Methodological Instructions to Lesson № 7 for Students
(practical lesson-6 hours)
Topic: 1. Hematooncoloigic diseases. Leukaemias. Lymphogranulomatosis. Agranulocytosis. Etiology, pathogenesis. Clinical pattern. Treatment. The role of a doctor-dentist in treatment. Prophylaxis
Place of training: educational rooms, hospital wards.
Aim: To be able to recognize symptoms and syndromes of blood diseases on the basis of the results of clinical, laboratory and instrumental examinations and to estimate the value of these symptoms in diagnostics. To acquaint with principles of treatment, prophylaxis and diagnostics of critical conditions in blood diseases.
Professional Motivation: Leucaemia is a severe disease of the blood connected with high mortality rate Pay attention that signs of this disease during dental examination.
І. Practical work – 900-1200
Visual Aids and Material Tools: Tables, slides, compact-disk
Methodics of Student s Practical Activitiy:
Work 1. Under the teacher’s control students perform consequently inquiry and inspection of patients with disease off the blood ( anemia or leukaemia) and their physical examination. They acquire with data of clinical and instrumental examinations.
Tasks:
Tasks: 1. To obtain patient’s complaints.
2. To determine signs of the disease by inspection, palpation, percussion and auscultation.
3.To be acquired with data of laboratory and instrumental examinations.
4. To revise data of laboratory and instrumental examinations of your patient.
5. To determine leading syndromes and diagnosis.
6. To prescribe necessary treatment and prophylaxis
Students¢ Independent Study Program
I. Leucemias. Lymphogranulomatosis. agranulocytosis. Etiology, pathogenesis. Clinical pattern. Treatment. The role of a doctor-dentist in treatment. Prophylaxis
1. Ethiology of leukaemias.
2. Pathogenesis peculiarities of chronic and acute leukaemias
3. Main clinical symptons and syndromes in chronicand acute leukaemias.
4. Diagnostical value of data obtained by inquiry of patients with leukaemias.
5. Data of physical examination in leucaemia.
6. Diagnostical value of blood examination. Peculiarities of haemogram in chronic and acute leukaemias.
7. Principles of treatment, peculiarities of prophylaxis and observation of patients with leucaemia. Prognosis.
The role of a doctor-dentist in prophylaxis.
ІІ. Seminar Discussion of practical work – 1230-1400 (2 hours)
Examples of real-life situations.
1. Patient М, 52 year old, complains of weakness, dyspnea, burning in tongue, numbness in extremities, subfebrile temperature and diarrhea. Objective: pallor, legs edema. Sternum is painful during percussion. Pulse – 140/min, BP – 130/80 mmHg. Heart tone weakened, in the apex – systolic sound. Raspberry tongue, “lacquered”. Liver + 2 см, spleen + 1 см. RBC – 2,0х1012/л, Нв – 60г/л, Leucocytes – 2,5х109л, Eosinophils – 1\%, п -5\%, с – 57\%, л – 36\%, г – 1\%, ESR – 62 mm/h, megaloblasts, Kebot rings, Jolli bodies, hyperchromasia. What is your diagnosis?
2. Patient О., 35 year-old, mother of many children, complain of quick fatigue, palpitation, fragile nails, falling of hair. RBC- 2,3х1012/L, Нв -65g/L, CI – 0,7, reticulocytes – 0,5, Thrombocytes – 200х109/L, L – 6,6х109/L, Stab – 2\%, Segmental – 56\%, Eo – 2\%, п – 1\%, L – 29\%, г – 10\%, anisocytosis, poikilocytosis, ESR – 5 mm/h. Your diagnosis?
3. 68-year-old man complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood tests: WBC – 35 * 109/L, lymphocytes – 60%, Botkin and Gumprecht bodies, level of hemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?
Answers on real-life situations:
1. В12-deficiency anemia.
2. Iron deficiency anaemia
3. Chronic lymphatic leucosis
§ Discussion of theoretical questions
Final level of knowledge and skills
Students must know:
- Ethiology of leukaemias.
2. Pathogenesis peculiarities of chronic and acute leukaemias
3. Main clinical symptons and syndromes in chronicand acute leukaemias.
4. Diagnostical value of data obtained by inquiry of patients with leukaemias.
5. Data of physical examination in leucaemia.
6. Diagnostical value of blood examination. Peculiarities of haemogram in chronic and acute leukaemias.
7. Principles of treatment, peculiarities of prophylaxis and observation of patients with leucaemia. Prognosis.
- The role of a doctor-dentist in prophylaxis.
Students should be able to:
1. To separate symptoms typical for each type of leukaemia by physical examination
2. To make interpretation of laboratory and instrumental examinations.
3. To use principles of treatment and observation of patients with anemia and leukaemia
4. ІІІ. Test control of students’ knowledge – 1400-1500 (1 hour).
Referenses:
Main
1. 1. Davidson’s Principles and practice of medicine (20th ed.) / by Boon N., Colledge N., Walker B., and Hunter J., eds. – Churchill Livingstone, 2006. – 1392 p.
2. Harrison’s principles of internal medicine (17th edition) / by Fauci A., Braunwald E., Kasper D.L., et al. (eds.). – McGraw-Hill Medical, 2008. – 2754 p.
3. The Merck Manual of Diagnosis and Therapy (seventeenth Edition)/ Robert Berkow, Andrew J. Fletcher and others. – published by Merck Research Laboratories,, 2006; 1876p.
4. Lawrence M. Tierney, Jr. et al: Current Medical Diagnosis and treatment 2000, Lange Medical Books, McGraw-Hill, Health Professions Division, 2000.
5. Christopher R.W. Edwards et al: Davidson’s principles and practice of medicine.
6. Practical classes materials.
B. Additional
1. Short Textbook of Medical Diagnosis and management. Mohammed imam Danish 3-rd Edition (Department of Medicine, Medical Unit III Dow Medical College and Clinic Hospital Rarachi Rakistgn).
http://en.wikipedia.org/wiki/Leukemia
http://www.medicinenet.com/leukemia/article.htm
Prepared by N. Bilkevych
Is addopted at the chair sitting 07.06.2013., Minutes № 11
Revised
