typical complaints at the nervous diseases.
15. Factors which could influence on development of nervous diseases.
16. Methods of research of the nervous system.
17. A care is of children with pathology of the nervous system.
18. Doctors first aid .
9. A student must be able:
1. To collect complains and anamnestic information at a sick child.
2. To appoint the complex of additional methods of inspection for finding out of the state of nervous system at a child.
3. To estimate the got results taking into account the anatomo-physiological features of organism of child.
4. To conduct the objective inspection of the reflexes of the child taking into account the features of research method at children.
5. To estimate the got results of inspection of the afore-mentioned systems on the basis of knowledges of their anatomo-physiological features at children.
6. To conduct syndromal diagnostics at children with pathology of nervous system
7. To choose from anamnesis given, that represent a presence at the sick defeat of the central and peripheral nervous system.
8. To explore and estimate the state of the nervous system at the children of different age.
Sources of information :
1.2 Lecture
2. Manual of propaedeutic pediatrics Nykytuyk s Balatskan Galiash N
3. S. M. Haneef, Sajid Maqbool, M.A.Arif. Text book of paediatrics. 2004.
4. Bergman and Vaughan: Nelson’s Textbook of Pediatrics, 12 th Edition, Philadelphia, WB Saunders, 1993.
5. Moses Grossman Ronald A.Dieckmann, Pediatric Emergency Medicine, 1991.
6. Brennemann J. A contribution to our knowledge of the etiology and nature of hard curds in infants’ stools. Am. J. Dis. Child. 1911;1:341-359
7. Brennemann J. The care of infants. J. Am. Med. Assoc. 1912;59:542–543, 623–624, 720–721, 797–798
8. de Roos V. M., Katan M. B. Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 1998. Am. J. Clin. Nutr. 2000;71:405-411
9. Elwood P. C., Newton D., Eakins J. D., Brown D. A. Absorption of iron from bread. Am. J. Clin. Nutr. 1968;21:1162-1169
10. Epps R. P., Jolley M. P. Unsupervised early feeding of solids to infants. Med. Ann. D. C. 1963;32:493-495
11. Executive Board American Academy of Pediatrics: Committee on Nutrition, Scope and Functions. Pediatrics 1956;18:159
12. Fomon S. J. Nutrition of Normal Infants 1993 W. B. Saunders St. Louis, MO.
13. Fomon S. J., Filer L. J., Jr, Anderson T. A., Ziegler E. E. Recommendations for feeding normal infants. Pediatrics 1979;63:52-59
14. KapitanT.V. Propaedeutics of children’s diseases [Textbook for students of higher medical educations]; Fourth edition, updated &translated in English. – Vinnitsa: The State cartographical Factory, 2012. – 808 p
15. Manual of propaedeutic pediatrics Nykytuyk s Balatskan Galiash N TSMU Ukrmedkniga 2005,467p
The methodical instructions were drawn up by associated professor Nykytyuk S.O., Ph. D.
Discussed and ratified on meeting of department
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
26 of June, 2013. Minute № 16
